Patella Tendinopathy
The patella tendon is a strong fibrous band that attaches the kneecap (patella) to the lower leg bone (tibia). Together with the quadriceps muscle and tendon, these structures allow straightening of the knee and provide strength for this movement. It is also very important in controlling the knee as it bends from a straightened position, such as walking downstairs and landing from jumping.
Patella Tendinopathy is generally an overuse injury of the patella tendon and is sometimes referred to as ‘Jumper’s knee’.
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Causes
Excessive stress and strain placed on the tendon, with activities such as jumping and landing, can cause wear and tear. Over time, the repetitive strain of the patella tendon may result in a breakdown of the fibres and subsequent inflammation and degeneration. Several factors can increase a person’s risk of developing patella tendinopathy. These include:
- Participation in sports that involve regular direction change and jumping, such as basketball, volleyball, track and field (running, high and long jump), tennis and soccer.
- Abnormal biomechanics of the knee, feet or hip control
- Lower limb muscle imbalance
- Tight quadriceps or hamstring muscles
- Repetitive knee extension exercises
- Inappropriate footwear or training surface
- A rapid increase in training amount or frequency or poor training technique
Assessment
Persons presenting with Patella Tendinopathy will have a very typical presentation including one or multiple of:
- Pain and tenderness at the front of the knee over the patella tendon (usually towards the bottom of the knee cap)
- Aggravated by activities such as jumping, hopping, landing or running
- Usually gradual onset and commonly related to an increase in sport activity
- Aching and stiffness may be present in the morning, after a period of prolonged rest
- Some swelling or thickening of the tendon may be present
The implementation of an appropriate treatment plan is the result of an accurate diagnosis. It is essential to see a Physiotherapist skilled at performing specialised orthopaedic tests of the knee to exclude other potential diagnoses. Imaging such as x-rays and ultrasound are not generally needed for a Physiotherapist to diagnose Jumper’s knee.
Treatment
Patella Tendinopathy typically responds very well to Physiotherapy treatment and we see excellent outcomes and return to normal sports/activities. The primary aim of initial treatment is to reduce pain and any inflammation that may be present. This may require some short term activity modification (rest from some sports activities), particularly from any aggravating activities which place large amounts of stress on the patella tendon. There are many activities which can be performed to maintain fitness during this period such as swimming and stationary cycling.
Physiotherapy treatment may include massage, ultrasound, shockwave therapy, stretching, strengthening, sport-specific training and correction of any biomechanical abnormalities with orthotics and taping.
Our Physiotherapy team can guide you through an individual exercise program, including a gradual increase to normal activity. Slow progression towards normal activity levels is essential. If pain returns, activity levels will need to be reduced again. Complete recovery of patella tendinopathy may take several weeks to months and if not treated properly the tendon can weaken, and possibly tear or symptoms may persist.