The Patella Tendon: A Common Rugby Injury, Prevention Is Better Than Cure
Rob Palmer, Elite Powerlifter and Head of Strength and Conditioning at London Irish offers his knowledge and expertise on an injury that is common within Rugby. Within this article, he also devises a training programme that can be done which strengthens this part of the knee.
In rugby, injuries are commonplace, at present we have a handful of players out with various injuries both upper and lower body with time out from rugby ranging from 2-10 weeks.
Some of the most common injuries we have seen this season are overload injuries relating to patella tendons, commonly known as a patella tendinopathy which is the subsequent repeated overload, inflammation and degeneration of the patella tendon. The patella tendon is the tendon which runs over the knee attaching the quadriceps muscle to the lower leg, injuries such as these are commonplace with field athletes due to the high running volumes associated with the competition and training.
These injuries generally do not keep players out from competition for very long if at all but can impede function and therefore performance in the long term. With the games being every week these become what is classified as load management players who are very closely monitored through the week so they can play at the weekend, the on pitch wok performed in the week is monitored through the use of GPS software, we use this GPS software to try and find the upper limits of the players threshold before symptoms become present, once established we then limit the player to that distance and workload for an individual training session.
For example Tom Homer would cover up to 5km per game and 3.5km during a training session, his threshold before symptoms present is 3km, we cannot change the game but we can adjust training.
With regards to the gym based sessions the work of Kongsgaard et al 2009 has had a heavy influence on the programming for these players. Below is a sample session for somebody suffering with a patella tendinopathy.
|Single Leg Press||4||12-15 each leg||3-0-3-0||1 min between legs|
|SL DB RDL||3||8-10 EL||3-0-1-0||2 mins between sets|
|Single Leg Extensions||4||12-15 Each Leg||3-0-3-0||1 min between legs|
|SL Calf Raises||3||12-15 EL||3-0-1-2||2 mins between sets|
With this program we would be manipulating the time under tension of the quads exercises to maximise the stimulus on the patella tendon in the hope of a remodelling of the collagen. You would look to complete this program between 2-3 times per week, although this program is very effective for this type of injury it is almost the polar opposite for how you would want to train for sporting activities that require strength and power to be expressed. So on top of doing this type of work we use a pool based jumps program to develop rate of force development without the negative effects of repeated landings.
|Double Leg Jumps||4||5||N/A||2 mins between sets|
|Single Leg Jumps||4||5 Each Leg||N/A||1 min between legs|
|Bounds||4||16||N/A||3 mins between sets|
As with all field sports athletes there is a need to maintain or improve aerobic and anaerobic qualities through the season, with an athlete suffering from a tendinopathy it is important to offlaod the tendon from repeated landings, this leaves only a few options, pool conditioning or bike conditioning. Depending on the athletes training focus the work periods and work:rest ratios will differ.
For Tom Homer and Athony Watson we use bike conditioning post rugby and utilise the Tabata method on the Watt Bikes to increase anaerobic capacity and V02 Max without adding a great amount of volume into the week of training. The session is 20 seconds maximal sprint followed by 10 seconds rest repeated 7-10 times depending on the quality of the output of work..
The training week when in the middle of a competition schedule when suffering from a patella tendinopathy would be as follows.
|Lower Limb Strength||Upper Limb Strength||Off||Lower Limb Strength + Pool Jumps||OFF||Match Day||Recovery Day|
|Rugby||Rugby + Conditioning||Off||Rugby||OFF|