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EPISODE 34: Pain-Free Knees - Treatment for Patellar Tendinopathy

Updated: Sep 28, 2023

Patellar Tendinopathy, aka Patellar Tendontis and "Jumper's Knee" is a very common injury we see in athletes who participate in sports that involve jumping and running activities. People who have this injury often complain of pain and tenderness below the kneecap. Patellar tendon injuries can be incredibly frustrating because they can get better on their own, but also they can linger and become debilitating if not addressed properly. We have learned a lot more about patellar tendon conditions in the past several years and this has helped us approach them a little differently so we can get our clients back to sports and recreational activities quicker. If you are having pain in the front of your pain this blog post is for you! We are going to cover the anatomy involved in this injury, how folks injure their patellar tendon, treatment options and things you can do to get back to sport.


Let's dive in!


The anatomy involved in this injury is pretty straight forward.


Anatomy of the Patellar Tendon

The patellar tendon is a fibrous piece of connective tissue. It connects the patella (kneecap) to the shin bone (tibia). Essentially the patella "floats" between the quadriceps tendon and the patellar tendon.


The patellar tendon plays a crucial role in the movement of your knee joint. It's primary functions are to:

1) transmit forces generated by the quadriceps muscles to the lower leg allowing you to extend your knee (knee extension is necessary for movements like walking, running, jumping, and kicking)

2)stabilize the patella and assist with maintaining proper alignment

of the knee during movement.


Now that we have covered the anatomy of the Patellar Tendinopathy, let's talk a little bit about how this injury occurs or what we call the Mechanism of Injury (MOI).

Inflamed Patellar Tendon

With Patellar Tendinopathy, specifically, we see tendon damage. Through repetitive stress, the tendon undergoes degenerative changes which involve a breakdown of the collagen fibers or "micro-tears" and abnormal thickening of the tendon. This can result in pain and weakening of the tendon structure.


In addition, we may see inflammation (heat & increased fluid/cells) & neurovascularization (new blood vessels) occur. Both of these natural processes are intended to promote healing in the tendon, but they can also contribute to pain. If the tendon continues to have inflammation, pain and weaken it can lead to a large tear or rupture of the tendon all together. This is why it is important to address the pain in the front of your knee when it occurs and not let it linger.


The proposed reason for injury to the tissue is overloading of the Patellar Tendon with repetitive activities or overuse. We find that this condition arises when there is an increase or peak in training with sports that involve frequent jumping, running and changing direction (basketball, volleyball, or track and field) which can place excessive tensile stress on the patellar tendon.


It is also important to note that factors such as biomechanical imbalances, muscle weaknesses, training errors, and genetic predisposition may also contribute to the development of patellar tendinopathy.


Okay so next let's talk about what we love...Treatment!


The treatment for Patellar Tendinopathy involves the a combination of conservative measures aimed at reducing pain, promoting healing, and improving the strength and movement mechanics in the knee and lower extremity.


Here are some things we do in Physical Therapy:

  1. Icing : Localized ice massage can help reduce pain in the patellar tendon if it is highly irritable. Ice should only be used when pain is limiting function and not daily for maintenance.

  2. Activity Modification : Avoiding the activities that aggravate the symptoms is important to let the body heal. This does not mean that you lay around and do nothing. This means that we instruct and guide you to participate in exercises that feel good and we modify your workouts and training to eliminate things that aggravate your knee in the beginning stages of healing.

  3. Taping/Bracing : Kinesiotaping or bracing can provide temporary relief by offloading the stress on the patellar tendon

  4. Manual Therapy: Soft tissue and joint mobilization can be utilized to reduce swelling, improve tissue mobility and improve joint mobility in the knee if lacking

  5. Blood Flow Restriction Training:

  6. Strengthening your Hip/ Knee/ Ankle: exercises focused on strengthening the quads primarily, but also addressing weakness in any other lower extremity muscles

  7. Improving Your Muscle Flexibility: quads can often be tight but also there may be tightness in the Glutes, hamstrings, calves.

  8. Improving Your Joint Mobility: going after any lack of mobility in the hips, knees and ankles if it is present

  9. Improving Your Movement Mechanics: addressing underlying bio-mechanical issues, improper running, jumping, pivoting/cutting mechanics with retraining and education.

Typically there is a Beginning, Middle and Late Phase of Rehab. In each phase, the goals for rehab change and there is progression towards return to sport/ activity. The timeline for the treatment course can vary depending in the severity of the injury, healing capacity and compliance with treatment and each phase duration is also based on each individual. Generally speaking, rehab is a gradual and progressive process and can take several weeks to months to achieve optimal performance and return to sport.


Below is s breakdown of each phase and some general timelines:


Beginning Phase (0-4 weeks)

Goals:

- Reduce pain & inflammation

- Activity Modification

- Begin engaging the quads, initiate low intensity exercises aimed at pain free strengthening of the

hip, knee and ankle musculature

-Address limitations in flexibility and mobility

-Initiate addressing muscle imbalances

- Focus on improving daily function

Rehab:

- Education & activity modification: activities to avoid, things to keep doing, optimizing movement

patterns

- Pain Management: Soft Tissue Mobilization, Cupping, Joint Mobilization, Kinesiotaping

- Range of motion exercises: focused on improving knee flexion/extension

-Strengthening exercises: Isometric, Eccentric, Isotonic, Proprioception

and balance exercises are commonly introduced during this stage

Middle Phase (4-8weeks)

Goals:

- Progressive strengthening exercises to increase loading of the knee & build tendon resilience

- Improve Balance and Control

- Continue addressing muscle imbalances

-Begin addressing movement mechanics with linear/lateral acceleration, jumping & hopping

- Initiate dynamic and plyometric movements

- Load Management

Rehab:

- Progressive Strengthening exercises: aimed at increasing load and intensity in the quads & hip

muscles includes: Isotonics & Heavy slow resistance training like squats, lunges, step ups, deadlifts

- Plyometrics: improve the tendon's ability to handle rapid movements and forces. Examples include

jump squats, box jumps, or jumping lunges.

- Proprioception and neuromuscular control exercises: focus on enhancing joint

stability, balance, and coordination. Examples include single-leg balance on unstable surfaces,

lateral hops, or agility ladder drills.

-Gradual return to sport-specific activities: gradual reintroduction of sport-

specific movements and activities, such as running, jumping, or cutting maneuvers, under the

guidance of a healthcare professional.


Late Phase (8weeks -months)

Goals:

- Aggressive strength

- Return to sport activities

- Improving performance

Rehab:

- Sports-specific drills: exercises and drills that mimic the movements and demands of the specific sport you participate in. These may include cutting, pivoting, jumping, or sprinting exercises tailored to your sport.

- Agility and coordination exercises: exercises that challenge your balance, agility, and coordination, such as ladder drills, cone drills, or shuttle runs.

- Power and plyometric exercises: dynamic exercises that involve explosive movements, such as jump squats, box jumps, or single-leg hops.

- Strength and endurance training: continued focus on strength and endurance exercises for the lower body, including squats, lunges, step-ups, and leg presses.

- Maintenance exercises: ongoing exercises to maintain the gains achieved during earlier phases, such as regular stretching, foam rolling, or mobility exercises for the lower body.

- Functional training: Integration of sport-specific movements into training sessions, focusing on improving movement patterns and biomechanics while minimizing the risk of re-injury.


At the end of the day, our goal is to get you back to your sports and recreational activities. This is a gradual process and it requires guidance and oversight by your Physical Therapist as we progress strength, plyometrics and return to sport activities. It also requires consistency on the part of the patient.


If you have knee pain and you are looking for some help we got you! We work with clients on site and virtually through Telehealth. Click here if you are interested in booking a a session or getting more information! https://www.physicaltherapysanpedro.com/sports


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Much Love <3 ,


The PTSP Docs

Dr. Brown, Dr. Bay, Dr. Daisuke & Dr. Sandoval












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