27 May, 2021
Patellar tendinitis: What it is, symptoms, causes, evolution and treatment
The patellar tendon attaches to the bottom of the patella and the tibia (Anterior tibial tuberosity). It is one of the largest and most powerful tendons in the body, as it has to propel us to overcome gravity in activities such as walking, running, and jumping. Patellar tendinopathy or tendinitis is also known as “jumper’s knee”, since it is more common in athletes whose sports include frequent jumping, such as basketball, volleyball, athletics, … However, if you are a person who does not practice jump sports but feels pain in the kneecap, you may also suffer from patellar tendinitis from what we call repetitive microtrauma.
PATELLAR TENDINITIS OR CHONDROPATHY?
Patellar tendinitis is closely related to patellar chondropathy, which we have already talked about in this blog. The patellar tendon joins the patella, both behaving as the same group. This is also why, on many occasions, it is a mixed problem.
SYMPTOMS OF PATELLAR TENDINITIS
Knee pain is the first symptom of patellar tendinitis. In tendinopathy it is usually more isolated than in the case of chondropathy. It is usually located between the patella and the point where the tendon connects with it. At first, you may only feel pain in your knee during physical activity or after strenuous exercise. Over time, the pain worsens and begins to interfere with playing sports. Ultimately, the pain affects daily movements, such as climbing stairs or getting up from a chair.
It is a pain that can range from a disabling discomfort, to pain under the kneecap or knee pain when running, which is aggravated by performing certain actions. For example, severe knee pain occurs when climbing stairs and/or descending them. Or, pain in the kneecap is evident when running on slopes or only when jumping.
CAUSES AND COURSE OF PATELLAR TENDINITIS
As I discussed earlier, patellar tendinitis is a frequent overuse injury. It is the consequence of repetitive stress on the patellar tendon. Repetitive stress on the tendon causes acute tendinitis in the early stages. Acute tendinitis is the pain caused by having done excessive exercise that we are not trained for. In this phase, tendinitis is usually fully reversible. It usually responds well to sports rest, local cold and taking oral anti-inflammatories.
The problem comes when this injury becomes chronic. In this phase there is no acute inflammation, small tears are produced in the tendon. Faced with these tears, the body tries to repair them. Most of the time it does so with abnormal scar tissue that alters the correct structure of the tendon. This causes a vicious cycle, where pain continues to perpetuate, more abnormal repair and we start over.
For this reason, in this phase, the patient does not usually respond to the previous treatment. There is no longer an inflammatory process, and in this case, rest only worsens the situation. And so we add a component of muscular atrophy due to the sports stop while the tendon injury persists. Therefore, when returning to activity after 2-3 weeks of inactivity, there is more muscle atrophy and the same (or more) abnormal reparative tendon injury. As tears multiply, they cause pain due to chronic inflammation and weakening of the tendon.
The area that is most commonly affected in patellar tendinitis is the so-called lower pole of the patella. That is, the area where the patellar tendon “hooks” to the patella. In fact, it affects this area more than the patellar tendon itself. For this reason, we technically call this condition patellar enthesitis.
If you try to ignore the pain and persist with physical activity “holding it”, it can lead you to increase this vicious circle and make it increasingly difficult to solve the underlying problem.
“If you try to ignore knee pain and persist with physical activity ‘holding it in’, it can make it increasingly difficult to fix patellar tendinitis”
Dr. Sergi Sastre – Traumatologist expert in Sports Medicine
RISK FACTORS FOR PATELLAR TENDINITIS
Several factors can contribute to the development of patellar tendinitis, including:
- Specific physical activity: Running and jumping are the factors most commonly associated with patellar tendinitis. Sudden increases in the intensity or frequency with which you perform the activity also increase the stress on the tendon. Changing running shoes can also play a role. Poor training planning or overtraining can contribute to it. In fact, this factor is often the most common cause of patellar tendinitis.
- Weak muscles in the legs: The weakness of the thigh muscle (quadriceps in particular) can increase the stress on the patellar tendon, causing the tendon to work “overloaded”.
- Muscle imbalance: The imbalance between agonist and antagonist muscles (quadriceps and hamstrings) can cause that, if some leg muscles are much stronger than others, the stronger muscles pull with more intensity on the patellar tendon. This imbalance can be one of the causes of patellar tendinitis.
- Chronic diseases: Some diseases interrupt blood flow to the knee, which weakens the tendon. Some diseases that could influence this are: kidney failure, autoimmune diseases, such as lupus or rheumatoid arthritis, and metabolic diseases such as diabetes. The latter factor is a less common cause of patellar tendinitis. What is proven is that smokers, having an alteration in blood capillarity, have a worse repair and healing process, so in these patients the healing process is much more difficult.
PREVENTION OF PATELLAR TENDINITIS
To prevent the progression of patellar tendinitis and avoid chronifying the process, we can adopt these measures:
5 tips to prevent patellar tendinitis
- Do not play when you are in pain. As soon as you notice pain in your knee from exercising, ice the area and rest. Until you no longer have pain in your patella or knee, avoid activities that put stress on your patellar tendon. It would be about acting in the initial phases of tendinopathy, when it is more easily reversible.
- Strengthen your muscles: Strong thigh muscles are better able to overcome the strain that patellar tendinitis can cause. Eccentric exercises are especially useful for tendon strengthening. They consist of lowering the leg very slowly after having extended the knee.
- Improve your technique: To ensure that you use your body correctly, consider taking classes or getting professional instructions. Especially when you start a new sport or when you want to progress in a certain sport.
- Plan your training and rest periods: Having a training plan, considering breaks, is essential to avoid overloading and overtraining.
- Complement with specific exercises for muscle and tendon stretching: To avoid tendon injuries or muscle injuries, it is essential to carry out the stretching pattern. Introduce eccentric exercises.
TREATMENT OF PATELLAR TENDINITIS
Initial stages of patellar tendinitis
As I have indicated previously, in the initial phases the treatment of patellar tendinitis is reduced to: resting, applying ice to the area to reduce pain and inflammation and the application of special elastic bandages. On a doctor’s guide, certain anti-inflammatories can be taken.
Eccentric rehab exercises and massages may also be helpful. These exercises will help strengthen your knee, quadriceps and calf muscles.
Evolved phases of patellar tendinitis
For the treatment of patellar tendinitis in more advanced stages, certain physiotherapy techniques may be necessary. These exercises are aimed at “destroying” the newly created anomalous tissue. This tissue that tries to heal the tendon injury does nothing more than perpetuate the injury.
Chronic phases that do not respond to treatment
If all these patellar tendinitis treatment techniques do not work, just like in the case of the FC Barcelona goalkeeper, Marc-André Ter Stegen, surgery may be necessary. In these cases, a surgical intervention is performed to remove this abnormal tissue and promote the creation of tendon tissue with the correct characteristics. Currently, specialists dedicated to sports traumatology perform patellar tendinitis surgery with a combination of arthroscopy and ultrasound. This combination allows us to act precisely only on the abnormal tissue. In all cases, patellar tendinitis surgery must be complemented with a specific muscle strengthening program.