Knee pain is one of the most common complaints in the active community. One cause of knee pain is patellar tendinopathy, also called jumper’s knee. Patellar tendinopathy is an overload condition felt just below the knee cap. The treatment for patellar tendinopathy can consist of joint mobilization, manual therapy, and exercise. This blog post will discuss what causes patellar tendinopathy and how it can be treated.
The patellar tendon is formed by the quadriceps muscles attaching to the tibia bone. When the quadriceps muscles contract, they pull on the patellar tendon causing leg to extend. Patellar tendon pain is felt just below knee cap and is worse with movements such as running, jumping, or squatting. Patellar tendinopathy is the term used to describe patellar tendon pain (replacing patellar tendinitis).
The patellar tendon can become irritated with overuse, such as with running, squatting, or jumping. Patellar tendon pain is felt on the front of the knee (just below the knee cap) and is worse with movement. When the patellar tendon becomes irritated and painful, it is called patellar tendinopathy.
Patellar tendinopathy is divided into two clinical stages: (1) reactive and (2) degenerative. The reactive tendinopathy stage occurs with a sudden spike in loading. This can occur with a workout if you haven’t exercised in awhile or suddenly changing your workout routine (ie. if you are use to running on flat land then begin incorporating hills). During the reactive stage, there can be swelling and pain in the tissues which lasts for a short period of time. After a sufficient amount of rest, the tissues calm down and adapt to the load by building more tissue.
With prolonged loading, the reactive tendinopathy can turn into a degenerative tendinopathy. The tissues begin to weaken and breakdown because they are unable to adapt to the chronic loading. Pain persists during the degenerative stage either because of the threat of causing more tissue damage or due to actual tissue damage. The changes to the tendon tissues in this stage are generally irreversible, however, the body can build more tissue around the tendon to strengthen it.
The focus of treatment for patellar tendinopathy in the beginning is load management. In reactive tendinopathy, the goal is to offload the tendon enough to allow the tendon to adapt to the load. Once the reactive tendon is able to tolerate load again, the load should gradually increase to avoid a second spike in loading. The general rule of thumb is to not increase load by more than 10 percent per week.
For degenerative tendinopathy, the goal is to modify the load on the tendon to avoid continually irritating the tissues, however, loading is necessary to stimulate the tendon to build more tissues. The loading program should start with contracting the quadricep muscles without knee movement (called isometric contractions), then including knee movement (concentric and eccentric contractions), and finally progressing to quick loading movements (plyometric movements).
There are many different exercise progressions you can follow, with some working better than others depending on the person. Here’s a sample exercise progression from isometric exercises through plyometric exercises.
Isometric exercises can be performed daily. Isometric exercises that can be used for patellar tendinopathy include a spanish squat or wall sit. The general recommendation is to hold for 30-45 seconds for 3-5 repetitions.
Concentric and eccentric exercises that can be part of an exercise progression include squats and split squats. It is important to not bend the knee past 90º because this will cause compression of the patellar tendon on the bone. Start by performing 15 repetitions for 3-5 sets, gradually increasing the weight that you can do 6 repetitions for 3-5 sets. Next day soreness should guide how often you perform these exercises.
The final piece of the exercise progression would be plyometric exercises. There are many variations of jumping that can be performed, anything from vertical jumps to jump squats. Since the load of plyometric exercises is higher, these should be performed every three days to allow the tendon to adapt to the load.
Patellar tendinopathy can be a challenging condition to resolve, taking anywhere from a few weeks to several months. Joint mobilization, manual therapy, and exercise can all be part of a treatment program to help decrease patellar tendon pain and getting you back on the field. If you need help resolving patellar tendon pain, a qualified medical professional can help create a customized treatment program to help you.