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Patellar Tendinopathy

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Introduction

This condition is typified by anterior knee pain at the lower boarder of the kneecap – the inferior pole of the patella. Tendinopathy of the Patellar tendon is also known as ‘Jumpers knee’ due to its close association with athletic population.

Signs & Symptoms

As mentioned earlier, symptoms are localised to the inferior pole of the patella and exacerbation will come from activities that require repeated utilisation of the ‘spring action’ of the tendon. Squatting, prolonged sitting with the knees bent, and stairs, are common actions that are reported as aggravators.

 

Other Tendon pains, regardless of their location are dose–dependent, which means the pain will be aggravated based on amount of load and the volume it is subjected to (Kountouris & Cook, 2007). Explained further, if you load the tendon excessively by exposing it to higher tensile forces or by performing many repetitive movements in a relatively short period of time, the tendon cannot adapt quick enough and may begin to break down, leading to pain.

Causes

Symptoms usually develop alongside an increase in load or activity and therefore most prevalent in young sporty adults. The power needed for jumping, landing, cutting, and pivoting when participating in these sports requires the patellar tendon to repetitively store and release energy, placing considerable load through the tendon (Malliaras et al., 2015). Energy storage and release (like a spring) from the long tendons is key as this can reduce the energy consumption through human movement. Repetition of this spring-like activity over a single exercise session, or with insufficient rest to enable repair & remodeling between sessions, can induce pathology and a change in the tendon’s mechanical properties, which is a risk factor for developing symptoms (Malliaras et al., 2015; Cook & Purdam, 2009).

 

Risk factors include:

  • Gender – men are more prone than women.
  • Being overweight – increased load on the tendons.
  • Poor flexibility – tight quadriceps muscles.
  • Lack of variation in training.
  • Sudden rise in training intensity/volume with a lack of preparedness.
  • Poor strength – mainly in hip and knee muscles.
  • Training involving excessive hill running.
  • Poor balance between plyometric exercises (explosive jumping/bounding movements) and graded strengthening.

(Kountouris & Cook, 2007; Lin, Cardenas & Soslowsky, 2004)

Prevalence

It is common in young athletes (between the age of 15-30) who are heavily involved in sports such as basketball, volleyball, athletic jump events, tennis, and football.

Assessment & Diagnosis

A specialist Physiotherapist can provide you with an accurate and timely diagnosis by obtaining a detailed history of your symptoms and performing a thorough physical examination. A series of physical tests will be performed as part of your assessment to rule out other structures involved, get a greater understanding of your mobility and strength, and to help facilitate an accurate diagnosis. Your Physiotherapist will want to know how your condition is effecting you day-to-day so that your treatment can be tailored to your needs and will mean personalised goals can be established. Regular re-assessment will ascertain if your are making progress towards your goals and will allow adjustments to your treatment to be made.

Self-Management

As part of your treatment, your Physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your Patellar tendinopathy. This will include activity modification strategies and useful methods of reducing discomfort.

Physiotherapy

Gaining an understanding of your symptoms, restrictions and normal levels of activity will help your Physiotherapist create an individualised self-management and exercise rehabilitation plan. A Physiotherapist-lead rehabilitation regime plays a key role in the recovery of this condition. However, it is important to have a realistic expectation regarding the recovery time frame for a return to full capacity and sport.

 

Normally your Physiotherapist will progress your exercises through 4 stages, starting with isometric exercises (static holds with tension), isotonic exercises (muscular contractions with movement, energy storage exercises such as jumps, short sprints etc. (plyometrics) and finally progressive and specific return to sport exercises. Your specialist Physiotherapist can guide you through these stages, adjusting where needed to ensure the best possible outcome is achieved (Malliaras et al., 2015; Kountouris & Cook, 2007).

 

As part of a multi-modal treatment approach, your Physiotherapist may also use dry needling/acupuncture to support symptom relief and recovery. We value regular re-assessment to ensure you are making progress towards your goal and so that your treatment can be modified to yield optimal outcomes. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.

Other Treatment Options

  • Podiatry referral to help with any adjustments to support any biomechanical issues.

 

  • High volume injection (an injection of saline and anaesthetic to the tendon surroundings).

 

  • Surgery – this could be the last option if the patient has exhausted all other pathways. Surgery has poor outcome in when done in less active patients.

References

Cook, J. L. & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine43(6), 409-416.

 

Kountouris, A. & Cook, J. (2007). Rehabilitation of Achilles and patellar tendinopathies. Best practice & research clinical rheumatology21(2), 295-316.

 

Lin, T. W., Cardenas, L. & Soslowsky, L. J. (2004). Biomechanics of tendon injury and repair. Journal of biomechanics37(6), 865-877.

 

Malliaras, P., Cook, J., Purdam, C. & Rio, E. (2015). Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. Journal of orthopaedic & sports physical therapy45(11), 887-898.

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