Patellar Tendonitis

Here are the basics of the knee in relation to patellar tendonitis.

Femur – this is the thigh bone and it is integral to the kneecap for the reason that it has a small groove at the end of the femur which allows the patella (kneecap) to sit in comfortably. As the knee flexes and extends the patella runs through the groove. The groove is perfectly formed to the shape of the kneecap.

Patella – also known as the knee cap. This is the small triangular like shaped bone which sits on the front of the knee. It is held in place by patellar ligaments which keep the kneecap secure, along with patella groove in the femur as we have mentioned. The Patella is connected to 2 tendons including the quadriceps tendon. This feeds off the quadriceps muscles and helps the kneecap to be secure.

Patella Tendon – the patella tendon runs from the bottom of the kneecap in to the top of the shin bone (tibia). Due to its placement at the front of the knee where a lot of flexion occurs and force is generated, this can become overloaded and painful. Tendons are strong, elastic and stiff in nature. They are designed to absorb load and generate force. This is important to understand as the main reason we develop tendonitis is when tendons cannot deal with the force they are being placed under.

Quadriceps – This is the muscle group consisting of 4 different muscles which make up the thigh. The help to extend the knee and flex the hip. The 4 muscles are the rectus femoris, vastus medialis, vastus lateralis and vastus intermedius.

Who is likely to develop patellar tendinitis?

We have briefly discussed who may be likely to develop patellar tendon issues in regard to ages. In fact, it can happen at any ages but the reason people below the age of 35 may be more likely to develop these issues is due to the fact it is more likely to develop with running and jumping type activity.

Another term for patella tendinitis is jumper’s knee and it is common in basketball, netball, athletics, running and most sports involving repetitive knee movements.

This is because the front of the knee is repetitively used and it can become aggravated until the tendon breaks down.  This leads us in to the next section which are causes and common factors in the development of patellar tendinitis.

These are the main symptoms you may experience when suffering from patellar tendonitis.

• Pain and tenderness at the bottom of your kneecap which you will be able to press. These are usually the first symptoms of jumper’s knee/ patella tendonitis.

• You may have some swelling and a burning feeling in the kneecap. Actions such as kneeling down or getting up from a squat can be especially painful as it puts a lot of pressure on the tendon itself or stretches it.

The pain may at first be intermittent, happening typically only after sports or exercise. If the patella tendon is more damaged, the pain can become progressively worse. It can interfere with any functional movement including your sport and exercise as well as with daily activities, such as stairs or sitting for any period.

Here are a few common contributing factors:

Imbalances of the lower limb

This can be differences in range of movement and also strength within the full lower limb. Our lower limb works together in order to help us remain pain free. If there is an imbalance which reduces the efficiency of the leg it may place more demand on the knee cap and tendon.

Sudden Changes in Routine

This is by the number one reason for patella tendon pain. Anytime you increase the amount of intensity of your training load – and it is done in a time period which is too quick – the patella tendon cannot keep up and starts to breakdown. Common examples of this are players starting a new season with poorly managed training schedules, they develop patella tendon pain during the first 6-8 weeks.

Poor Biomechanics

If you have poor control of your knee, hip and ankles – this can lead to excess force and stress going through the front of the knee causing small tears and stress to the patella tendon. Always engage in a good strength and conditioning program and movement training to improve your lower limb control.

Being overweight

There is already a considerable amount of force and weight going through the patella tendon when you are walking, running and jumping – but that will indefinitely increase if we are carrying excess weight. This is a big reason as to why knee pain can develop. Ensure you are eating a calorie controlled and balanced diet to reduce the chances of this happening.

Inadequate Footwear

Having shoes which are not fit for the job can be a part cause of patella tendon pain. If shoes are not able to absorb force or are for the wrong type of surface – they will not help to manage the force that is being sent through the knee and this will get passed on to the patella tendon causing it to become overloaded.

Hard Surfaces

Road running, indoor sports halls and artificial grass are big drivers of knee pain. This is because they cause us to absorb more force than we would if we were playing on natural surfaces such as grass. Artificial surfaces are improving but some are very unforgiving.

Chronic Disease

This one is rare but there are inflammatory issues which can affect the patella tendon and will cause it to become inflamed.

Patella tendon problems can resolve on their own when mild in nature but if you are struggling to get rid of your symptoms then consulting a physio will be a great option.

Physiotherapy will help to assess your problem, confirm a diagnosis and provide you with a treatment and exercise plan which will progressively improve your issue.

The 3 most important factors for tendon pain management are:

Loaded Exercise

Tendons do not have a very good blood supply so they need blood delivered to them to help them heal. The number one way to do that is with loaded exercise – this is exercise which uses a light resistance, performed slowly to help encourage blood flow. Using heavy weights does not target the tendon and can engage the surrounding muscles. See our best patella tendon exercises below for some examples.

Graded Exercise Increase

Returning to sport or exercise at the same amount as when the tendon became painful will not help your problem to improve. You have to steadily increase your exercise amount in line with your symptoms in order to ensure it continues to heal.

Treatment 

Soft tissue work can be helpful to keep the surrounding areas relaxed and promote blood flow. The gold standard for tendonitis problems is shockwave therapy which helps to improve. Shockwave treatment helps to create micro trauma in the tendon, making it bleed and then start a healing response. This helps the tendon to heal faster than it usually would. The evidence associated with this technology states improvements are 40% quicker than traditional management of tendon pain, but it has to be combined with loaded exercise.

Here are a selection of the best exercises for improving patella tendon pain. These are simple examples of what can be done to aid patella tendonitis but each case is individual and you should seek help from a professional who can advise you on the best exercises to perform at certain stages.

• Straight Leg Raise – this is a great exercise for when the patella tendon is at its worst. In long sitting, tense your quads, so that your knee is forced straight and raise about 1 foot in the air.

In order to target the tendon, perform these slowly and aim for high reps.

You should aim for 3-4 sets and to fatigue to the tendon as much as possible within your comfort levels.

• Slow Partial Squats – purposefully done at a slow tempo for the tendon to be targeted.

Stand with your feet hip width apart and slowly pulsate upwards and downwards in a squat, building a nice burn in to the quads and tendon.

Again – only perform this when it is the right time to do them.

• Static Single Leg Balance – this isn’t just a balance exercise but more specifically a loading exercise for the patella tendon.

Stand with a small bend in the knee and hold your position for as long as possible. Start with small amounts such as 20 seconds and build for longer periods.

Aim again for 3-4 sets of your target time.

• Single Leg Squat – once you are controlling your pain levels and you feel things are getting better then you can start to strengthen the patella tendon.

Simple stand on one leg and control your weight down as far as you are able and return to standing.

You may need a wall or surface to steady yourself as you perform this exercise if your balance isn’t great.

• Knee Extension Machine – engaging the quads and keeping the knee strong is essential for the recovery of your knee pain.

If you have access to a knee extension machine – then use it! It’s the only way to isolate the quads. In the painful stage – you can still use this machine, just at a lighter weight.

As your issue improves, increase the weight to strengthen the full lower limb. This will also help to prevent the recurrence of the problem.

That’s concludes our guide to patella tendinitis, we hope that it has been helpful. If you think this could help someone you know then please share this article with them. We also have articles on knee supports if you are experiencing knee pain – please read our reviews which can help you choose the best product. Thanks for taking the time to read.