Overview

 

Patellar tendinopathy (or tendonitis), commonly known as jumper’s knee, is a condition characterised by load related pain in the patellar tendon, at the front of the knee. This tendon plays a crucial role in the function of the knee joint, especially during explosive activities such as jumping, running, or kicking. Patellar tendinopathy typically affects athletes who engage in repetitive high-impact activities, such as basketball players, volleyball players, and runners. Overuse and biomechanical factors often contribute to the development of this condition. Patellar tendinopathy can often be misdiagnosed as other sources of anterior knee pain, so an accurate diagnosis and specific management program is vital. 

 

Anatomy 

The patellar tendon connects the kneecap (patellar) to the shinbone (tibia). This is the attachment for the 4 muscles of the quadriceps group which all connect into the quadriceps tendon, which encases the patellar and forms the patella tendon, attaching to the tibial tuberosity. This musculotendinous complex forms the knee extensor mechanism, which is a vital aspect of participation in sports and general activities of daily living. Patellar tendon pain will commonly present at the inferior pole of the patellar and can extend into the mid portion of the tendon. Research indicates 45% of elite jumping athletes will experience patellar tendon pain during their career, whereas quadriceps tendinopathy is only estimated to affect 0.2-2% of athletic populations.

Common Causes 

Patellar tendinopathy is an overload condition. Tendinopathies lie on a continuum from reactive, through to tendon disrepair and degeneration and can be shifted along this continuum through exposure to load. Tendons are responsible for energy storage and release, acting like a spring that connects our muscles to the surrounding bones. During a spike in training load (which often emerges along with a lack of rest between training and games), the patellar tendon becomes overloaded. This causes the rate of collagen breakdown in the collagen matrix of the tendon to exceed the rate of repair, causing a tendinopathy.  

 

Furthermore, factors outside of just training load can contribute to the tendon becoming overloaded. These include altered biomechanics and movement patterns, decreased quadricep strength, kinetic chain strength deficits, gender and age, with patellar tendinopathy being most common in men between the ages of 15-30. 

 

Diagnosis 

Patellar tendinopathy is commonly misdiagnosed due to the range of knee conditions that can cause anterior knee pain. A thorough assessment involves a detailed subjective history as well as screening for other knee conditions that could be causing pain, such as fat pad irritation, patellofemoral pain or infra-patella bursitis. 

 

Load related pain that remains localised is an important aspect of diagnosis. Pain will present over the patellar tendon and will remain pinpointed to this spot whilst increasing in severity as the difficulty of the functional tests increase. A general progression of tests we move through at Motus Health and Performance is double leg squat, single leg squat, single leg decline squat, double leg jumps and finally single leg hops. 

 

Amongst youth athletes, assessment may uncover the prevalence of Osgood Schlatters Disease or Sinding-Larssen Johanssen Syndrome, two conditions that have a very similar presentation to patellar tendinopathy, but differ in terms of management. 

Management 

Management for patellar tendinopathy needs to follow specific stages to ensure it does not worsen and progress along the tendinopathy continuum. Pending on the severity, relative rest from the aggravating activity or sport may be advisable. With exercise for tendinopathies, a small amount of pain is accepted, providing there is no increase in pain following exercise. 

 

The first stage is isometric loading. This involves static holds that load both the quadriceps and the patellar tendon. Isometric holds often have an analgesic (pain relieving) effect for tendon pain. Soft tissue release work can also be performed in this stage to provide pain relief and interim symptom modification. 

 

Once isometric loading has been implemented and pain has been controlled in an acceptable range, heavy slow loading is the next stage of management. This involves low reps of heavy weighted quad exercises, helping to build strength and stiffness back into the tendon. Other kinetic chain strength deficits will also be addressed in this phase of management such as targeted core, hip and calf exercises. 

 

After building and correcting any strength deficits, energy storage and release exercises will be introduced. These involve jumping exercises moving through the plyometric continuum to gradually expose the quads and specifically the tendon to greater force and power loads. 

 

This phase is often combined with sports specific exercises and returning to running (if appropriate for the individual and their activity requirements) which is a vital component to ensuring the individual returns back to their activities safely whilst limiting the chances of recurrence. This is done by progressing through our 6-stage return to run protocol. 

Role for taping 

Taping can be an effective management strategy for patellar tendinopathy. An offload style taping can help to temporarily reduce pain and may enable increased participation in sports and activity. We often use this method in the reactive phase of tendinopathy to provide interim pain relief. Whilst this method of taping is effective in altering symptoms, it is not a strategy that we rely on in the long term, as exercise based rehabilitation has been shown in the research to be the most effective way to manage patellar tendinopathy

Expected Timeframes 

The recovery time frame for patellar tendinopathy will differ depending on which phase of the tendon continuum it lies upon. A reactive tendon can be settled back to a pain free range anywhere between 2-8 weeks, whereas a more long standing tendon issue may require progressive treatment and graded exercise loading exposure over several months to return to a pain free level of function. 

 

If patellar tendinopathy occurs during a sporting season, activity does not necessarily need to be ceased. Training and game intensity and volume can be monitored and combined with targeted exercises, taping and soft tissue release work to enable you to complete the remainder of the season. If however, you are out of season, it may be advisable to limit exposure to the aggravating sport or activity (e.g. running) for a brief period of time to allow symptoms to settle whilst commencing a progressive tendon loading program.