Patellar Tendinopathy

What is Patellar Tendinopathy?

Do you participate in a running or jumping workout routine? Has your knee pain gradually gotten worse? Does your knee hurt every time you push off the ground for the next step or leap? You might be suffering from patellar tendinopathy.

Patellar tendinopathy is a term that classifies most patellar tendon injuries including patellar tendonitis and patellar tendinosis. The patellar tendon sits just below the kneecap (patella) and helps to connect the kneecap to the top portion of the ‘shin-bone’ (tibia). The tendon allows the kneecap to move correctly and allows the knee to straighten efficiently.

Patellar tendinopathy occurs when the tendon becomes swollen due to an external force or overloading on the tendon. The swelling occurs as an attempt for the body to heal the tendon through extra blood rushing to the injured area. Unfortunately, in many cases, the patellar tendon lacks good blood supply and the tendon cannot receive the blood that it needs in order to heal. In this case, the tendon begins to degenerate.

Sports Commonly Associated with Patellar Tendonitis:

There are a variety of sports and workouts that can bring on patellar tendinopathies. It is common to see patellar tendinopathy in running sports, jumping activities, weight lifting, volleyball, cycling, basketball, gymnastics, and soccer. Out of all of these sports, jumping activities are the most common culprit for bringing on this type of knee pain.[1]

Causes:

The main causes of this condition include a sudden increase in activity, repeated force on the knee, weak quadriceps muscles, weak gluteus muscles, and repetitive movements. The condition usually comes on over time and has a gradual onset. A blow to the knee or an external force exerted on the knee may cause a rapid onset of pain.[1]

Additionally, abnormal alignment or poor biomechanics may exasperate the tendon and cause a tendinopathy. A maligned extensor mechanism or a mal-tracking patellar are just a few examples of anatomical features that can predispose an individual to patellar tendinopathy.

Symptoms:

There are many sources of knee pain. Understanding the symptoms is the first step to diagnosing the condition. Symptoms of patellar tendinopathy include pain on the tendon, pain when touching the bottom portion of the kneecap, painful and weak quadriceps, pain with the knee fully bent, and pain when extending the leg. Additionally, the tendon may appear slightly swollen and the patient might feel clicking or popping when bending and straightening the knee.[1]

MRI is the best way to diagnose a patellar tendinopathy. Diagnostic ultrasound can also be used in order to rule-in the condition. Extreme cases of patellar tendinopathy can be detected on X-ray images, however this is not common.[1]

Prevention:

The best way to prevent patellar tendinopathy is to be a well-rounded athlete. Spend time cross-training in order to develop the quadriceps, hamstrings, and gluteus muscles. It is also important to increase activity gradually and follow a progressive training plan. Icing the knee after workouts can help to limit swelling and ultimately delay the onset of the condition.

Treatment:

Modalities:

Ultimately the best treatment for this injury is rest. Most athletes, however, struggle with this concept. Ice will help reduce the swelling of the knee and help restore range of motion. TENS units have also been seen to reduce pain.

Stretching:

Some basic hip stretching includes the Thomas stretch and the Figure 4. The Thomas stretch can be completed by lying on your back and pulling one knee to your chest while keeping the other leg straight. The Figure 4 stretch is also done lying on your back. The athlete will bend one knee to 90 degrees and put the other ankle over the knee. The athlete will then pull the knee toward his or her chest.

Strengthening:

The most important type of strengthening for patellar tendinopathy is eccentric training. Standing on a slanted surface with your toes pointing down the ramp, stand on the leg that is injured. Begin the exercise by lowering yourself down into a single-leg squat. When you feel that you have gone as far down as you can comfortably go, place the other leg on the ground and stand up using both legs.

Additionally, hamstring and gluteus strengthening can benefit the athlete with knee pain.2 One example would be to lay on your back with a Swiss ball under your feet out in front of you. Use your glute muscles to lift your back off of the ground. Once you are in a straight line with your shoulder blades touching the ground and your feet on the ball out in front of you, bend your knees so that the ball comes back and underneath you. Return to the starting position and continue the exercise.

References:

1. Starkey, Chad, and Sara D. Brown. Examination of Orthopedic & Athletic Injuries. F.A. Davis Company, 2015.

2. Higgins, Michael. Therapeutic Exercise: from Theory to Practice. F.A. Davis Company, 2011.