Patella Tendinopathy

Patella tendinopathy

Your patella tendon is the tendon which connects your knee cap to your shin bone. Patella tendinopathy, also referred to as jumper’s knee, was previously known as ‘patella tendinitis’ as it was believed it was a purely inflammatory condition (the suffix ‘itis’ denotes inflammation). Advances in our understanding of the condition lead to the renaming of the condition as a tendinopathy.

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What is tendinopathy?

Tendons are flexible but inelastic cords of strong fibrous collagen tissue, which attach muscle onto bone. Tendons, like bones, muscles and ligaments, are in a constant state of building new tissue and breaking down old tissue. This process of building tissue and breaking down tissue is affected by the amount of load placed on a structure. If we put too much load on a tendon and we continue to do it frequently, the process of tissue breakdown can exceed tissue growth. With this, the structure of a tendon starts to change, often becoming swollen and painful, making it less capable of dealing with load, which in turn tends to lead to even more tissue breakdown.  This cycle is difficult to reverse without appropriate intervention. This process of changes involving the tendon, is called tendinopathy.

Do you have patella tendinopathy?

The following factors are often associated with a diagnosis of patella tendinopathy:

• Well-localised pain at the front of your knee.
• Pain which has a gradual onset.
• Pain is often precipitated by an increase in the frequency or intensity of repetitive ballistic movements of the knee such as jumping.
• Initially pain may present as a dull ache at the beginning of or after strenuous activity. Generally, in the early stages, it warms up with further activity. With continued use, pain typically progresses to being felt before, during and after activity, and ultimately can interfere significantly with performance, as well as day-to-day life.
• Sometimes people experience a constant ache at rest and night pain that disturbs sleep.
• Other common aggravating factors include prolonged sitting or navigating stairs.

Risk factors 

The following risk factors are associated with patella tendinopathy:

• Poorly controlled load.
• Gender: Men > Women.
• Increase waist circumference.
• Poor hamstring length.
• Poor quadricep length.
• Reduced ankle dorsiflexion.
• Poor landing strategies – Poor trunk and lower limb alignment, poor shock absorption through knees when landing.
• Larger infra patella fat pad.

How do we manage patella tendinopathy? 

• Settle symptoms by controlling load on the patella and commencing an appropriate exercise program to increase the body’s tolerance to load and trigger the body’s natural release of pain relieving chemicals.
• Avoid stretching – While stretching may provide short term relief for tendinopathy, it appears that it may have negative effects on the tendon structure. Research has shown that compression of the tendon against a bone (which occurs with stretching) causes the tendon to alter its collagen structure.
• Encourage you to speak to your pharmacist and or doctor about appropriate non-steroidal anti-inflammatories (NSAIDS), which can downregulate the irritated tendon cells.
• Identify the cause(s) of problem that are modifiable.
• Rehab by targeting the cause(s) that have been identified.
• Follow a graduated loading program to return to normal activities and strengthen to reduce the chances of recurrence.