Key Points
- Patellar tendinopathy is an overuse injury that occurs more often in elite athletes
- Impairments of the hip and foot/ankle are associated with patellar tendinopathy
- Reduced hip internal range and weak hip abductors may contribute to patellar tendinopathy
What can contribute to the pain in the front of my knee?
Hold on now, this pain in my knee, it’s not from my knee?! What does that even mean?
Yeap! We’re saying that your knee pain could be caused by your hip or foot because it isn’t moving the way it should be. Patellar tendinopathy is an overuse injury that happens with repetitive loading on the patellar tendon. It is commonly seen in athletes who do sports that require lots of jumping and landing activities, such as basketball or volleyball.
Understanding this condition is so important because of its association with long-term pain and functional limitations. Many studies have been done to evaluate patella tendinopathy and its related factors, and it’s possible that factors such as the impairments of the hip and foot/ankle contribute to overloading of the patella tendon which subsequently leads to patella tendinopathy.
How does the impairment of my hip and/or foot contribute to tendinopathy in my knees?
The impairments may influence our movement patterns or alignment in our lower body. This could easily overload our knee joints. A similar condition would be patellofemoral pain. Evidence shows that individuals with patellofemoral pain have weaker hip musculature than others, and this causes their altered hip motions that increase loading in their knee joints, thus causing them pain.
How do I know if my hips and feet are influencing my patella tendinopathy? Here are some predictors based on a study that looked at athletes with and without impairments in their hip and foot/ ankle:
- Lower passive hip internal rotation range
- Lower hip external rotation torque
Essentially, reduced hip internal movement and weak hip abductors may contribute to patella tendinopathy.
What are some exercises for patella tendinopathy?
Now that we know patella tendinopathy may be influenced by impairments of the hip and foot/ ankle, what can we do about it? Based on individual cases, interventions and preventative programs can be implemented as part of the rehabilitation!
Rehabilitation for patellar tendinopathy is focused on introducing and progressively increasing load tolerance on the patella tendon. Some exercises such as single-legged squats on a decline board, hack squats, or leg presses could be a good start. But take caution not to exceed your load tolerance as that would be detrimental to your progress. It is also important to emphasise that experiencing some pain before and after doing these exercises is acceptable as long as the symptoms resolve themselves fairly quickly rather than continue to get worse over the course of rehabilitation.
If the cause of your patella tendinopathy is attributed to any foot or ankle issues, they will be addressed as well.
Why is Physiotherapy important in patella tendinopathy?
Patellar tendinopathy rehabilitation can be complex in terms of knowing when to increase load tolerance or introduce a new set of exercises. It is important not to rush into overloading the tendon as it diminishes the effects. Similarly, under-loading the tendon will not give the desired outcome either. It is best to consult a therapist who understands when to progress the stages of rehabilitation better, and work together in order to return to sport and prevent re-injury.
Your Physiotherapist will also identify areas of deficits that are contributing to your patella tendon pain which would include your hip and foot since we know that it will cause unusual loading patterns in the patella tendon.
Unsure of what to do? Contact us to speak to our Physiotherapist who will be able to ascertain the source of pain and have it addressed early!
DISCLAIMER: These advice and exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.
Ref:
Mendonça, L. D., Ocarino, J. M., Bittencourt, N. F. N., Macedo, L. G., & Fonseca, S. T. (2018). Association of hip and foot factors with patellar tendinopathy (Jumper’s knee) in athletes. Journal of Orthopaedic & Sports Physical Therapy, 48(9), 676–684. https://doi.org/10.2519/jospt.2018.7426
