The patella tendon is a strong fibrous band that attaches the kneecap (patella) to the lower leg bone (tibia). Together with the quadriceps muscle and tendon, these structures allow straightening of the knee, and provide strength for this movement. It is also very important in controlling the knee as it bends from a straightened position, such as with walking down stairs and landing.
Patella Tendinopathy is generally an overuse injury of the patella tendon and is sometimes referred to as ‘Jumper’s knee’.
Causes of Injury
Excessive stress and strain placed on the tendon, such as with activities such as jumping and landing, can cause wear and tear. Over time, repetitive strain of the patella tendon may result in breakdown of the fibres and subsequent inflammation and degeneration. There are a number of factors that can increase a person’s risk of developing patella tendinopathy. These include:
- Participation in sports that involve regular direction change and jumping, such as basketball, volleyball, track and field (running, high and long jump), tennis and soccer.
- Abnormal biomechanics of the knee, feet or hip control
- Lower limb muscle imbalance
- Tight quadriceps or hamstring muscles
- Repetitive knee extension exercises
- Inappropriate footwear or training surface
- Rapid increase in training amount or frequency or poor training technique
- Pain and tenderness at the front of the knee over the patella tendon (usually towards the bottom of the knee cap)
- Aggravated by activities such as jumping, hopping, landing or running
- Usually gradual onset and commonly related to an increase in sport activity
- Aching and stiffness may be present in the morning, after a period of prolonged rest
- Some swelling or thickening of the tendon may be present
- Sufficient rest from any aggravating activity or activities which place large amounts of stress through the patella tendon.
- Low impact exercise, such as swimming or stationary cycling, can allow fitness to be maintained without causing further injury
- Reduce inflammation through rest, ice, physiotherapy. Anti-inflammatory medication as recommended by a doctor or pharmacist may also assist in the healing process.
- Physiotherapy- massage, ultrasound, stretching, strengthening, sport specific training and correction of any biomechanical abnormalities with orthotics and taping.
- Education and advice regarding appropriate warm up and cool down, regular stretches and any technique corrections
The primary aim of treatment is to reduce pain and any inflammation that may be present. Once pain is controlled, a gradual return to activity will be commenced under the supervision of a physiotherapist.
Treatment and management options include:
Return to Sport/Activity
Complete rest will lead to weakness of the thigh muscles, which is undesirable. Swimming is a great form of exercise that does not place excessive load on the knee joint. Exercises such as this can be used to maintain fitness while allowing the knee time to recover fully. A physiotherapist can guide you through an individual exercise program, including a gradual increase to normal activity. Slow progression towards normal activity levels is essential. If pain returns, activity levels will need to be reduced again. Complete recovery of patella tendinopathy may take many weeks to months and if not treated properly the tendon can weaken, and possibly tear or symptoms may persist.
If symptoms persist longer than six months after a disciplined physiotherapy treatment program, surgery may be considered. Return to normal activity after surgery may take up to twelve months.