Patellar Tendinopathy (Patellar Tendinitis)

Description:

Patellar tendinopathy has also been referred to as “jumper’s knee” and patellar tendinitis. It is common in athletes who are involved in jumping sports but also occurs in runners and other athletes. This injury differs from patellofemoral pain syndrome (PFPS) and is characterized by localized pain at the bottom (inferior pole) of the patella and there is often a palpable thickening of the tendon itself.

Common Signs and Symptoms:

• Pain exacerbated with jumping or running activities,
• Loss of strength with forceful extension of the knee: jumping, rising from a seat or squat position,
• Throughout the course of a run, the pain is present at warm-up, settles down, and then reappears after exercise, and
• Inferior pole (lower patellar pole) is tender to palpation with a thickening of the tendon possible.

Causes:

• Anatomical factors :
  • Foot:
    • Unhealthy degree and velocity of foot pronation,
    • Flat and high-arched feet, and
    • Restricted ankle dorsiflexion.
  • Knee: hyper- or hypo-mobile patella and tight iliotibial band.
• Inflexibility:
  • Quadriceps, hamstrings and calf muscles, and
  • Iliotibial band.
• Muscular weakness:
  • Quadriceps,
  • Gluteals,
  • Abdominal, and
  • Calf muscles.
• Unhealthy biomechanics of pelvis, patellofemoral joint, and foot and ankle,
• Sudden increase in exercise intensity, and
• Direct blow to the knee or patellar tendon .

Preventative Measures:

• Appropriate warm-up and stretch before exercise bouts,
• Ample time for rest and recovery between exercise bouts,
• Maintaining appropriate conditioning:
  • Calf muscle flexibility,
  • Muscular strength and endurance, and
  • Cardiovascular fitness.
• Proper footwear:
  • Replace running shoes every 500-800 kilometers.

Management:

• Recovery usually takes 2-3 months,
• Ice to relieve pain,
• Activity modification: relative rest, 
• Tendon unloading through activity modification,
• Quadriceps strengthening (eccentric drop squats),
• Massage,
• Custom foot orthoses, infra-patella brace and footwear prescription, and
• Physiotherapy modalities: ultrasound.