Patellar Tendinitis is also known as jumper’s knee. It is an inflammation in the patellar tendon, the band of tissue that connects the kneecap (patella) to the shinbone (tibia). It is usually an overuse injury caused by repetitive strain.
Patellar tendinitis can be a tricky condition to treat, and requires a substantial period of rest, along with a thorough treatment and rehabilitation programme. In the most severe or persistent cases, surgery may be required.
It consists of pain at the bottom front of the kneecap, over what is called the lower pole of the patella. The bottom of the patella will be very tender when pressing in. The athlete is likely to experience aching and stiffness after exercise, and pain when contracting the quadriceps muscles in acute cases.
The affected tendon may appear larger than the unaffected side. In particular, jumping activities are likely to be most painful. Jumper’s knee can be categorised into four grades of injury:
• Grade 1: Pain only after training
• Grade 2: Pain before and after training but pain eases once warmed-up
• Grade 3: Pain during training which limits your performance
• Grade 4: Pain during every day activities
This injury may seem like a minor injury, so many athletes continue to train and compete with it.
The most common activity causing this ailment is jumping, hence it being commonly referred to as jumper’s knee. Activities that place repetitive stress on the patellar tendon may cause it to become inflamed. Other activities such as running, walking or bicycling may also cause it. In most instances though, patellar tendinitis is caused by tightness of the quadriceps muscles.
Related to one’s alignment, it can be caused by problems with the way your hips, legs, knees or feet are aligned. Having wide hips, being knock-kneed, or having flat feet, can predispose you to patellar tendinitis, since certain body mechanics will place more stress on this area with activity.
It begins with a complete history of your knee problem followed by an examination of the knee, including the patella. There is usually tenderness with palpation of the inflamed tissues at the insertion of the tendon into the bone. The knee will be assessed for range of motion, strength, flexibility and joint stability.
X-rays may be ordered on the initial visit as an X-ray can show fractures of the tibia or patella. But because X-rays do not show soft tissue injuries, in these cases other tests, such as ultrasonography, or magnetic resonance imaging (MRI), may be suggested. Ultrasound uses sound waves to detect tendon tears. MRIs use magnetic waves rather than X-rays to show the soft tissues of the body. Usually, this test is done to look for injuries, such as tears in the quadriceps.
• Rest from training in mild to moderate cases; adaptation of training to reduce impact and jumping activities may be suitable.
• Apply cold therapy on a regular basis, especially during the acute stage, which is usually the first 24 to 48 hours, and after any form of exercise.
• Wearing a knee support or jumper’s knee strap can reduce pain and ease the strain on the tendon. A jumper’s knee strap wraps around the tendon just below the knee, changing the angle of the tendon against the patella. In turn, the part of the tendon through which the forces are transmitted, is changed.
• Stretch the quadriceps muscles regularly, and start an exercise rehabilitation programme.
Medication and therapy
• Anti-inflammatory medication may help in the short term with acute inflammation and pain, but could hinder healing later on.
• Ultrasound or laser therapy can be administered to reduce pain and inflammation, aiding the healing process.
• Cross friction massage to the tendon may also be beneficial, particularly for more chronic cases.
• Aprotinin injections may help tendinopathies by restoring enzyme balance in the tendon.
There is little convincing evidence to support the use of surgery over conservative treatment for patellar tendinopathy. But if the knee does not respond to conservative treatment, surgery may be required as a last resort. A lateral release of the patella tendon is usually successful.
The procedure either includes excision of the affected area of the tendon, or a lateral release where small cuts are made at the sides of the tendon, which take the pressure off the middle third. An intensive rehabilitative programme is normally advised following the surgery. In particular, the use of eccentric strengthening exercises may help stimulate healing.
Your feet mirror your general health . . . cherish them!
Leana Huntley is an English trained foot health practitioner
attached to ALMAWI Limited The Holistic Clinic. Contact the clinic at firstname.lastname@example.org Tuesday
– Saturday, or visit the Website at www.almawiclinic.com.