What She Came In With

She came in scared. A D1 commit, her senior season eight weeks away, and bilateral knee pain that had been building for most of the summer. She had been pushing through practice after practice on knees that were talking to her, quite a bit, and by the time she sat down across from me, she was genuinely worried she would have to sit out the season she had worked toward for four years.

Her primary concern was patellar tendinopathy. Pain directly at or just below the kneecap that is extremely common in athletes with high jumping and cutting demands. The pain had gotten bad enough that she was modifying her approach in practice. Her coaches had noticed. She was protecting, and it showed.

The question she asked me was direct: “Is my season over?”

My answer was equally direct: no. But we had to start immediately, and we had to do it right.

The Diagnosis and What Was Actually Going On

Patellar tendinopathy in a high-volume athlete almost always has the same story behind it: load that exceeded the tendon’s adaptive capacity over a period of weeks or months. Summer training ramps are a classic culprit. She had increased her plyometric volume significantly over the summer with insufficient recovery between sessions, and the tendon had accumulated more load than it could handle.

The structure of the tendon was not torn. This was a reactive tendinopathy, the early stage of a failed healing response, where the tendon’s internal architecture begins to break down under repeated excessive load. Caught at this stage, it is highly treatable. Left untreated, it progresses into degenerative tendinopathy that takes much longer to resolve. We were working against the clock with the season start, but we had the right tools for it.

The Treatment Plan

We started shockwave therapy in the first week. For reactive tendinopathy, shockwave is particularly effective at reducing the tissue irritability and increasing local blood flow to tissue that is poorly vascularized. After three sessions over ten days, her pain at rest had dropped from a 7 to a 3, and her pain during warm-up was significantly reduced. Shockwave gave us the window we needed to introduce load, without it, the tendon was too sensitive to tolerate the isometric protocol that is the backbone of tendinopathy rehab.

Once shockwave reduced the tissue irritability, we introduced isometric loading: sustained leg extension holds at a meaningful load for 45 seconds, five sets, daily. The pain relief that follows an isometric session meant her knees felt noticeably better for the hour or two afterward, which we used strategically to schedule her hardest practices on isometric days. Within two weeks, she reported that her knees felt better during practice than they had in months.

The final piece was a graded plyometric program. Tendons that have been reactive need to be progressively reintroduced to the fast-loading demands of jumping and cutting. We started with low-load plyometrics and built to full approach plyometrics over four weeks. This rebuilt the tendon’s capacity to absorb and release energy, and it rebuilt her confidence in her knees, which had taken a hit after months of pain during her primary movements.

What Changed

By the time the season started, she was not just managing the pain. She was training without modification. Her approach was back. Her coaches noticed a different athlete, more explosive, more committed off the ground.

Her words, roughly: “My knees haven’t felt this good since freshman year.”

That outcome happened because we hit the problem with three different tools simultaneously, in the right sequence, and we did not let the season timeline push us into doing too much too fast. The shockwave addressed the tissue. The isometrics reloaded it safely. The plyometrics rebuilt the capacity her sport demands.

Is Your Athlete in a Similar Situation?

If you have an athlete dealing with knee pain heading into a season, or fighting through one right now, do not wait to see if it gets better on its own. Reactive tendinopathy responds well to early treatment and poorly to neglect. The sooner we start, the more options we have.

Schedule a visit at cospineandjoint.com/schedule-appointment/ and we will tell you exactly what you are working with and what the realistic timeline looks like.

 

In your corner,
Dr. Blake Richard, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment