Patellar tendonitis is a condition characterized by pain in the proximal part of the patellar tendon. The pain is usually intensified if a person:
- Walks uphill
- Shifts from sitting to standing position or
- Engages in sport and physical activity
The condition is most common in middle-aged runners, racket sport athletes (both professionals and recreational players) or in athletes who engage in jumping sports (basketball or volleyball, for instance); for this reason the condition is also called Jumper`s Knee.
The condition is generally divided into three stages:
- Stage 1 – pain presents itself only after physical activity
- Stage 2 – pain appears during and after physical activity
- Stage 3 – debilitating pain during and after physical activity which affects performance
When palpating, doctor will mainly focus on the difference between healthy and injured knee. Knee affected with patellar tendonitis will be:
- Tender on touch
- Red, swollen and warm and
- The patellar tendon will feel thicker than the healthy one
Ultrasound and MRI will also be required to aid with the diagnosis and to determine the severity of the condition.
Patellar Tendonitis Treatment
In the first three months treatment usually involves conservative measures – rest, training modification, stretching and strengthening exercises. This condition is usually chronic and if it the patient does not respond well to traditional, non-surgical treatment, surgery may be required.
The role of the patient is crucial in treating this condition, the doctor is only here to provide guidance. These guidelines include:
- Resting – it is absolutely crucial to stop engaging in activities which lead to pain! Patients need to rest at least until the symptoms subside, otherwise the condition will get worse and go from acute to chronic; and especially avoid jumping and deep squats
- RICE method – RICE is a common method, ,most effective in the first 72 hours after injury. RICE is an acronym formed from: R – rest, I – icing, C – compression (using bandages) and E – elevation
- Being gradual – patients should alternate walking and jogging and work on reducing the walking distance while increasing running distance. The process HAS to be gradual, otherwise condition might worsen
- Stretching and strengthening – patients with patellar tendonitis are commonly prescribed exercises to strengthen their quadriceps muscle and stretch the tendons
Quadriceps, or quad, is a group of muscles located at the front of the thigh. Quad is crucial in patellar tendonitis rehabilitation and strengthening it will not only shorten the recovery time but also prevent the injury from re-occurring.
NOTE: Before you begin doing these exercises you should consult your physical therapist and check how suitable they are for your specific condition.
Standing Quadriceps Stretch
This is a basic stretch, it can be done at any place at any time and, most importantly, it does an awesome job stretching the quadriceps.
- Stand on one leg and flex your leg other in the knee
- (Optional) Grab onto something for balance – chair, table, wall etc.
- Grab your foot and pull it towards your butt
- Pull the feet as much as you can until you feel pain (you must not “push through the pain”)
- Hold the stretch 5-10 seconds and alternate your legs. Repeat 10-15 times with each leg
“Lying On The Side” Quad Stretch
Another basic stretch; the only difference is that this stretching position is more suitable for people with knee problems.
- Lie down on the side
- Flex the opposite leg in the knee
- Support your head with one hand and pull your foot towards your but with the other hand
- Hold the stretch for 10 seconds and repeat 10 times with each leg
Stretching Other Muscles
Tightness in other muscles can contribute to patellar tendinopathy, so it is beneficial to stretch those muscles as well.
Hip Flexor Stretch
Patients are advised to use a seated stretch with legs extended in the knees. You can view the video demonstration of this stretch below:
We already covered the topic of hamstring stretching in our previous article. You can read the article here: Hamstring Stretching Exercises You Can Do At Home
Gastrocnemius and Soleus Stretch
Gastrocnemius and soleus are the two muscles in your calves and they are involved in most of the movements and exercises people do on a dialy basis. Stretching these muscles will relax the entire lower leg and help with the knee relaxation.
- Stand in front of the wall, facing it and place your hand on it (chest high)
- Bent knees slightly and place one leg behind the other one
- Lean gently towards the wall until you feel a slight stretch in your calves (you must keep your feet flat on the floor)
- Hold the stretch for up to 15 seconds and repeat 5-10 times with each leg
Quad Strengthening Exercises
A controlled muscle exercise and strengthening program will play a crucial role in patellar tendonopathy rehabilitation. Most commonly prescribed quad exercises are:
Static Quad Contraction
Static contractions are great because they will strengthen the muscle without putting additional strain to the tendon.
- Sit on your bed and extend the affected leg
- Roll up a towel and place it under the knee
- Contract your quad and hold the contraction for up to 5 seconds
- Repeat up to 10 times (or until the pain appears)
Quad Contraction With Leg Extension
- Lie down on your bed
- Roll up a towel and place it under your knee
- Contract your quad and bring the lower leg up and hold for up to 5 seconds
- Repeat up to 10 times with each leg
Water will reduce the pressure to the joints, ligaments and tendons so it is a perfect environment for patients with knee injuries. The exercise is fairly self explanatory; the only thing worth mentioning is that there needs to be progression: the patient will start in waist deep water, then move to shallower hip/thigh deep water.
Chair Knee Extensions
- Find a high enough chair so that your knee can bend to 90 degrees
- Flex your quadriceps and raise your leg
- Hold for up to 5 seconds
- Repeat up to 10 times with each leg
Modification: as the patient progresses, the muscles become stronger and they need more resistance. Tie a flexible, rubber band around the leg of the chair and the patient`s ankle, to increase resistance.
Squatting should be limited to no more than 60 to 70 degrees knee flexion. Flexing to 90 degrees will cause excessive stress to patellofemoral joint and its tendons and should be avoided. Patients need to start out slow, doing 4 sets of 4-6 repetitions and slowly work their way up. Make sure to stop if the pain appears.
Weight Bearing Squats
In the final stages of rehabilitation (when the muscles get strong enough), the program should involve partial or full weight bearing exercises, squats with increased speed and, eventually, explosive/jump squats, to prepare the patient for returning to sport.
- (2007.) Christer R. Knee Injuries, The Sports Injuries Handbook, page 114
- (September 5. 2010.) Group of authors, Evidence-Supported Rehabilitation of Patellar Tendinopathy, NCBI. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/
- Image 1 source: MendMeShop
- Image 2 source: Pixgood.com
- Image 3 source: Healthwise.org
- Image 5 source: http://exercisewithlea.blogspot.com/
- Image 6 source: http://www.haemophilia.org.za/physio.html
- Image 7 source: http://www.orthowilmington.com/patient_education/knee_exercises.html