13/11/2025
Patella tendon repair rehab 🦵🩼
I remember my first ever athlete whom I rehabbed from a patella tendon repair, for the first few weeks post-op, his program looked like “3 x 10-15reps of quads setting, 3 x 10-15 of passive knee flexion” etc, up to maybe 3 or 4 other exercises, and he did that once a day 😬
How things have changed…
Something like that may be OK for the general population, but I cringe when I see a protocol mocked up by some Canadian surgeon which super under-doses athlete populations. Then it’s the whole “run at 3 months” when the thigh still looks like a toothpick. And we wonder why re-rupture rates are through the roof
Even now when you’re discharged from hospital post operatively, the piece of paper has similar reps and set schemes.
You learn very quickly that when local inhibition is through the roof, there’s not much that 3 x 10-15 quad contractions will do…
However, chasing traditional strength gains (I.e loading up a leg extension to hit a set of 15 to failure, or loading up a barbell back squat) is impossible immediately post-op for obvious reasons
Hence the very high-repetition, small ROM and low-force approach in the earlier days post op — very long duration contractions and a lot of time under tension to force motor unit recruitment and metabolite accumulation so that we can lay the foundation for strength work to be commence earlier and more effectively, overall having a quicker and easier recovery
Would I give this to a non-injured athlete to improve quad strength? Of course not.
Would I give these to a fairly high functioning athlete with a chronic patella tendonopathy, even then probably not. This type of super high volume is reserved for the very atrophied, inhibited muscle groups, which is usually in the early days post-op
Purely load the muscle, keep joint forces super low
And lastly….Isaac completing his body weight elevated box squat - that what was in the program for that day. However, the knee was pretty sore as Isaac mentioned. Therefore we modify foot position, ex*****on, and a tad more hip hinge. Just exemplifying that protocols won’t work for everyone and Individualisation is crucial for athlete rehab.
