Patellar tendonitis, also known as jumper’s knee, is caused by damage to the patella tendon. This causes pain and tenderness below the knee and limits activity.
Repetitive sports activities such as kicking and jumping place a great deal of stress on the tendon, causing microscopic tears, inflammation, and gradual pain to begin and progress.
Effective treatment is essential to prevent patellar tendinitis from worsening until the tendon ruptures completely.
Here, we’ll look at the common causes of patellar tendonitis, common symptoms, how it progresses, and the best treatment options for jumper’s knee.
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What is patellar tendonitis?
Jumper’s knee, aka patellar tendonitis, causes pain just below the knee
Patellar tendonitis is caused by inflammation and/or degeneration of the tendon that sits just below the knee.
The patellar tendon is a long, thick cord-like structure that connects the quadriceps muscles to the tibia, the shin bone through the knee.
It is about 2 cm wide and very strong. Its function is to work with the quadriceps muscles to straighten the leg and control power through the lower leg.
If there is repeated friction or tension through the patellar tendon, small microscopic tears can form in the tendon leading to inflammation and gradual degeneration – patellar tendonitis.
These microscopic tears make the tendon less strong and therefore more prone to damage. Even severe patellar tendonitis can cause the tendon to tear completely.
The patella tendon is the most common site of knee tendonitis and the most common cause of pain below the knee.
What causes patellar tendonitis?
Patella tendonitis develops when excessive force is repeatedly applied to the patella tendon, usually during sports. The more power, the more damage.
Common causes of patellar tendonitis include:
- Repetitive jumping: Take off and landing place a huge force on the tendons about ten times the body weight. To be able to jump, the quads must work with the calf muscles to lift the body off the ground, and on landing, the quads must work again to stabilize the leg.
- Repetitive kicks: Places a force of about seven bodyweights on the tendon
- Muscle imbalances: Tightness and weakness in the quadriceps muscles can put the patellar tendon under more stress, making it more prone to damage.
- Overtraining: Training too hard, suddenly increasing your activity level or not getting enough rest between training sessions increases the risk of developing patellar tendonitis.
- Bone spurs: Extra lumps of bone can form, known as knee spurs or osteophytes. If they are large enough, they can rub against the patellar tendon, increasing the risk of patellar tendonitis.
- If someone does a lot of activity, such as sports players, the strain on the patella tendon can become too high and microscopic tears can form in the tendon. This is more likely if the activity is done on a hard surface such as a basketball court instead of grass
Patellar tendinitis usually comes on gradually over time rather than being caused by a specific event. Initially there may be no pain, but as the condition progresses and more tears develop, the knee may gradually become more painful.
Symptoms of jumper’s knee
The most common symptoms of patellar tendonitis are:
- Pain just below the knee cap with activities such as jumping, running, sitting
- Pain with any pressure through the tendon such as touch, kneeling
- Pain and stiffness after activity
- Stiffness in the morning
- Tendon thickening
Symptoms of jumper’s knee tend to worsen over time, increasing in frequency and severity.
Patella tendonitis is often mistaken for runner’s knee, Osgood Schlatter’s or chondromalacia patella, but the most defining feature of jumper’s knee is tenderness when pressing on the patella tendon just below the knee.
Jumpers knee stage
Patella tendonitis typically progresses through four stages:
Stage 1: Pain after activity only that does not affect function
Stage 2: Pain with initial activity that disappears as you warm up, but returns after activity. Performance is generally not affected.
Stage 3: Chronic pain during and after activities and difficulty performing at a satisfactory level
Stage 4: A complete tear of the tendon requires surgical repair
Inflammation or degeneration?
Patella tendonitis is a degeneration, or tear, of the patella tendon below the knee.
It was thought that the main cause of jumper’s knee was inflammation, hence the name patellar tendonitis (itis = inflammation).
However, recent studies have shown that an inflammatory reaction is actually very rare.
It is actually more common to wear and tear tendons. As a result, health professionals now often refer to it as patellar tendonosis (Osis meaning degeneration).
This explains why non-steroidal anti-inflammatories such as ibuprofen often have little effect on the symptoms of patella tendonitis, and they can make things worse by slowing healing.
The body recovers from the degeneration associated with jumper’s knee by making collagen to repair tissue damage.
However, this is a slow process and takes about three months to fully mature and lay down enough collagen to allow the tendon to return to full strength.
Treatment of patellar tendonitis
So how do you treat patellar tendonitis? There are a variety of treatment options for jumper’s knee that help reduce tendon tension and improve strength around the knee.
Treatment of patellar tendonitis usually involves a combination of:
1. Relative rest
Patella tendonitis is one of those cases where the saying “no pain” doesn’t apply. It’s really important to take complete rest from any activity that causes pain for the tendon to heal, otherwise it’s like picking a scab.
Every time you interrupt the healing processes by overloading the tendon, you cause more injury which increases the healing time.
It may take up to 3 months for you to return to sports after a jumper’s knee injury.
2. Knee strap
Knee straps can really help reduce the pain associated with patellar tendonitis by taking tension off the tendon.
In the early stages of jumper’s knee, knee straps can work really well to reduce the stress on the patellar tendon and relieve symptoms.
These reduce the cross-sectional area of the tendon and the pressure exerted by the strap reduces the force transmitted through the tendon.
Visit the Knee Straps section to learn more about how they can help with patellar tendonitis, including recommendations based on user feedback.
3. Regular ice
Ice packs applied for 10-15 minutes every few hours, before and after activity can help reduce pain from patellar tendonitis. Visit the ice treatment section to find out how to safely and effectively use ice therapy and the ice wrap section for the best way to apply ice.
4. Extend the knee
Tightness in the hips, quads and hamstrings increases the risk of jumper’s knee so it’s important to stretch these muscles.
This will not only help with knee pain and stiffness, but also reduce the chance of symptoms returning when you resume your normal activities.
Visit the knee stretches section for simple tests you can do to find out if you have muscle tension and the best way to stretch.
5. Strengthening exercises
Muscle strengthening is an important part of the recovery process with jumper’s knee. Authorized use hep2go.com
Strengthening exercises are an important part of patellar tendonitis treatment to prevent the problem from returning in the future.
The best place to start is with quad strengthening exercises to improve strength, control and endurance of the anterior thigh muscles. This should also include VMO exercises for the smaller muscles on the side of the knee.
Weak glutes can affect knee position and increase the force going through the patellar tendon, causing tendonitis so this really helps strengthen them. The easiest way to strengthen the glutes is with clams and bridging exercises – visit the glutes strengthening section to learn how to do these and more loads.
Eccentric exercises can also be helpful, this is when you strengthen the muscle as it lengthens instead of the normal way of strengthening it.
6. Knee surgery
If patellar tendonitis fails to resolve after 6-12 months of rehabilitation, surgery is performed as a last resort. Surgery involves removing degenerative tissue and increasing blood flow to the area to promote healing.
If the patellar tendon ruptures (a complete tear), surgery is needed to repair the tendon by sewing it back together. After surgery, careful rehabilitation is essential as the tendon will be weakened and return to sports usually requires 3-6 months of physical therapy.
What else could it be?
There are several other conditions that produce patellar tendonitis-like symptoms, the two most common being:
Symptoms of patellar tendonitis
- Runner’s Knee: A condition where there is a problem with knee movement – as likely to affect office workers as runners, despite the name!
- Chondromalacia patella: damage to the cartilage lining the back of the knee cap
Another condition closely related to patellar tendonitis is quadriceps tendonitis, which affects the tendon directly above the knee. The two conditions often go hand in hand. Alternatively, hamstring tendonitis occurs behind the knee.
If this doesn’t sound like your pain, visit the below knee pain or anterior knee pain section to learn about the most common causes of front knee pain, including causes, symptoms and treatment options.
Summary
- Patella tendonitis is a common problem that causes pain below the knee.
- The patellar tendon is found under the knee connecting the quads muscles to the shin bone.
- Repeated overloading causes irritation, inflammation and degeneration of the patellar tendon.
- The most common cause of patellar tendonitis is sports that involve repetitive jumping and kicking.
- Treatment for patellar tendonitis usually includes a rehabilitation program that includes a combination.
- of rest from strenuous activity, strengthening and stretching exercises, ice, knee straps, and medication.
- Most cases of jumper’s knee resolve in about 3 months with proper patellar tendonitis treatment