Patellar tendinopathy historically was called Patellar tendinitis, but we now know more about the condition which is degenerative, caused most probably by poor biomechanics and therefore repetitive over-loading.
The Patellar tendon is a strong structure and is found underneath your patella (kneecap) itself and joins into the top of the tibia bone. It is a continuation of the quadriceps and works to control your knee in varying degrees of bend. Patellar tendinopathy is common in running and jumping sports and can occur on just one or on both sides simultaneously, but you do not need to be an athlete to suffer with this condition. Diagnosis is important to ensure that you have not sustained a more significant injury such as a partial or total rupture to the structure. These tendons can take a long time to repair due to their poor local blood supply so be patient as you are looking at several months for resolution.
What are the symptoms of Patellar Tendinopathy?
The most common signs are local dull or sharp pain, tenderness, swelling around or thickening of the tendon itself. Weakness can also be associated. The pain is usually worse first thing in the morning, after activity and as the condition progresses, it can become painful during activity as well.
What are the causes of Patellar Tendinopathy?
This is another condition that is now thought to be due to repetitive microtrauma. As with many injuries, these cases are multi-factoral and require a multi-faceted approach to treatment and rehabilitation. What you need to do is address the underlying factors and not just try and make the pain go away – that is how you will get long term resolution from this and any other biomechanical issue.
The structure of the Patellar tendon should be strong and linear. Chronic tendinopathy occurs over time when the arrangement of the collagen fibres that make up the tendon becomes more haphazard. Because the tendon has a poor blood supply, it doesn’t heal well on its own and this is why you have to try and identify and remove all the aggravating factors and causes.
Inadequate shock absorption, tight Iliotibial (IT) bands, tight quadriceps or hamstrings, excessive rear foot pronation and weak hip/pelvic muscle control can be risk factors for Patellar tendinopathy.
How is Patellar Tendinopathy diagnosed?
Our diagnosis is made from the signs and symptoms your present with as well as your case history and our own assessment including palpation of the tendon itself.
An x-ray won’t show any soft tissue damage or degeneration. We would choose to refer for diagnostic ultrasound but this is not usually necessary unless your symptoms are not settling with conservative treatment and management.
How is Patellar Tendinopathy Treated?
Historically patients with Patellar tendinopathy were given anti-inflammatory medication but we know now that this is of very little use.
It can take a while for PT to settle even if you are religious about your treatment and management approach to it. This is because our bodies have a cyclical regeneration/repair process which takes around 12 weeks and so you should start to see some real improvement after this time. If running is what makes your pain worse, whilst you many not want to hear this, it may be that rest is what is needed. However we will likely give you lots of things to be doing in the meantime to keep you busy as complete rest is not usually advised. I will often recommend using a cross trainer as a non-impact alternative together with swimming and cycling and we will normally get you back running as soon as you can do so within certain limits.
There is some evidence to show that stretching a reactive tendon will irritate it so don’t think that stretching madly all day every day is what you need to be doing and listen to the advice that is given.
A typical treatment program here at our clinic after initial consultation would be soft tissue massage to the hips, quadriceps and hamstrings in the first instance all aimed at de-loading the tendon. We will look at your strength, flexibility and function all the way from your feet up to your hips and pelvis. We may use kinesiotape around your patellar tendon and/or up into your quadriceps. We will provide a stretching and strengthening program which is unique to you but will usually include the proven 12 week progressive eccentric loading protocol described by Prof Hasan Alfredson. Some therapists use acupuncture to try and increase local blood supply and healing.
We will also look at what you spend your days doing, and what your wear on your feet during this time. We might recommend a basic over the counter orthotic to support your rear foot motion and provide some support for your foot arches.
Should conservative treatment fail, there are a number of options now for the treatment of Patellar tendinopathy. Cortisone injections are no longer recommended. Shockwave therapy is a more recent option and is showing some promising positive research. PRP injections have limited research driven results. Surgical intervention is a last resort.