Patellar Tendonitis "Jumper's Knee"

What is it?

Patellar Tendinitis is a condition characterised by the presence of pain, inflammation, weakness, and in severe cases, microscopic tears of the patellar tendon and is often caused by repetitive use. Recent studies have highlighted the prevalence of this condition in sports requiring frequent jumping such as basketball and volleyball; however, it can manifest itself in athletes of all ages and levels of experience. While patellar tendinitis is commonly thought of as an overuse injury, other risk factors include age, obesity, limited flexibility, poor quadricep/hamstring strength, and muscle imbalances. Studies have also shown that sport specialisation and poor training technique increases one’s likelihood of developing this condition. As symptoms of patellar tendinitis develop, proper management is crucial to recovery and the prevention of a patellar tendon rupture.

Symptoms

• Pain (localised inferiorly to the patella) with weight-bearing movements such as walking, running, jumping, and squatting

• Inflammation

• Hesitancy during athletic competition

Mechanism of Injury

Patella tendinitis is a common overuse injury, caused by repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon multiply, they cause pain from inflammation and weakening of the tendon. When this tendon damage persists for more than a few weeks, it's called tendinopathy.

A combination of factors may contribute to the development of patellar tendinitis, including:

• Physical activity. Running and jumping are most commonly associated with patellar tendinitis. Sudden increases in how hard or how often you engage in the activity also add stress to the tendon, as can changing your running shoes.

• Tight leg muscles. Tight thigh muscles (quadriceps) and hamstrings, which run up the back of your thighs, can increase strain on your patellar tendon.

• Muscular imbalance. If some muscles in your legs are much stronger than others, the stronger muscles could pull harder on your patellar tendon. This uneven pull could cause tendinitis.

• Chronic illness. Some illnesses disrupt blood flow to the knee, which weakens the tendon. Examples include kidney failure, autoimmune diseases such as lupus or rheumatoid arthritis and metabolic diseases such as diabetes.

Common Management Techniques

• Ice and massage

• Analgesic balm (ie. Voltaren, Fisiocrem) 

• Deep tissue massage 

• Shoulder manipulation 

• Stretches

• Muscle energy techniques 

• Active release techniques 

• Dry Needling

• Education

• Postural education and programs 

• Pain Relief Medications prescribed by your GP, such as pain relief of anti-inflammatories can assist in reducing pain.

• Platelet Rich Plasma (PRP) Injections

• Patella braces

Surgery – in severe cases, your Doctor may suggest debridement of the damaged tendon to promote healing. 

Due to the nature of athletics and the patient’s desire to return to competition, rest is not the answer that any athlete desires to hear. However, when combined with eccentric muscle strengthening and icing, rest allows for decreased inflammation and the opportunity for the tendon to heal. If immediate relief is needed, many athletes turn to knee braces and patellar bands which provide support and reduce the severity of the associated pain.

Prognosis

To reduce your risk of developing patellar tendinitis, take these steps:

• Don't play through pain. As soon as you notice exercise-related knee pain, ice the area and rest. Until your knee is pain-free, avoid activities that put stress on your patellar tendon.

• Strengthen your muscles. Strong thigh muscles are better able to handle the stresses that can cause patellar tendinitis. Eccentric exercises, which involve lowering your leg very slowly after extending your knee, are particularly helpful.

• Improve your technique. To be sure you're using your body correctly, consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.