Patellar tendinopathy: Symptoms, Causes and Treatment

Patellar tendinopathy or jumpers’ knee is a painful knee condition which usually results in knee pain just below the patella (kneecap) to the top of the tibia (shin bone). It is commonly a result of an overuse injury when repeated strain is put onto the tendon. This can cause small tears which can result in a thickening of the tendon, and it becomes painful to load with weight bearing movements.

 What causes Patellar Tendinopathy? 

• Sudden increase in activity
• Activities on hard surfaces
• Muscle weakness
• Increase in body weight 
• Muscle tightness
• Inadequate footwear

Who does Patellar Tendinopathy affect? 

It is highly prevalent in sports which involve running and jumping (hence the name) particularly on hard surfaces e.g., Basketball and football. Patellar tendinopathy is most common at ages 15-30 due to its high impact nature but can happen at any time to anyone. 

Symptoms of Patellar Tendinopathy

Frequently, symptoms begin without a sudden onset and normally result in a gradual increase in pain. You may notice pain during activity that fades away and then returns after activity. Once symptoms are aggravated, activities of daily living such as stairs, sit to stand, squats and kneeling can be especially painful, it may even be sore to touch.

How long does it take for patellar tendinopathy to heal?

In mild cases patient’s can be pain free after about 6 weeks. With cases more severe patients can have pain for several months for a full recovery although with a tailored exercises programme pain symptoms can improve within the first few weeks.

What is the difference between patellar tendinopathy and patellar tendinitis?

The two terms are frequently used interchangeably and have near identical symptoms. However, tendinopathy occurs when the collagen fibers that make up tendons begin to degenerate and break down – increasing the severity. Tendonitis occurs when the tendon is inflamed but has not begun to degenerate.

Is patellar tendinopathy permanent?

No, in most cases symptoms should resolve after a few months, more severe cases can have symptoms for up to 6 months. There are various treatment modalities (mentioned in this article) which stops the condition from being permanent. If left untreated research suggests tendinopathy can lead to other degenerative knee conditions over time.

Is squatting recommended if you have patellar tendinopathy?

If the patellar tendon is sensitive, heavy knee bending exercises can be very painful. It can be beneficial to modify this to reduce the knee bend initially. Later into the rehabilitation from patellar tendinopathy squatting can be an excellent exercise to aid with range of movement and build strength within the tendon and surrounding muscles. 

Patellar tendinopathy treatment 

The early initial treatment for patellar tendinopathy is to rest from the activity that causes you pain for a very short period. Low impact sports such as cycling or swimming can be a good alternative while this short period is ongoing. NSAIDs such as ibuprofen can also be useful during this period. 

After this it’s important to begin an exercise programme revolving around specific strengthening and stretching exercises. Varying types of loading exercises are regularly used as the most effective form of rehab. You may want to see a physiotherapist to enquire about this further.

Top exercises to help patellar tendinopathy

• Straight leg raise
• Glute bridges
• Clams - side lying
• Squatting – high or mini quat if sensitive
• Quadriceps stretch

For tendons that are not reactive to exercise and have entered a disrepair or degenerative phase of tendinopathy, shockwave therapy can be an excellent rehabilitation tool. Shockwave therapy is a non-invasive procedure that delivers shockwaves to the symptomatic area. The shockwaves are low energy audible sound waves (not electric waves), that increase the blood flow to speed up the body’s healing process. Combined with an appropriate exercise programme research has shown shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life.

FAQs

How long does it take for patellar tendinopathy to heal?

In mild cases patient’s can be pain free after about 6 weeks. With cases more severe patients can have pain for several months for a full recovery although with a tailored exercises programme pain symptoms can improve within the first few weeks.

What is the difference between patellar tendinopathy and patellar tendinitis?

The two terms are frequently used interchangeably and have near identical symptoms. However, tendinopathy occurs when the collagen fibers that make up tendons begin to degenerate and break down – increasing the severity. Tendonitis occurs when the tendon is inflamed but has not begun to degenerate.

Is patellar tendinopathy permanent?

No, in most cases symptoms should resolve after a few months, more severe cases can have symptoms for up to 6 months. There are various treatment modalities (mentioned in this article) which stops the condition from being permanent. If left untreated research suggests tendinopathy can lead to other degenerative knee conditions over time.

Is squatting recommended if you have patellar tendinopathy?

If the patellar tendon is sensitive, heavy knee bending exercises can be very painful. It can be beneficial to modify this to reduce the knee bend initially. Later into the rehabilitation from patellar tendinopathy squatting can be an excellent exercise to aid with range of movement and build strength within the tendon and surrounding muscles.  

Top exercises to help patellar tendinopathy

• Straight leg raise
• Glute bridges
• Clams - side lying
• Squatting – high or mini quat if sensitive
• Quadriceps stretch

References

_{Muaidi, Q.I., 2020. Rehabilitation of patellar tendinopathy. Journal of musculoskeletal & neuronal interactions, 20(4), p.535.}

_{Pearson, S.J., Stadler, S., Menz, H., Morrissey, D., Scott, I., Munteanu, S. and Malliaras, P., 2020. Immediate and short-term effects of short-and long-duration isometric contractions in patellar tendinopathy. Clinical Journal of Sport Medicine, 30(4), pp.335-340.}

_{Rudavsky, A. and Cook, J., 2014. Physiotherapy management of patellar tendinopathy (jumper's knee). Journal of physiotherapy, 60(3), pp.122-129.}

_{Schwartz, A., Watson, J.N. and Hutchinson, M.R., 2015. Patellar tendinopathy. Sports health, 7(5), pp.415-420.}

_{Smallcomb, M., Khandare, S., Vidt, M.E. and Simon, J.C., 2022. Therapeutic ultrasound and shockwave therapy for tendinopathy: A narrative review. American Journal of Physical Medicine & Rehabilitation, 101(8), pp.801-807.}‍