Patella is the frontal prominent part of the knee joint (also referred to as kneecap) that articulates with bones of lower limb (or femur, tibia and fibula) to optimize knee function. Any injury or disease process that affects the integrity of tendons supporting or connecting patella to these bones can lead to patellar tendinitis.
The role of patellar tendons is pivotal, especially in properly utilizing leg muscles for maximal efficiency and activity in active sports. For example, patellar tendons facilitate muscles of the leg to extend the knee while kicking the ball, jumping high in air and running uphill. Patellar tendinitis is more common among athletes (especially those who play volleyball and basketball).
According to a latest study published in the American Journal of Sports Medicine (1), investigators reported that the overall prevalence of patellar tendonitis in general population is 8.5%. Other salient features of the report include:
- Patellar tendinitis is more common in non-elite players as compared to elite players (that is possibly attributed to more sophisticated training and conditioning exercises in elite players)
- Volley ball players are most frequently affected with this type of sports injury (with prevalence as high as 14.4%). Likewise, the prevalence is lowest in soccer players (only 2.5% of all soccer players are at risk of developing patellar tendinitis)
- Female athletes are at lesser risk (only 6.4%) as opposed to males (10.2%)
What are some common symptoms of patellar tendinitis?
Patellar tendinitis (also known as jumper’s knee) usually presents with a multitude of symptoms that may vary in severity depending upon several factors. Pain is usually the most common and initial symptom that may extends from patella (kneecap) to the area where tendons get attached to tibia (shinbone). Other characteristics of knee pain due to patellar tendinitis are:
- Pain is usually felt at the beginning of physical activity. However, some patients may feel pain after moderate exercise only.
- Stiffness and rigidity co-exists due to pain and active inflammation that significantly compromises the quality of sports performance.
- The symptoms of patellar tendinitis often begins to interfere with day to day activities in untreated cases. For example, in advanced cases, patients often report difficulty in getting up from chair or climbing stairs.
What may cause patellar tendinitis in patients?
Patellar tendinitis is classified as one of the most frequently reported sports related injuries since most active injuries pose added stress and strain on the micro-fibers of tendons. Due to undue pressure, muscle fibers, ligaments and tendons undergo injury (that mostly involves only micro-fibers).
However, when the severity and depth of tears increases beyond the capacity of human repair, tissues initiate an inflammatory response to warn the body and to gather some time and resources for repair. Unfortunately, in some cases the repair and inflammation process go out of hand that leads to excessive pain scarring and weakening of tendons leading to overt complications.
What are some risk factors that are strongly linked to patellar tendinitis?
There are several factors that may increase the risk of developing patellar tendinitis. For example:
- Frequency and intensity of physical activity: Jumping repeatedly is among the most common patho-physiological factors that may increase the risk of patellar tendinitis. Sudden increase in frequency of jumping or poorly regulated physical activity may pose added stress on the tendons.
- Stiff leg muscles: Poor flexibility and range of motion of hip joint or knee joint due to stiff muscles can add stress as well as strain on the patellar tendons, thereby increasing the risk of trauma or injury.
- Disproportion of muscles: Having well-developed, bulky strong muscles in the thigh but weaker or less developed muscles in the leg region adds stress and strain (since the activities generated by thigh muscles create an unequal pull on leg muscles), thereby causing tendon damage.
What may happen if no intervention is taken for management?
In vast majority of cases, when athletes ignore the origin of symptom or adopt ineffective therapeutic strategies, to manage pain, the risk of complications increases significantly. Long standing patellar tendinitis can lead to chronic complications that may affect range of motion and flexibility of knee joint.
In addition, tendinitis may deteriorate to patellar tendinopathy. Research published in peer reviewed Sports Medicine (3) suggested that patellar tendinitis is an inflammatory condition. However, patellar tendinopathy is a degenerative issue that may lead to disability and functional deficit (ultimately leading to pre-mature termination of the career of professional athletes).
When should you see a doctor?
If you are experiencing mild pain in knee joint after activity, simple home remedies like application of ice over the affected area and avoiding (or reducing) the activities that are triggering the symptoms is usually enough to treat patellar tendonitis. However, if you are experiencing following symptoms, it is highly recommended to see a healthcare professional
- If knee pain or swelling continues or gets worse
- If disabling symptoms of patellar tendinitis are interfering with your routine tasks
- If you are developing signs of active inflammation or infection along the involved joint (such as redness or swelling)
It is imperative to mention that patellar tendinitis is a chronic condition and according to the study published in the American Journal of Sports Medicine (1), the average length of symptoms can be as long as 18.9 months.
What are the best ways to treat patellar tendonitis?
Treatments and drugs
The treatment protocols for the management of patellar tendinitis usually begins with physical therapy exercises to stretch and strengthen the knee muscles. Initially healthcare providers begin with less insidious treatment before switching to other options like surgery.
Medications: Pain relieving drugs like naproxen (Aleve) or ibuprofen (Motrin, Advil and others) may provide transient relief for a brief period. However, over the counter analgesics are not recommended for a long period of time mainly because of the risk of complications (gastric ulcer, high risk of gastrointestinal bleeding or others)
Physical Therapy: There are several physical therapy techniques available that are helpful in managing the symptoms of patellar tendinitis. Some includes:
- Stretching exercises reduces muscles spasm and helps in improving the flexibility of tendon fibers to avoid injury and damage. In addition, stretching exercises also aid in normal healing and regenerative activities.
- Strengthening exercises includes exercises that involves active-passive motion.
- Use of patellar tendon strap is also encouraged by physical therapists. The strap is helpful in dissipating the pressure and force from tendon to the strap and then evenly distributing to the entire joint. This helps in relieving pain and tension, while also reducing the risk of future injuries.
- Lontophoresis is a specialized therapy that involves administration of corticosteroids on the surface of skin and use of electrical devices to enhance the absorption to alleviate inflammation.
Based on a case study published in Physical Therapy in Sports (4), investigators reported that physical therapy exercises are also effective as an adjuvant therapy in addition with other popular modalities like platelet-rich plasma injection and surgery to enhance the pace of healing. Report suggested that an ideal physical therapy program must offer these benefits for effective management of severe degenerative variety of patellar tendinitis.
“Muscle strength, power, endurance and retraining sport-specific function form the fundamental basis for an effective physical therapy program that aims at improving the load dissipating capacity of knee joint. An ideal program should gradually increase the intensity and difficulty of exercises”
According to the best seller book Evidence-Based Sports Medicine (5), author conducted a detail research on the most effective methods of treatment that can be utilized for patellar tendinitis. Based on the analysis, massage, friction therapy, physical therapy and exercise regimens are more superior, cost-effective and less risky than surgical interventions.
If a conservative treatment modality fails to deliver quality results, your healthcare provider may advice other therapeutic regimens to manage acute and chronic symptoms of patellar tendinitis. This include
- Platelet-rich plasma injection: Based on the extensive research analysis published in Korean Journal of Sports Medicine (6), investigators reported that chronic and refractory patellar tendinitis responds significantly to platelet rich plasma injection.
- Hyaluronan Injection: Research published in Journal of Orthopaedic Science (7) suggested that 54% cases reported remarkable improvement in their symptoms after only 2 injections.
- Corticosteroid injections
What are some effective lifestyle and home remedies to manage patellar tendonitis?
If you are experiencing acute pain, discomfort or swelling due to patellar tendinitis, you can utilize following strategies to alleviate the symptoms at home until professional medical help is available:
- Use OTC medication like naproxen and ibuprofen to achieve optimal pain relief in addition to resolution of swelling and redness.
- It is optimal to discontinue hard physical labor or other activities that are triggering pain. In addition, avoid exertion as long as the joint is painful in order to minimize destruction or severe damage.
- Use ice to massage the affected area for immediate relief from pain. You can also prepare your home-made cold compresses by putting some ice cubes in a bag and wrapping it with a towel.
How to prevent patellar tendonitis?
Patellar tendonitis is a fairly common issue or complication in physically active or dynamic individuals. However, instead of relying on the best ways to treat patellar tendonitis, research and clinical data indicates that several strategies can be adopted to prevent patellar tendonitis in athletes. For example:
- Do not play when injured: A fairly common cause of complicated patellar tendonitis is recurrent injury and ongoing inflammation. It is therefore recommended to take optimal rest (and avoid vigorous physical activity) until the inflammatory process has resolved completely.
- Stop as soon as it gets painful: Pain is a warning sign of impending injury. If you are experiencing pain, discomfort or stiffness while playing, immediately take a break. You can also try to massage the involved limb or apply ice to alleviate pain and/ or swelling.
- Perform conditioning and strengthening exercises: An important cause of sports related injuries is unequal distribution of force that increases stress and pressure on one set of muscles. Athletes who perform traditional gym training often focus more on large group of muscles and so small muscle fibers are often missed. Unfortunately, during active sports when weak group of muscles are subjected to strain or pressure, the risk of injury increases. It is therefore highly recommended to follow efficient exercise and muscle conditioning regimens to minimize the risk of injury. Eccentric exercises are helpful in strengthening thigh muscles.
- Change your exercising technique: Often time injuries or sports related accidents are the result of poor technique, inadequate warm-up or inefficient cooling down. If you are experiencing other sports related injuries as well besides patellar tendonitis, you may need expert opinion to change or switch your exercise or training technique. Healthcare providers advise lessons and professional training before initiating a new sports or physical activity. In addition, use protective equipment and devices to reduce the risk of trauma or accidents.
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2. Gililland, J. M., Webber, N. P., Jones, K. B., Randall, R. L., & Aoki, S. K. (2011). Intratendinous tophaceous gout imitating patellar tendonitis in an athletic man. Orthopedics, 34(3), 223.
3. Peers, K. H., & Lysens, R. J. (2005). Patellar tendinopathy in athletes. Sports Medicine, 35(1), 71-87.
4. Van Ark, M., Van den Akker-Scheek, I., Meijer, L. T. B., & Zwerver, J. (2013). An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection. Physical Therapy in Sport, 14(2), 124-130.
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6. Cook, J. L., & Khan, K. M. (2011). Patellar Tendinopathy: Where Does the Pain Come From?. In Anterior Knee Pain and Patellar Instability (pp. 223-228). Springer London.
7. Seo, W. Y., Ha, J. K., Kim, J. G., & Wang, B. G. (2012). Treatment of Chronic Patellar Tendinitis with Platelet Rich Plasma Injection. The Korean Journal of Sports Medicine, 30(2), 110-115.
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