Patellar Tendonitis

 What is it?

Tendons connect muscle to bone and in the case of the patellar tendon it connects the thigh muscles (quadriceps) to the upper shin bone (tibia). The patella tendon can be felt as a thick fibrous band just beneath the kneecap. The quadriceps are a very strong group of muscles and are responsible for straightening the leg from a bent position. The quadriceps are capable of contracting and shortening i.e. when the leg is straightened out to kick a ball and they can also contract and lengthen or ‘pay out’ i.e. when walking downstairs. These types of contraction are called concentric and eccentric respectively. Patellar tendonitis is a condition where the tendon becomes inflamed (in the early stages) and painful, making squatting or knee bending movements painful. It is sometimes known as ‘jumpers’ or runners’ knee’ as it is usually the eccentric contraction type movements typical of running and jumping, which cause the problem to start. Eccentric movements can be particularly damaging to tendons and overtime can lead to degenerative micro tears. Coupled with the tendons’ poor propensity to heal itself due to a poor blood supply, further degeneration can occur leading to chronic knee pain which may persist in the absence of inflammation. This is known as tendinosis and is thought by many sports practitioners to be a more appropriate term for this type of condition.
 

Causes

Due to the degenerative nature of this condition it is thought that the tendon becomes symptomatic when it is no longer able to cope with the high eccentric loads to which it is subjected. There are of course certain predisposing anatomical and biomechanical factors such as tight thigh or hamstring muscles, patella positional dysfunctions, pelvic alignment problems and leg length discrepancies which can contribute to the problem. Environmental factors such as the choice of playing or running surface as well as an athlete’s type of footwear can increase the strain through the tendon and cause further degeneration.
 

Treatment

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following:

Depending on the severity or chronicity of the problem, initial treatment management will vary.

• Ice and rest from aggravating activities

• Taping to offload tendon or correct kneecap alignment

• Electrotherapy to promote healing and reduce pain

• Acupuncture for pain relief, inflammation and restore normal muscle tone

• Correction of relevant anatomical abnormalities with orthotics / heel raises

• Adjustment of relevant biomechanical factors i.e. tight and overactive muscles

• Progression of a tailored rehabilitation programme including appropriate eccentric strengthening and sports specific exercises