Patellar tendinopathy

Patellar tendon pain is a common source of knee-cap pain. Referred to as patellar tendinopathy, the condition is associated with a combination of cellular changes affecting the patellar tendon usually due to overuse and excessive chronic stress upon the tendon. 

 

The patellar tendon plays an essential role in straightening the knee and controlling the amount of knee bend under load. The tendon runs from the quadriceps muscles in the thigh, around the knee-cap (Patella) and into the shin bone (Tibia). Patellar tendinopathy is most commonly seen in younger (15-30 years old) active patients, especially men, who participate in sports involving jumping and landing such as basketball, volleyball, athletic jump events, tennis, and football.

 

Although patellar tendinopathy is often connected to sports activities, the condition is also often found in people who do not practice sports. Signs and symptoms will often manifest as:

  • Pain localsised to the area between the kneecap and the shin bone
  • Pain increases as quadriceps load increases
  • Pain with prolonged sitting, squatting or stairs
  • Rapid onset of pain with loading
  • Pain will usually reduce or “warm up” as activity continues

 

Great! So how do I get better?! 

Tendons are slow to recover, and getting rid of the pain and making sure it stays gone will take months of commitment. The first step is identifying what is causing overload of the tendon, for some this might be training load and for others this might be a new job. Once the external factors have been addressed then the biomechanical factors can be addressed, in the early stages this could mean taping or getting certain muscles stronger to share the load of the body. 

 

A few months to get better?! But I’m feeling pretty good now, can I start running? 

If all the risk factors, loads and strength/biomechanical deficits are addressed then the tendon may settle down within a few weeks, unfortunately this does not mean we can rush back into activity. A common pitfall is, surprise surprise, doing too much too soon (I’m seeing a pattern here…) and sending things backwards. A typical progression of patellar tendinopathy will depend on a person’s goals, but might look something like:

  • Wall sits at 45 degrees
  • Wall sits at 90 degrees
  • Single leg wall sit
  • Fitball squats
  • Lunges
  • Step up
  • Box jumps
  • Directional Jumping
  • Directional hopping
  • Running

The bottom line of patellar tendinopathy:

  • patellar tendons can get overloaded by an increase in load or a change in demands.
  • Pain and tenderness in the area is a common sign along with pain on quadriceps loading.
  • Recovery will involve identifying and correcting risk factors and deficits.
  • Returning to goals must be slow and progressive to avoid flare-ups.

Blog by Luca Scomazzon-Rossi

Luca is physiotherapist here at Evolve Physio Group on St Kilda Road. Luca has experience treating Achilles tendinopathy within the Albert Park, South Yarra, Melbourne and Middle Park community

 

References:

Aicale, R., Oliviero, A., & Maffulli, N. (2020). Management of Achilles and patellar tendinopathy: what we know, what we can do. Journal of Foot and Ankle Research, 13(1). https://doi.org/10.1186/s13047-020-00418-8

Breda, S. J., Oei, E. H. G., Zwerver, J., Visser, E., Waarsing, E., Krestin, G. P., & de Vos, R.-J. (2020). Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. British Journal of Sports Medicine, bjsports—2020–103403. https://doi.org/10.1136/bjsports-2020-103403

Patellar Tendinopathy. (2022). Physiopedia. https://www.physio-pedia.com/Patellar_Tendinopathy

Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2015). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British Journal of Sports Medicine, 50(4), 209–215. https://doi.org/10.1136/bjsports-2015-095215

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