Front of knee pain
Patella tendinopathy, also known as jumper’s knee, is a common overuse injury that affects the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). This condition often occurs in athletes involved in sports that require repetitive jumping or running, such as basketball, volleyball, or track and field. In this article, we will delve into the causes, symptoms, diagnosis, and treatment options for patella tendinopathy.
You will usually feel pain in the front of the knee when you jump (not when you land!). Find out more about what is tendinopathy!
Causes of Patella Tendinopathy
Patella tendinopathy typically develops due to a sudden increase in physical activity load. Several factors contribute to the development of this condition, including:
- Overuse: Engaging in activities that involve repetitive jumping, running, or kicking can put excessive strain on the patellar tendon, leading to overuse injuries.
- Muscle Imbalances: Weakness or tightness in the muscles surrounding the knee, particularly the quadriceps and hamstrings, can alter biomechanics and increase stress on the patellar tendon. Anecdotally, we sometimes observe some weakness in the hips in patients with patella tendinopathy.
- Training Errors: Rapidly increasing the intensity, duration, or frequency of training without adequate rest and recovery can overload the patellar tendon and increase the risk of injury.
How does Patella Tendinopathy Present?
Patella tendinopathy typically presents with a variety of symptoms, which can vary in severity depending on the stage and extent of the condition. Here are the typical symptoms associated with patellar tendinopathy:
1. Pain in the front of the knee when landing from a jump
Pain is the hallmark symptom of patella tendinopathy. It usually manifests as a dull, aching pain in the front of the knee, just below the kneecap (patella). The pain may be localized to the area of the patellar tendon or may radiate along the tendon or into the surrounding tissues.
Pain associated with patella tendinopathy tends to worsen with activities that involve jumping, running, squatting, or any repetitive bending of the knee. At its worst, however, it may progress to the point where it interferes with even everyday movements and activities.
Interestingly, in some cases, the pain in the front of the knee will get lesser over the course of your exercise. The pain is usually worse when you start and better during and after the session.
2. Tender on touch
The area around the lower part of the patella, where the patellar tendon attaches to the shinbone (tibia), is often tender to touch. Palpating this area may elicit pain or discomfort.
3. Stiffness
Patients with patellar tendinopathy may experience stiffness or tightness in the knee, particularly after periods of rest or inactivity. This stiffness typically improves with movement but may return after prolonged periods of sitting or immobility.
4. Swelling
In some cases, swelling may be present around the patellar tendon or the lower part of the kneecap. Swelling is often mild to moderate and may be accompanied by warmth or redness in the affected area.
5. Pain at the Start of Activity
Many individuals with patellar tendinopathy also experience the “warm-up phenomenon,” where the pain is most severe at the beginning of physical activity but improves as the activity continues. This pain then subsequently builds up with prolonged loading, and may return or worsen after the activity is completed.
How is Patella Tendinopathy Diagnosed?
Diagnosing patella tendinopathy typically involves a thorough clinical evaluation by a Physiotherapist. This may include:
- Medical History: Your Physiotherapist will inquire about your symptoms, activity level, training routine, and any previous knee injuries or conditions.
- Physical Examination: A physical examination will be performed to assess for tenderness, swelling, range of motion, muscle strength, and biomechanical abnormalities around the knee joint.
How is Patellar Tendinopathy Managed?
The treatment for patella tendinopathy typically involves a combination of rest, physical therapy, pain management, and sometimes medical interventions. Here’s a comprehensive approach to managing patellar tendinopathy:
A. Rest and Modification of Activities
Initially, it’s important to rest the affected knee to allow for healing. Activities that exacerbate symptoms should be avoided or modified. This might include reducing the frequency or intensity of high-impact activities like running or jumping.
B. Physiotherapy
A structured and well-designed program focused on strengthening and flexibility exercises is crucial for rehabilitation. Eccentric exercises, where the muscle lengthens under tension, have shown to be particularly effective in treating chronic patella tendinopathy. This might include exercises like eccentric squats and decline board exercises. Additionally, stretching exercises for the quadriceps, hamstrings, and calf muscles can help improve flexibility and reduce strain on the patellar tendon. This follows some of the concepts that has been shown to be effective in the management of tendinopathies.
C. Orthotics and Biomechanical Correction
Addressing any underlying biomechanical issues, such as improper foot mechanics or muscle imbalances, can help alleviate stress on the patellar tendon. Orthotics or shoe inserts may be recommended to correct foot alignment and provide support.
D. Taping or Bracing
Some individuals may benefit from taping or bracing techniques to offload the patella tendon and provide additional support during activities. Do note that this is temporal and doesn’t solve the root cause of the problem.
E. Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) has been used as a treatment option for patella tendinopathy, particularly in cases where conservative measures have failed to provide relief. ESWT involves the application of high-energy shockwaves to stimulate healing in the affected tendon.
It’s important for you with patella tendinopathy to work closely with your Physiotherapist, to develop a personalised treatment plan tailored to your specific needs and goals. Additionally, gradually returning to sports or activities after treatment is essential to prevent recurrence of symptoms. Please contact us immediately to consult with our experienced physiotherapist for a comprehensive evaluation and personalized treatment plan.
DISCLAIMER: This information should not replace the need for a consultation with our Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.