patellar tendinopathy...

lots of people with patellar tendinopathy... but what can be done to prevent this?... does the problem stem from the patella/knee... from above?... from below?... here are some thoughts stemming from a recent article in the american journal of sports medicine [sept 2011]...

Low Range of Ankle Dorsiflexion Predisposes for Patellar Tendinopathy in Junior Elite Basketball Players: A 1-Year Prospective Study.
Am J Sports Med. 2011 Sep 14. [Epub ahead of print]

Backman LJ, Danielson P.
Source
Department of Integrative Medical Biology, Anatomy, Umea° University, Umeå, Sweden.

Abstract
BACKGROUND:
Patellar tendinopathy (PT) is one of the most common reasons for sport-induced pain of the knee. Low ankle dorsiflexion range might predispose for PT because of load-bearing compensation in the patellar tendon.

PURPOSE:
The purpose of this 1-year prospective study was to analyze if a low ankle dorsiflexion range increases the risk of developing PT for basketball players.

STUDY DESIGN:
Cohort study (prognosis); Level of evidence, 2.

METHODS:
Ninety junior elite basketball players were examined for different characteristics and potential risk factors for PT, including ankle dorsiflexion range in the dominant and nondominant leg. Data were collected over a 1-year period and follow-up, including reexamination, was made at the end of the year.

RESULTS:
Seventy-five players met the inclusion criteria. At the follow-up, 12 players (16.0%) had developed unilateral PT. These players were found to have had a significantly lower mean ankle dorsiflexion range at baseline than the healthy players, with a mean difference of -4.7° (P = .038) for the dominant limb and -5.1° (P = .024) for the nondominant limb. Complementary statistical analysis showed that players with dorsiflexion range less than 36.5° had a risk of 18.5% to 29.4% of developing PT within a year, as compared with 1.8% to 2.1% for players with dorsiflexion range greater than 36.5°. Limbs with a history of 2 or more ankle sprains had a slightly less mean ankle dorsiflexion range compared to those with 0 or 1 sprain (mean difference, -1.5° to -2.5°), although this was only statistically significant for nondominant legs.

CONCLUSION:
This study clearly shows that low ankle dorsiflexion range is a risk factor for developing PT in basketball players. In the studied material, an ankle dorsiflexion range of 36.5° was found to be the most appropriate cutoff point for prognostic screening. This might be useful information in identifying at-risk individuals in basketball teams and enabling preventive actions. A history of ankle sprains might contribute to reduced ankle dorsiflexion range.

this has also been well studied in volleyball players... see:
J Sci Med Sport. 2006 Aug;9(4):304-9. Epub 2006 May 2.
Reduced ankle dorsiflexion range may increase the risk of patellar tendon injury among volleyball players.
and
Clin J Sport Med. 2002 Sep;12(5):266-72.
Relation between ankle joint dynamics and patellar tendinopathy in elite volleyball players.

so... can one stretch to increase ankle dorsiflexion ROM?...


Does stretching increase ankle dorsiflexion range of motion? A systematic review.
Br J Sports Med. 2006 Oct;40(10):870-5; discussion 875. Epub 2006 Aug 22

Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C.
Source
School of Biomedical and Health Sciences, University of Western Sydney, Campbelltown, Australia. j.radford@uws.edu.au
Abstract
BACKGROUND:
Many lower limb disorders are related to calf muscle tightness and reduced dorsiflexion of the ankle. To treat such disorders, stretches of the calf muscles are commonly prescribed to increase available dorsiflexion of the ankle joint.

HYPOTHESIS:
To determine the effect of static calf muscle stretching on ankle joint dorsiflexion range of motion.

STUDY DESIGN:
A systematic review with meta-analyses.

METHODS:
A systematic review of randomised trials examining static calf muscle stretches compared with no stretching. Trials were identified by searching Cinahl, Embase, Medline, SportDiscus, and Central and by recursive checking of bibliographies. Data were extracted from trial publications, and meta-analyses performed that calculated a weighted mean difference (WMD) for the continuous outcome of ankle dorsiflexion. Sensitivity analyses excluded poorer quality trials. Statistical heterogeneity was assessed using the quantity I2.

RESULTS:
Five trials met inclusion criteria and reported sufficient data on ankle dorsiflexion to be included in the meta-analyses. The meta-analyses showed that calf muscle stretching increases ankle dorsiflexion after stretching for < or = 15 minutes (WMD 2.07 degrees; 95% confidence interval 0.86 to 3.27), > 15-30 minutes (WMD 3.03 degrees; 95% confidence interval 0.31 to 5.75), and > 30 minutes (WMD 2.49 degrees; 95% confidence interval 0.16 to 4.82). There was a very low to moderate statistical heterogeneity between trials. The meta-analysis results for < or = 15 minutes and > 15-30 minutes of stretching were considered robust when compared with sensitivity analyses that excluded lower quality trials.

CONCLUSIONS:
Calf muscle stretching provides a small and statistically significant increase in ankle dorsiflexion. However, it is unclear whether the change is clinically important.

i think that it is clinically important... not just for ankle health, but patellar/knee health as well as for low back/SI...

~gm2