Patella tendon straps: Help or hinder?

It always makes me cringe when I see people wearing neopreme supports around their knee, when they suffer knee pain. These kinds of people use these to support their knee when they're performing certain sports: Tennis, badminton and running for example. Any good clinician of worth would encourage people to cease wearing these as they take away the job of the muculature around the knee and potentially make the problem worse. It has always been advisable to strengthen the muscles around the knee, to reduce knee pain and support your knee. Now, we have started to see patella tendon straps on the market. They are targeted at people with patella tendinopathy. The premise is, you can wear a patella tendon strap whilst still performing your chosen sport. But are these any better or indeed just as deficient as the neopreme supports?

What is patella tendinopathy?

Tendinopathy refers to a tendon that is unable to withstand the load being transferred through it. you can read my blogs on tendinopathy in the blogs section.

Sufferers report pain below the patella (knee cap) and usually affects those who have to land on one leg, ie: volley ball players and runners. Tendinopathies usually occur when load is increased too quickly and the tendon cannot absorb or manage that load. Graduated, steadily increased exercises have been proven to reduce these symptoms over time and the suffer can usually return to a moderate level of their chosen sport. Providing they don't ignore the problem, they do their exercises and they don't leave it too late.

So, what is the theory behind patella-straps?

I recently read an article by Rosen et al (2017) "Patella tendon straps decrease pre-landing quadriceps activation in males with patella tendinopathy". Physical Therapy in Sport (24) pp: 13 - 19 {Copy available on request} who have suggested that wearing a patella strap dissipates the load through only part of the patella tendon. by dissipating the load, the sufferer feels less pain and is able to continue with their chosen sport.

The quadriceps consist of four muscles (quad: 4) ceps (inserts)

with vastus intermedialis laying beneath rectus femorus. We already know and it is widely accepted that these quadriceps work in synchronicity to ensure a smooth, pain free movement of the knee cap over the tibia (shin bone).

The researchers in the article hypothesise and set out to prove that by wearing a patella-strap, dissipates the load through the tendon by altering how and when the muscles of the quadriceps work. Their research proved that there was a decrease in activation of rectus femoris and vastus lateralis and an increase in vastus medialis.

It is also widely accepted that this muscle activation pattern is attributed to patella-femoral joint maltracking. Or to you, another knee pain! The authors reported that their study demonstrated an altered activation in the muscles and yet did not identify how this affects pain perception in their study. In addition, they only compared 10 healthy, young, elite male athletes with 10 similar symptomatic patients. This does not represent the general public with this pathology. But my concern is with the altered muscle activation whilst wearing the strap to the quadriceps. Any change to muscle activation will be remembered by the brain. You may know this as muscle memory, to us we term this neuroplasticity. We are changing how the brain remembers how these muscles need to work. it therefore stands to reason that when or if you remove the patella strap, your quadriceps will be working differently than beforehand, and you are at risk of a new knee injury. My advice is: as before. Don't wear knee supports including patella straps. Perform the exercises given to you by your physiotherapist. Take rest from the sport that is giving you patella tendon pain and take the time needed to rehabilitate. If you feel you have patella tendinopathy and would like assessing and appropriate advice and exercises, then contact your local, friendly physiotherapist.