Welcome back to our “Injury in the Spotlight” series. In this edition we are going to discuss a very common source of knee pain, patellar tendinopathy. This injury can affect athletes in any sport but is more common in sports that involve a lot of jumping such as basketball, netball and GAA, as well as runners. It can be a tricky injury to treat and a sensible, progressive rehab process is needed to manage a successful return to sport. So what exactly are we dealing with with this injury?
The patella tendon is actually a ligament, which lies below the patella (or knee cap) and connects the patella to the tibia (shin bone). Above the kneecap we have the large tendon that comes from the four quadriceps muscles which joins onto the top of the patella. When all these structures work together they straighten the knee.
Simply put, patellar tendinopathy is an overuse injury usually resulting from a training error (too much, too soon). In running and jumping sports a high load is placed on the knee and patellar tendon and after a while the tendon struggles to deal with the overall stress. Over time micro tears with develop on the tendon and a degeneration of the tendon will occur, resulting in pain and swelling. The condition used to be called patellar tendonitis, with “-itis” referring to inflammation. But it is now known that rather than an inflammatory process, the pain is a result of these micro tears and degeneration. This is also why anti-inflammatory medicines should be avoided as they are not effective with this type of injury and may interfere with the body’s natural inflammatory healing process.
So, what are some of the main symptoms of patellar tendinopathy?
- Pain on the tendon below the knee cap
- Swelling of the tendon
- Stiffness in the tendon, especially in the morning
- The area may be tender to touch
- Tightness in the quadriceps muscles
- In some chronic cases, you will see a thickening of the tendon itself
In the early days of the injury the pain may go away after the area warms up but with continued exercise the pain will become more ever present and chronic. Continuing to train on a damaged tendon can significantly weaken the structure and it may eventually rupture.
The important thing, as with all injuries, is to manage the symptoms and as soon as possible (when pain allows) to start the rehab process and to load the tendon. In the beginning this may mean taking a break from the activities that aggravate the issue. However other forms of cross training can be done to maintain aerobic conditioning as long as they don’t stress the tendon. Ice can be applied to the area every couple of hours to try and reduce swelling. A good rehab plan should be tailored to the individual but will focus on
- Restoring range of motion in the quadriceps muscles
- Assessing and addressing any biomechanical issues that maybe be at play in other areas of the kinetic chain (hip, ankle)
- Strengthening the surrounding tissue (quads, hamstrings, hips)
- As soon as the pain allows, eccentric loading exercises should begin
Eccentric loading of the tendon should begin as soon as the pain allows as these are vital for successful treatment of most tendon injuries. These exercises stimulate collagen development which assists in the successful repair and regeneration of the tendon. Manual therapies such as deep tissue massage and dry needling can be used during the healing process to speed up and assist with recovery. It is important to work with your therapist during this rehab phase so the process is progressive and correct form is done during the exercises.
So that is the low down on patellar tendinopathy. It is much easier to treat this injury in the early days and if caught early can be managed in a shorter timeframe. Always listen to your body and don’t allow a small niggle become a chronic condition. Please feel free to add comments below and if you are suffering from patellar tendinopathy then get in touch with us here at The Rebuild Clinic.