What is Patellar Tendonitis, aka Jumper's Knee?
Patellar Tendonitis, aka 'Jumper's Knee', is something very near and dear to my heart. Being a former University Volleyball player, 'Jumper's Knee' is something I suffered from for YEARS. It was a really quick way to make a 21 year old feel about 70. The good news is, there is hope for you, as this is something that I have managed to get rid of (with a heck of a lot of hard work doing rehab stretches and exercises, and a variety of other therapeutic interventions). But, if I knew when I was 20 what I know now, my knees would have hurt WAY less for WAY shorter.
The patellar tendon (or ligament as they are calling it these days) is a thick band of connective tissue that connects the knee cap (patella) to the shin bone (the tibia). Typically the pain in this area is the result of other parts of the leg (mostly the hip and thigh) being tight and weak. We start to feel pain in the patellar tendon when the Quadriceps muscles (the muscles on the front of the thigh) get excessively tight, as the patellar tendon is essentially continuous with the Quadriceps, thus tight Quads can result in painful patellar tendon.
While it is nick-named 'Jumper's Knee', it can happen to anyone, but is most common in jumpers in sports like Volleyball & Basketball (affecting almost 20% of these athletes!), but can also affect athletes who explosively load the leg like sprinters.
What Causes Patellar Tendonitis?
-Repetitive loading of the patellar tendon (ie lots of jumping or lots of sprinting/change of direction)
-Tight& Weak thigh and hip muscles
-Hard playing surfaces
-Inappropriate footwear (ie footwear with not enough cushion)
Repetitive loading (ie more jumps) and tight& weak thigh and hip muscles are the most significant in terms of developing patellar tendonitis. In theory, good hip and leg muscle control should be able to counteract hard playing surfaces and footwear without adequate cushion for the most part.
Signs & Symptoms of Patellar Tendonitis:
-Pain at the bottom part of the knee cap (in advanced cases this is usually the MOST painful spot)
-Pain on the area of the patellar tendon
-Pain on the tibial tuberosity (the bony bump on the shin bone where the patellar tendon attaches)
-Mild swelling on the front of the knee
-Pain after athletic activity, especially after an activity with lots of jumping or excessive loading
-Pain in the front of the knee worse after sitting for long periods, or sitting with confined leg room
-Pain that might go away once the muscles in the leg are warmed up, but returns after activity
-Pain in the front of the knee going up or down stairs
-Pain relieved by stretching the Quadriceps muscles or lateral hip muscles
-Pain relieved by ice
As you can see, pain is the most common symptom, however in severe cases the pain might limit physical activity.
Treatment of Patellar Tendonitis:
-Rest (yes, this can be hard, especially for an athlete, but trying to unload the tendon is very helpful here)
-Active Release Technique to affected tight muscles. This typically includes work to the patellar tendon, Quadriceps, Gluteus Medius and Iliopsoas in most cases in my experience.
-Laser Therapy or Shockwave Therapy. I have used both myself, both are fantastic, and in a stubborn case like mine that I had for 8 years before really addressing it I needed a modality to move along the healing process.
-Rehab Stretches & Strengthening. This involves self work at home to stretch and strengthen the hips, quads, patellar tendon.Some keys for me were working leg extensions and eccentric step downs ( I will talk about these next week in my follow up blog!)
-Tendon de-loading strap or Kinesiology Tape. You can purchase patellar tendon straps at the drug store, but I prefer the cheaper version of tightly wrapping pro-wrap (pre-wrap) around my knee and placing it just under the knee cap. For me, this did the same thing as the pricier patellar tendon strap, but was less bulky, and for me wearing knee pads playing volleyball less bulky was key!
In my opinion from suffering from this myself, and my professional opinion from treating this condition, the sooner you start treatment for this the better. The patellar tendon is largely avascular, meaning it has poor blood supply to begin with, so an injury here typically is slow to heal under the best circumstances for this reason! The faster you treat it, the faster it should go away! Waiting 8 years while doing exceptionally high loading of the tendon is definitely not my recommendation!
Check out my blog next week for my favourite stretches and exercises to help manage patellar tendonitis!
Dr. Elaine Screaton (DC, BSc) is a Chiropractor in NW Calgary currently practicing at Synergea Family Health Centre.