PATELLAR TENDONITIS (Tendinopathy)
Patellar tendinopathy (or as it is commonly known patellar tendonitis or tendinitis) is an overuse injury affecting your knee. It is the result of your patella tendon being overstressed. A common name for it is Jumper’s Knee.
Anatomy of the Knee
The patella tendon is located just below the patella (knee cap). It has attachments on the patella and the tibial tuberosity on the tibia (shin bone). The role of the patella tendon is to transfer the force of the quadriceps muscles, much like a rope around a pulley, as your knee straightens.
Your quadriceps is even more important when controlling your knee as you bend from a straight position eg walking downstairs, landings. Your quadriceps muscles are heavily involved in most sports, especially those which involve jumping, running and kicking.
Patella Tendonitis
Why is it Called Jumper’s Knee?
The greatest level of stress through the patella tendon is during jumping and landing activities. During jumping, the quadriceps muscles provide an explosive contraction, which straightens the knee and pushes you into the air. When landing, the quadriceps muscle helps to absorb the landing forces by allowing a small amount of controlled knee bend.
Excessive jumping or landing strains the patella tendon. At first the damage may only be minor and not cause any problem. However, if the tendon is repeatedly strained, the lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a patellar tendinopathy (tendon injury).
Who Usually Suffers Patellar Tendonitis?
Patellar tendonitis usually affects athletes involved in sports such as basketball, volleyball, soccer, football, track and field (running, high and long jump), tennis, dancing, gymnastics and skiing.
In older people, the main cause of patellar tendinopathy is a result of degeneration which results from repetitive micro-damage over time. Also, some patients develop patella tendonitis after sustaining an acute injury to the tendon, and not allowing adequate healing. This type of traumatic patellar tendonitis is much less common than overuse syndromes.
Signs and Symptoms of Patellar Tendonitis
Anterior knee pain over the patella tendon
Pain made worse with jumping, landing or running activity and sometimes with prolonged sitting
Onset of pain is usually gradual and commonly related to an increase in sport activity
Localised tenderness over the patella tendon
Often the tendon feels very stiff first thing in the morning.
The affected tendon may appear thickened in comparison to the unaffected side
What Causes Patellar Tendonitis?
There are a number of factors which can contribute to the development of patellar tendinopathies. These include:
Training Errors:
Rapid increase in amount of training
Sudden increase in training intensity
Playing/training on rigid surfaces
Poor Flexibility
Tight quadriceps and hamstring muscles
Lower Limb Biomechanics
This can include poor foot posture, knee or hip control. Your physiotherapist can assess and treat these issues.
What are the Symptoms of Tendinopathy?
Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
The pain may get worse when you use the tendon.
You may have more pain and stiffness during the night or when you get up in the morning.
The area may be tender, red, warm, or swollen if there is inflammation.
You may notice a crunchy sound or feeling when you use the tendon.
The symptoms of a tendon injury can be a lot like those caused by bursitis.
How is a Tendon Injury Diagnosed?
To diagnose a tendon injury, your physiotherapist will ask questions about your past health, your symptoms and exercise regime. They’ll then do a physical examination to confirm the diagnosis. If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.
How is Tendinopathy Treated?
In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:
Rest the painful area, and avoid any activity that makes the pain worse.
Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
Do gentle range-of-motion exercises and stretching to prevent stiffness.
Have your biomechanics assessed by your physiotherapist.
Undertake an Eccentric Strengthen Program. This is vital!
How Does Physiotherapy Help Patellar Tendonitis?
There are a number of different causes of anterior knee pain. Patellar tendinopathy is just of the potential conditions. The correct diagnosis is vital since treatment can significantly vary.
Luckily, at immediate care clinic physiotherapists are highly skilled professional who can quickly assess and diagnose your knee injury. Once confirmed, they will ensure the correct injury management and rehabilitation to get you back to sport in the quickest time possible.
Common Patellar Tendonitis Treatment
In the early phase, your physiotherapist with address the pain and inflammation using electrotherapy modalities, cryotherapy (ice) and taping techniques or de-loading braces. Relative rest is advised from aggravating activity in the early stages. Your body is the best guide to know how much to rest the injured knee. If an activity hurts the knee then you should avoid doing it.
Complete rest is not usually necessary. If this is the case, your physiotherapist can suggest some alternative exercise ideas which are low to no impact. This will allow you to maintain your cardiovascular fitness and maintain muscle strength without causing pain in your knee.
Stretching can also be started early in your rehab under instruction from your physiotherapist to help with lower body flexibility. Even once your symptoms resolve you should incorporate a stretching program into your training to prevent re-occurrence.
As pain allows, your physiotherapist will start and progress you on a specific strengthening program designed to improve the strength of your quadriceps and the patella tendon to allow them to cope with the loads involved with your sport. Tendinopathies respond best to an eccentric based program.
