ATHLETIC EDGE
Sports Medicine
Sports Injury Prevention & Rehabilitation
 540 BRYANT ST, PALO ALTO, CA 94301
(650) 815-6552

Voted Best Sports Therapy Clinic in the San Francisco Bay Area 2010-2016!

Patellar Tendonitis

(Also known as Patellar Tendinopathy, Patellar Tendinitis, Jumper's Knee)
 
Note - Although research suggests that 'patellar tendinopathy' is the more appropriate term to describe overuse injuries to the patellar tendon, we will use the term 'patellar tendonitis' in this document as it is more widely known.

What is patellar tendonitis?
Patellar tendonitis is a condition characterized by tissue damage and inflammation to the patellar tendon causing pain in the front of the knee.
The large muscle at the front of your thigh is called the quadriceps. This muscle attaches to the knee cap which in turn attaches to the tibia (shin bone) via the patellar tendon.
The quadriceps muscle is primarily responsible for straightening the knee during activity and is particularly active during running, jumping and kicking. During contraction of the quadriceps tension is placed on the patellar tendon via the patella. When this tension is excessive due to too much repetition or high force, damage to the patellar tendon may occur. Patellar tendonitis is a condition whereby there is damage to the patellar tendon with subsequent degeneration and inflammation.

Causes of patellar tendonitis
Patellar tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the patellar tendon. This typically occurs due to repetitive running, jumping, hopping, squatting or kicking activities. It is also particularly common in sports requiring frequent jumping and landing such as basketball or tennis.
Occasionally, patients may develop this condition suddenly due to a high force going through the patellar tendon beyond what it can withstand. This most commonly occurs when landing from a jump (particularly on hard surfaces) or during rapid acceleration whilst running.

Signs and symptoms of patellar tendonitis
Patients with this condition typically experience pain that develops gradually at the front of the knee just below the knee cap. In less severe cases, patients may only experience an ache or stiffness in the knee that increases with rest following activities requiring strong or repetitive contraction of the quadriceps muscle. These activities typically include running, jumping, hopping, squatting, kicking or climbing stairs. The pain associated with this condition may also warm up with activity in the initial stages of the condition.
As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Walking or standing may be enough to aggravate symptoms. Patients with this condition typically experience pain on firmly touching the patellar tendon. Occasionally, a feeling of knee weakness may also be present particularly when attempting to jump or accelerate while running.

Diagnosis of patellar tendonitis
A thorough subjective and objective examination from a physical therapist is usually sufficient to diagnose patellar tendonitis. Occasionally, further investigations such as an Ultrasound or MRI scan may be required to assist with diagnosis and assess the severity of the condition.

Prognosis of patellar tendonitis
Most patients with this condition heal well with appropriate physical therapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had their condition for a long period of time. Early physical therapy treatment is vital to hasten recovery in all patients with this condition.

Treatment for patellar tendonitis
The success rate of treatment for patellar tendonitis is largely dictated by patient compliance. One of the key components of treatment is that the patient rests from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage to the patellar tendon. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
  • Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate, appropriate treatment in all patients is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
  • Patients with patellar tendonitis should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE involves resting from aggravating activities, regular icing, the use of a compression bandage and keeping the affected leg elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
  • Patients with this condition should undergo a graduated flexibility and strengthening program (including eccentric strengthening exercises), particularly of the quadriceps, to ensure an optimal outcome. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
  • In the final stages of rehabilitation, a graduated return to running program is required to recondition the patellar tendon for running in a safe and effective manner. This should include the implementation of progressive acceleration and deceleration running drills and should be guided by the treating physical therapist.

Contributing factors to the development of patellar tendonitis
There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physical therapist. Some of these factors include:
  • joint stiffness (particularly the hip, knee, ankle and lower back)
  • muscle tightness (particularly the quadriceps and hamstrings)
  • muscle weakness (especially the quadriceps, gluteals and calf)
  • poor pelvic or core stability
  • inappropriate or excessive training
  • change in training conditions or surfaces
  • inadequate warm up
  • biomechanical abnormalities (e.g. flat feet)
  • inappropriate footwear
  • inadequate rehabilitation following a previous quadriceps injury

Physical therapy for patellar tendonitis
Physical therapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • stretches
  • the use of crutches
  • bracing (via a patellar tendon strap)
  • protective taping
  • joint mobilization
  • ice or heat treatment
  • exercises to improve strength, flexibility, balance and core stability
  • education
  • anti-inflammatory advice
  • activity modification advice
  • biomechanical correction
  • a gradual return to activity program

Other intervention for patellar tendonitis
Despite appropriate physical therapy management, some patients with patellar tendonitis do not improve adequately. When this occurs the treating physical therapist or doctor will advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who will advise on any interventions that may be appropriate to improve the condition. In rare cases, where patients have been unresponsive to a high quality therapy program, surgery may be indicated.