Patella Tendinopathy

Patella Tendinopathy or Jumpers Knee is the most common source of pain in the front of the knee. It is generally aggravated by an increase in training or increased loading of the patella. Pain can be brought on my tasks such as climbing the stairs, jumping, squatting and even sitting for long periods of time (Rudavsky & Cook., 2014). It is a condition that is primarily seen in young and active athletes between the ages 15 – 30 who participate in sports such as football, tennis, running or volleyball.

 

How do we diagnose it?

Clinical features that are reported in the literature that help when diagnosing patella tendinopathy are:

•         Pain around the base of your patella,

•         Stiff at the beginning of exercise but eases during activity,

•         Increased pain after activity,

•         Pain increases as load increase, e.g. walking down stairs or landing from a jump,

•         Little to no pain experienced when resting.

 

Differential diagnosis

Other sources of pain through the front of the knee may include; patellofemoral pain syndrome or fat pad disorders but we would expect pain with prolonged sitting, squatting or climbing the stairs.

 

Can I treat this at home or do I need the gym?

Both are suitable. The key to recovery is load management is one of the most important things to understand before trying to treat patellar tendinopathy. Progressive loading of this structure allows it to reverse the physiological changes and in turn reduce pain. 

Management of Patellar tendinopathy can be broken down a few different stages. Below outlines these with home exercise examples: 

 

Stage 1: Isometric loading (loading the muscle without moving the joint)

Isometric exercises have been proven to immediate pain relief in patella tendinopathy (Rio, Kidgell, Purdam et al., 2015).  It is important to remember that pain can be 3-4/10 during these exercises, however, do not let it increase to more than 5/10 during the exercises.

A wall squat is a perfect example of this that you can do at home

•         Stand with your feet shoulder width apart, measure three-foot lengths from the wall and lean back against it.

•         Slide down the wall so that your knees are bent to 60°, and you are in a seated positing

•         Hold this position for a minimum of 30 seconds with the aim to build up to 3 minutes.

 

Stage 2: Isotonic Loading (loading of the muscle through movement)

This stage can begin when the movements can be performed without pain increasing passed 3-4/10.

In this stage, squats are a good exercise to load the tendon through movement progressively.

•         Stand with feet shoulder-width apart, and feet slightly turned out

•         With your upper body upright, push your hip back so that you bend your knees and hips (imagine you are going to sit on a chair)

•         Only squat down to a max of 60°

•         You can progress by squatting deeper, adding weight or performing a single leg squat.

 

Stage 3: Sport specific loading

This phase is about reintroducing power to the tendon through movement that is specific to your sport.

Exercises can vary from jumping, landing, multidirectional hopping, running accelerating and decelerating in different directions if it is required in your sport.

 

Conclusion

I hope this blog helps you to become pain-free. It is not an easy condition to manage and often takes discipline focusing on slow progression. 

A general rule of thumb is to ensure that you PROGRESSIVELY load the tendon if you have loaded it too quickly your pain levels or irritability of the tendon will increase. Generally expect pain to improve anywhere between 2 to 12 weeks, however, depending on the severity of the individual case it can take up to 12 months.

If you do not see any improvements, please feel free to call our clinic and arrange to come in for an assessment with us.

 

Bibliography:

Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. The Journal of orthopaedic and sports physical therapy. 2015 Sep:1-33.

Rio, E., Kidgell, D., Moseley, G. L., & Cook, J. (2015a). Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain. Scandinavian Journal of Medicine & Science in Sports.