Patella Tendonitis (Tendinopathy)

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Article by Zoe Russell

Patellar Tendonitis

Patellar Tendonitis

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.

More info about: Tendinopathy

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

Typically, tendon injuries occur in three areas:

  • musculotendinous junction (where the tendon joins the muscle)
  • mid-tendon (non-insertional tendinopathy)
  • tendon insertion (eg into bone)

Non-insertional tendinopathies tends to be caused by a cumulative microtrauma from repetitive overloading eg overtraining.

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means "inflammation of the tendon," but inflammation is actually only a very rare cause of tendon pain. But many doctors may still use the term tendinitis out of habit.

The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. These tendinopathies therefore do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

What Causes a Tendon Injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Your tendons are designed to withstand high, repetitive loading, however, on occasions, when the load being applied to the tendon is too great for the tendon to withstand, the tendon begins to become stressed.

When tendons become stressed, they sustain small micro tears, which encourage inflammatory chemicals and swelling, which can quickly heal if managed appropriately.

However, if the load is continually applied to the tendon, these 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 tendinopathy or tendinosis.

Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces generated during sport or an activity causes a tendinopathy. Cumulative microtrauma appears to exceed the tendon’s capacity to heal and remodel.

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.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent. Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good. Tissue is attempting to heal.
  • It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Poor Prognosis - Tendon cells are giving up!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

It is very important to have your tendinopathy professionally assessed to identify it’s injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.

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 a physiotherapist.
  • Undertake an Eccentric Strengthen Program. This is vital!

More information about Tendinopathy.

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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, your PhysioWorks physiotherapist is a 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.

Stretchbands are a fun and easy way to stretch and maintain your flexibility. They are available from our online store in three sizes. More info: Stretchband

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.

Eccentric Strengthening Program

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More Patellar Tendonitis Treatment Options

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Eccentric Strengthening
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Orthotics
  • Soft Tissue Massage
  • Brace or Support
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Kinesiology Tape
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Please contact your physiotherapist for the latest in patellar tendinopathy rehabilitation.

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    Last updated 09-May-2017 03:36 PM

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