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Patellar tendinitisBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/patellar-tendinitis/DS00625
Patellar tendinitis is an injury that affects the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon plays a pivotal role in the way you use your leg muscles. It helps your muscles extend your knee so that you can kick a ball, run uphill and jump up in the air.
Patellar tendinitis is most common in athletes whose sports involve frequent jumping — such as basketball and volleyball. For this reason, patellar tendinitis is commonly known as jumper's knee. However, even people who don't participate in jumping sports can experience patellar tendinitis.
For most people, treatment of patellar tendinitis begins with physical therapy to stretch and strengthen the muscles around the knee.
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Pain is the first symptom of patellar tendinitis. The pain usually is located in the section of your patellar tendon between your kneecap (patella) and the area where the tendon attaches to your shinbone (tibia).
The pain in your knee may:
- Initially be present only as you begin physical activity or just after an intense workout
- Progress to the point that it interferes with your sports performance
- Eventually interfere with daily tasks such as climbing stairs or getting up from a chair
When to see a doctor
If you experience knee pain, try self-care measures first, such as icing the affected area and temporarily reducing or avoiding activities that trigger your symptoms.
Call your doctor if your pain:
- Continues or worsens
- Interferes with your ability to perform routine daily activities
- Is associated with swelling or redness about the joint
Patellar tendinitis is a common overuse injury. It occurs when you place repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon become more numerous, they cause pain from inflammation and a weakening of the tendon structure. When this tendon damage persists over more than a few weeks, it is called tendinopathy.
A combination of factors may contribute to the development of patellar tendinitis, including:
- Intensity and frequency of physical activity. Repeated jumping is most commonly associated with patellar tendinitis. Sudden increases in the intensity of physical activity or increases in frequency of impact activity also put added stress on the tendon.
- Tight leg muscles. Reduced flexibility in your thigh muscles (quadriceps) and your hamstrings, which run up the back of your thighs, could increase the strain on your patellar tendon.
- Muscular imbalance. If some muscles in your legs are much stronger than others, the stronger muscles could pull harder on your patellar tendon. This uneven pull could cause tendinitis.
If you try to work through your pain, ignoring the warning signs your body is sending you, you could cause larger and larger tears in the patellar tendon. Knee pain and reduced function can persist if the factors contributing to patellar tendinitis are not addressed, and you may progress to the more chronic state of patellar tendinopathy.
Preparing for your appointment
If you have knee pain during or after physical activity and it doesn't improve with ice or rest, make an appointment with your doctor. After an initial exam, your doctor may refer you to a sports medicine specialist or to a doctor with advanced training in the treatment of musculoskeletal problems.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- List any symptoms you've been having, and for how long.
- Write down your key medical information, including other conditions with which you've been diagnosed and all medications and supplements you're taking.
- Log your typical daily activity, including the length and intensity of sports practice or other exercise. Your doctor also will be interested to know if you've recently changed the frequency, intensity or method of your workouts.
- Note any recent injuries that may have damaged your knee joint.
- Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
Below are some basic questions to ask a doctor who is examining you for possible patellar tendinitis. If any additional questions occur to you during your visit, don't hesitate to ask.
- What is the most likely cause of my signs and symptoms?
- Are there any other possible causes?
- Do I need any tests to confirm the diagnosis?
- What treatment approach do you recommend?
- With treatment, do you expect I will eventually be able to return to my current sport?
- How long will I need to avoid my current sport?
- What kind of workout routine can I safely follow while I'm healing, if any?
- What other self-care measures should I be taking?
- What is the likelihood that I will need surgery?
- How often will you see me to monitor my progress?
- Should I see a specialist?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in depth. Your doctor may ask:
- What are your symptoms?
- When did you first notice these symptoms?
- Have your symptoms been getting worse?
- How severe is your pain?
- Does your pain occur before, during or after your workouts — or is it constant?
- Is the pain associated with any knee swelling, locking or instability?
- What is your regular exercise or sports-training routine?
- Have you recently made any changes to your training routine, such as training harder or longer, or using new techniques?
- Are you still able to perform your sport or preferred exercise at a satisfactory level?
- Are your symptoms affecting your ability to complete normal, daily tasks, such as walking up stairs?
- Have you tried any at-home treatments so far? If so, has anything helped?
- Have you recently had any injuries that may have caused knee damage?
- Have you been diagnosed with any other medical conditions?
- What medications are you currently taking, including vitamins and supplements?
Tests and diagnosis
During the physical exam, your doctor may apply pressure to different parts of your knee to determine exactly where you're experiencing pain. Pain associated with patellar tendinitis usually concentrates on the front part of your knee, just below your kneecap.
Your doctor may also suggest one or more of the following imaging tests:
- X-rays. X-rays don't show the patellar tendon, but they do help to exclude other bone problems that could contribute to knee pain.
- Ultrasound. This test uses sound waves to create an image of your knee, revealing the location of tears in your patellar tendon.
- Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to create images that are more detailed than ultrasound images. MRI can reveal more-subtle changes in the patellar tendon.
Treatments and drugs
Doctors typically begin with less invasive treatments before considering other options, such as surgery.
Pain relievers such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) may provide short-term relief from pain associated with patellar tendinitis.
A variety of physical therapy techniques can help reduce the symptoms associated with patellar tendinitis, including:
- Stretching exercises. Regular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit. Don't bounce during your stretch.
- Strengthening exercises. Weak thigh muscles contribute to the strain on your patellar tendon. Eccentric exercises, which involve lowering your leg very slowly after you extend your knee, are particularly helpful.
- Patellar tendon strap. A strap that applies pressure to your patellar tendon can help to distribute force away from the tendon itself and direct it through the strap instead. This may help relieve pain.
- Iontophoresis. This therapy involves spreading a corticosteroid medicine on your skin and then using a device that delivers a low electrical charge to push the medication through your skin.
Surgical and other procedures
If conservative treatments haven't helped, your doctor may suggest other therapies such as:
- Corticosteroid injection. An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon may help relieve pain. But these types of drugs can also weaken tendons and make them more likely to rupture.
- Platelet-rich plasma injection. An injection of platelet-rich plasma has been tried in some people with chronic patellar tendon problems. Studies are ongoing. It is hoped the injections might promote new tissue formation and help heal tendon damage.
- Surgery. If conservative approaches aren't helping after many months of treatment, in rare cases your doctor might suggest surgical intervention for the patellar tendon. Some of these procedures can be accomplished through small incisions around your knee.
Lifestyle and home remedies
If you think you're experiencing patellar tendinitis, consider these approaches to pain relief at home:
- Pain relievers. Over-the-counter medications such as ibuprofen and naproxen may provide short-term relief from pain associated with patellar tendinitis.
- Avoid activity that causes pain. This may mean reducing how often you practice your sport or temporarily switching to a lower impact sport. Don't try to work through the pain, as this can further damage your patellar tendon.
- Ice. Apply ice after activity that causes pain. Place ice in a plastic bag and wrap the bag in a towel. Or try an ice massage. Freeze water in a plastic foam cup and hold the cup as you apply the ice directly to your skin.
To reduce your risk of developing patellar tendinitis, take these steps:
- Don't play through pain. As soon as you notice exercise-related pain your knee, take a break and apply ice to the painful area while you rest. Until your knee is pain-free, avoid activities that put stress on your patellar tendon.
- Strengthen your muscles. Strong thigh muscles are better able to handle the types of stresses that can cause patellar tendinitis. Eccentric exercises, which involve lowering your leg very slowly after extending your knee, are particularly helpful.
- Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
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