Patellar Tendonitis Pain

Patellar tendinopathy (PT; also known as jumper’s knee) is a painful, chronic, activity-related overuse injury of the patellar tendon. Most people know and call patellar tendinopathy, patellar tendonitis, but there is a difference, which shows itself in the suffix.

-itis: forming names of inflammatory diseases (Dictionary.com).

-pathy: denoting disorder in a particular part of the body (Dictionary.com).

Therefore, understanding the phase of an injury is mandatory for proper treatment, as patellar tendonitis pain is the acute phase of patellar tendinopathy. This phase dictates the best patellar tendinitis treatment. This article technically addresses non-acute patellar tendinopathys, but since most people call this condition “patellar tendinits”, this nomenclature we’ll use for the rest of the article.

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Repetitive stress of the knee extensor apparatus can lead to this common injury, and a high prevalence of patellar tendonitis pain is found particularly in jumping athletes including both elite and non-elite populations.  This injury can have a major impact on sports activities; in many athletes with patellar tendinotis pain, the level of performance is affected (Lian et al., 2005) and it has even been found to be an important reason for athletes to cease sports after several years of symptoms (Kettunen et al., 2002).

5 Secrets for Improving Patellar Tendonitis Pain Video

5 Secrets for Improving Patellar Tendonitis Pain

1. Patellar Straps and Sports Tape: Patellar straps and sports tape are commonly used by athletes with patellar tendonitis pain during sports in order to reduce activity-related pain. There are a few theories about the working mechanism of these orthoses: one is that the orthosis changes the patella-patellar tendon angle, causes a reduction in the effective length of the tendon and thereby reducing the tendon strain.  Others hypothesize that wearing an orthosis like a patellar strap or sports tape leads to improved proprioception. A recent study by de Vries (2015) had participants rate their pain during a single leg step down test and other sports testing. The patellar strap group and the sports tape group had a reduction of 20% during the single-leg decline squat and nearly ~40% reducing in 10 single-leg decline squats and single leg vertical jumping.

2. Quadriceps Self Myofascial Release: During an injury muscular compensations occur. These compensations can limit range of motion, increase stress, and dysfunction. self myofascial releases (SMR) are new techniques without much literature, but a 2013 study by MacDonald noted an improvement in knee range of motion with a bout of foam roll (a type of SMR) of the quadriceps. In patellar tendonitis pain, the quadriceps muscle is often overused due to poor form or simply overuse (high activity). Therefore, relaxing and restoring range of motion in the muscle often helps reduce pain and improve movement quality. At COR, we often start foam rolling on the quadriceps for those with patellar tendonitis pain, but progress to using a baseball on the wall or even a heavy bar on the thigh (ease into it!).

3. Biomechanics Training: Poor squatting and jumping biomechanics can increase stress on the patellar tendon (hence the nickname jumper’s knee). Typically bending too much at the knee joint and not bending from the hips can increase the angle at the knee and stress on the patellar tendon. Overtime, this extra stress on the tendon can cause pain and dysfunction. Therefore, altering the biomechanics and shifting jumping and squatting biomechanics to a hip driven movement, not a knee driven movement, can reduce knee stress and patellar tendon stress.

4. Glute Strengthening: Many bend too much from their knees during jumping and squatting due to poor biomechanics (see above) and strength in the glutes. The glute muscles are the largest in the body, making them capable of handling activities requiring high levels of force. Therefore, ensuring adequate glute strength is key for proper jumping and squatting form.

5. Quadriceps Control: The quadriceps muscle transfers energy into the patellar tendon. Descending from a squat or a jump requires high control, as gravity and force is higher during this phase of a movement, compared to ascending phase. Therefore, improving muscular control of the quadriceps can reduce stress on the patellar tendon. This is first accomplished through controlled strengthening through the eccentric phase of a movement (the lowering).

Clearly, these 5 tips only scratch the surface of recovering from patellar tendonitis pain or Jumper’s Knee. It is important to note that the origin of tendon pain is very complex and not fully understood. Also, the stage of an injury varies the course of treatment, as inflammation at the joint can alter the treatment approach.

Peripheral and central mechanisms, as well as local tissue changes, seem to play a role in tendon pain. Furthermore, pain and tendon abnormalities appear to be only weakly related (Lian et al., 1996). This may sound silly, but simply because you have less pain, doesn’t mean your tendon is healing, the pain may simply be masked, increasing your risk for further damaging the patellar tendon. Simply reducing pain is our first priority at COR Physical Therapy, but healing the tendon is also important as sometimes treatments can simply mask pain. Reducing pain should be the first priority, but not the only goal of treatment, as this can result in a larger injury in the future or recurrent injuries.

Reducing pain is only part of the battle. If you reduce pain, it is like turning off the smoke alarm during a fire. Don’t forget to stop the fire!

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References:

1. de Vries A, Zwerver J, Diercks R, Tak I, van Berkel S, van Cingel R, van der Worp H, van den Akker-Scheek I. Effect of patellar strap and sports tape on pain in patellar tendinopathy: A randomized controlled trial. Scand J Med Sci Sports. 2015 Sep 17. doi: 10.1111/sms.12556.
2. MacDonald GZ, Penney MD, Mullaley ME, Cuconato AL, Drake CD, Behm DG, Button DC. An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. J Strength Cond Res. 2013 Mar;27(3):812-21.

Written by Dr. John Mullen, DPT, CSCS