Tendonitis is an acute inflammatory condition that is caused by repeated stress to a tendon. Under normal conditions, your body adds collagen to make your tendons stronger under stress.
Over time, is the stress rate is greater than the healing rate, this leads to breakdown of the tendon structure. The result of this is pain, inflammation and over time, weakness that develops in the muscles attached to the tendon and those involved in complementary motion.
With patellar tendonitis, it’s usually repetitive jumping motions that without adequate preparation (think off season training) before getting involved in a demanding sport. Runner’s are also susceptible to patellar tendon issue, although there tends to also be biomechanical contributors.
People typically feel pain at the tendon beneath the kneecap with jumping, running and squatting. There is often tenderness to the touch and swelling can be present in the acute phase.
Generally, patellar tendonitis responds well to progressive loading over time, usually taking about 8-12 weeks to resolve with proper management.
[Mechanism of Injury + Affected Tissues]
There are several factors that contribute to the development of patellar tendonitis, including rapid increases in training load, quick increase in training intensity and changing to very hard training surfaces. To better understand the development of tendonitis, it’s important to understand how tendons normally behave in response to training.
There are 4 stages of tendon damage.
- (Normal) Reactive Tendinopathy, where the rate of tissue healing exceeds tissue damage.
- Tendon Dysrepair, where the rate of tissue damage exceeds that of healing.
- This is where most people start to notice symptoms of tendonitis.
- Degenerative Tendinopathy, where collagen cell death starts to occur and the tendon integrity is diminished.
- This happens with long term damage to the tendon and weakness is widespread.
- Tendon Tear or Rupture, where tendon damage is most extreme.
Most people seek treatment in stage 2 or 3 as they begin to notice pain and changes in performance. The further you progress in tendon damage the longer it will take to recover.
Typically with patellar tendonitis, the middle portion of the tendon is most affected, but tearing can occur near the patella (knee cap) and down to the tibial tuberosity on the shin bone where the patellar tendon attaches.
Conservative treatment for patellar tendinopathy includes stretching, mobility and eccentric strengthening of the quadriceps. Additionally, a physical therapy program should incorporate strength and mobility work to the foot, hip and spine on the affected side as altered gait and movement mechanics can affect the loading and health of these tissues.
Additionally, physical therapy should address:
Modulating the pain
Normalizing knee, hip and ankle range of motion
Mobilizing the soft tissue surrounding the joint (knee)
Making the proper exercise and ADL modifications to promote pain free activities & movements – shoe inserts such as a temporary heel lift may be indicated to offload the tendon.
IASTM may have an impact on physiological changes by providing an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, & an improvement of flexibility of underlying tissue
Healing depends on the amount of time that symptoms have persisted and what stage of tendon dysrepair has occurred. Generally, resolution can be expected in 8-12 weeks with additional time required to regain full strength.
In one study, up to 22% of active adults (16-40 years old) have experienced some form of patellar tendon pain over their lifetime.
Please refer to our instagram post Rx: Patellar Tendonitis for more information
*This does not constitute medical advice. If you have pain or injury please consult a medical profession in person.