Pattellar Tendinitis (Jumper's Knee)
The knee joint is one of the most complex joints. It consists of a synovial hinge joint and a synovial gliding joint. The knee consists of 4 bones, the femur (thigh bone), the tibia (shin bone), and the fibula (next to the tibia and the patella (the knee cap).
The Patella is a thick triangular shaped bone which sits above the knee joint. Its main functions are to protect the knee joint, which it covers; and knee extension. The patella articulates with the femur, and it is the biggest sesamoid bone (a bone located within a tendon) in the human body. The patella connects with the femoral groove to form the patella joint, a synovial gliding joint. The patellar tendon attaches the bottom of the patella to the front of the shin bone (tibia) at the tibial tubercle. This tendon combined with the quadriceps tendons form the ‘extensor mechanism’, which strengthens the knee and allows it to straighten.
When the leg straightens from a flexed (bent) position it causes the quadriceps muscles (thigh muscles) to shorten, which draws the quadriceps tendon, patellar tendon and the tibia to move the knee from a bent position to an extended position.
There are four ligaments (the medial and lateral collateral ligaments and the anterior and posterior cruciate ligament) which also strengthen the knee and prevent extreme movement of the knee joint. In addition the meniscus (which are formed by the lateral and medial menisci) play a crucial role in the anatomy of the knee. They are C shaped pads of fibrocartilage, located between the femur and the tibia and act as shock absorbers, protect the articulating cartilage of the femur and the tibia, and play a crucial role in preventing hyperextension of the knee.
Patellar tendinitis is a common overuse injury, as a result of the pressure that the patellar tendon comes under in many sporting activities. Most notably in sports that involve repeated activities, such as running, tennis, kicking and jumping. Repeated strain can result in small tears occurring. If the patellar tendon tears or becomes ruptured the patella loses the stabilising support of the tibia, and becomes vulnerable to excessive movement.
Pain is felt below the knee cap and comes on gradually.
Pain which increases with activity.
Pain is felt when the quadriceps muscles are contracted, for example when kneeling.
Swelling might be felt around the tendon.
Tenderness might be felt when gently pressing the base and front of the patella.
The patellar tendon might feel stiff first thing in the morning or after effort.
Tightness of the quadriceps can occur, and enlarged muscles.
The Patella might be unstable, and in a full rupture can give way.
Patellar tendinitis can be broken into 4 grades of pain:
Grade 1: pain only occurs after training.
Grade 2: Pain eases after warm up, but happens before and after exercise.
Grade 3: Pain affects training or exercise.
Grade 4: Pain occurs most of the time.
Recovery from Patellar tendinitis can be slow and is important to seek medical advice to aid recovery. Athletes often ignore the early stages of jumper’s knee, which can end up resulting in a long term injury that might require surgery.
Rest: to prevent further damage.
In the sub acute (3 days to 3 weeks) and the chronic stage (3 weeks to 2 years) it is important that training should be adapted to avoid jumping or any exercises that put excessive strain on the patellar tendon. A physiotherapist or sports massage therapist can advise when exercise should be resumed and what exercise would be appropriate.
Ice treatment: Ice, can be applied every 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary. In the sub-acute stage (3days – 3 weeks) heat therapy can be applied.
Compression: to reduce swelling and restrict movement
Elevation: gravity will assist lymphatic drainage and aid venous return.
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Knee supports and kinesiology taping can aid recovery.
Massage can help aid recovery, and improve joint mobility and range of movement. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
A medical practitioner can recommend strengthening, flexibility and proprioceptive exercises in the sub acute and the chronic stage of recovery. Exercises should focus on eccentric strengthening; focusing on the quadriceps muscles, the intensity of the exercises should be increased gradually and in a measured way.
A physiotherapist or doctor might prescribe ultrasound or laser treatment to aid recovery; or advise surgery.
Published: October 31, 2011Author: Sophia Cross, BA (Hons) MA
Patetellar Tendinitis Treatments