Patella Tendinopathy

Patella Tendinopathy

Article by J.Miller, Z.Russell

Patella Tendinopathy

Patellar tendinopathy (or as it is commonly known as patellar tendonitis or tendinitis) is an overuse injury affecting your knee. It is the result of repeated overstress of your patella tendon beyond its coping capacity. It is a common name for it is Jumper’s Knee since it is common in jumping sports such as volleyball and basketball.

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 via your patella (kneecap) and your upper shinbone (tibia).

Your quadriceps are even more critical when controlling your knee as you bend from a straight position, e.g. walking downstairs and landings. Your quadriceps muscles are heavily involved in most sports, especially jumping, running and kicking.

patella tendonitis

Why is it Called Jumper’s Knee?

The most exceptional level of stress through the patella tendon is during jumping and landing activities. The quadriceps muscles provide an explosive contraction during jumping, which straightens the knee and pushes you into the air. When landing, the quadriceps muscle helps 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, repeated overstrain of your tendon causes microtrauma. 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 patellar tendinopathy (tendon injury).

Who Usually Suffers Patellar Tendinopathy?

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 leading 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 Tendinopathy

  • Anterior knee pain over the patella tendon
  • The pain made worse with jumping, landing or running activity and sometimes with prolonged sitting.
  • The onset of pain is usually gradual and commonly related to an increase in a sports 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 (e.g. into bone)

Non-insertional tendinopathies tend to be caused by a cumulative microtrauma from repetitive overloading, e.g. overtraining.

What Causes Patellar Tendinopathy?

Many factors can contribute to the development of patellar tendinopathies. These include:

Training Errors:

  • A rapid increase in the amount of training
  • A sudden increase in training intensity
  • Playing/training on rigid surfaces

Poor Flexibility

  • Tight quadriceps and hamstring muscles

Lower Limb Biomechanics

  • Biomechanical issues can include poor foot posture, knee or hip control. Your physiotherapist can assess and treat these issues.

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 means “inflammation of the tendon,” but inflammation is only an infrequent 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. It 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 repeatedly in their jobs, sports, or daily activities are more likely to damage a tendon.

Tendons role is to withstand high, repetitive loading; however, on occasions, when the load applied to the tendon is too high for the tendon to endure, the tendon begins to become stressed.

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

However, if the continually overloaded 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 currently suggest the cumulative microtrauma associated with high tensile and compressive forces cause tendinopathy. Cumulative microtrauma appears to exceed the tendon’s capacity to heal and remodel.

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

Your tendon’s inability to adapt to the load quickly enough causes the 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. The tissue is attempting to heal.
  • You must 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 is inferior.
  • Surgery is often the only option.

It is crucial 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 specific modalities or exercises should only be applied or undertaken in distinct tendon healing phases.

How is a Tendon Injury Diagnosed?

Your physiotherapist will ask questions about your past health, symptoms, and exercise regime to diagnose a tendon injury. They’ll then do a physical examination to confirm the diagnosis. If your symptoms are severe or do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

How is Patella 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 two 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 physiotherapist assess your biomechanics.
  • Undertake an Eccentric Strengthen Program. Specific exercises are vital!

How Does Physiotherapy Help Patellar Tendinopathy?

There are many 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 Tendinopathy Treatments

In the early phase, your physiotherapist with address the pain and inflammation. Your physiotherapist may utilise electrotherapy modalities, cryotherapy (ice) and taping techniques or de-loading braces. Most patients require relative rest from aggravating activities in the early stages. Your body is the best guide to know how much to rest the injured knee. If an exercise 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. These exercise options 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 enable them to cope with the loads involved with your sport. Tendinopathies respond best to an eccentric based program.osis. 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.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

Knee FAQs

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your knee physiotherapist.