Patellar Tendinopathy
Patellar tendinopathy is one of the most common causes of anterior knee pain. It is characterized by pain in the tendon that runs between the bottom of the patella and the bony prominence at the top of the shin bone called the tibial tuberosity. The condition is aggravated by any activity that requires explosive use of the quadriceps muscle which helps to straighten or extend the knee. For this reason, the group most affected are athletes aged 15-35, men more than women, usually those competing in sports such as tennis, volleyball, basketball, football & athletic jumping events hence the nickname “jumper’s knee”.
There is a similar problem seen in the same area in the younger athlete known as Osgood Schlatter’s disease.
Causes
Tendinopathies are normally caused by either a normal tendon under an abnormal load or an abnormal tendon under an normal load.
Examples of a normal tendon under an abnormal load include a rapid increase in training load (amount, frequency or intensity), tight quadriceps and hamstring muscles, inappropriate footwear, poor exercise technique & abnormal foot or lower limb biomechanics (eg poor hip or knee control or altered foot postures such as flat feet).
Examples of an abnormal tendon under a normal load include degenerative changes in the tendon (usually a result of accumulation of stress over time in the older athlete).
Signs & Symptoms
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Pain at the front of the knee that is worse with jumping, changing direction or decelerating activities
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Usually a gradual worsening of the pain as time goes on
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Commonly starts after an increase in training load
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Pain when touching the patella tendon
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Swelling or thickening of the tendon
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Weakness of the knee
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Feelings of soreness and stiffness in the knee particularly in the mornings and after activity.
Treatment
The first step of any treatment plan is to reduce the load on the tendon. This will normally require resting from any aggravating activity until some of the pain and inflammation has settled.
During this time your physiotherapist will advise you to continue with pain free exercise to maintain cardiovascular fitness, this may include cycling or swimming. They will also give you exercises to strengthen any other weak muscles identified and to stretch any that may be tight.
Hands on therapy such as massage, joint mobilisations, therapeutic ultrasound, dry needling, shockwave therapy and taping techniques are all useful at different stages throughout the rehab process.
As the recovery progresses, the key to successful rehabilitation will be a gradually increased tendon loading program. In this case it will start will basic quads exercises with light or no resistance and be progressed to include eccentric exercises such as decline squats and then weighted work such as leg press. Your physio will include sports specific drills and then some testing before clearing you for a return to play. You will then be given an ongoing maintenance / injury prevention program to limit the chances of a recurrence of the problem.
A full recovery from patellar tendinopathy can take anywhere from a few weeks to a few months, depending on the severity. Unfortunately, it will not simply heal or recover with rest and inflammatory management alone. The research shows that active rehabilitation in the for of a structured exercise program is the key component of restructuring the tendon and preparing it for a return to previous activity, and the longer the issue is left, the harder it becomes to treat. If you suspect you may have patellar tendinopathy, then for best results come and get assessed ASAP.
As with any tendinopathy, patellar tendinopathy is the result of an overloading of the tendon. The job of the patella tendon is to transfer the force of the large quads muscle as the knee straightens, similar to a rope and pulley system. The quads are the main muscle (eccentrically) controlling the knee as you lower down into a knee bend from a straight position such as when walking down stairs or landing from a jump. They are also heavily involved in most sports, especially those involving jumping, running and kicking.
