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Treating Knee Pain

Patella tendinopathy is a condition that can cause knee pain in active individuals.

It’s more common in those aged between 14 – 40 years and athletes involved in jumping sports, hence the nickname jumper’s knee. Don’t let the name mislead you – patella tendinopathy can affect anyone at any age, but it has been shown to occur more often in jumping sports like basketball (one in three players), high-level volleyball (one in two players)1 and even rugby (one in ten players).

This condition of the patella tendon can be a devastating blow to social sport enthusiasts and athletes alike. Depending on the extent of the problem, patella tendinopathy can result in weeks, months or even years away from playing sport and for some athletes, force an early retirement. 

The key to getting back on your feet is treating the condition early – and doing it right, using evidence-based approaches. This is exactly what our physio team does here at Allsports Physiotherapy, so today, we’re sharing factors that can contribute to developing patella tendinopathy, what the condition means for you, and how to effectively manage it so you can get back to enjoying the sports you love.

Patella Tendinopathy: Why Has It Happened To Me?

If you have patella tendinopathy, it’s likely that you’re feeling some pain or aching at the front of your knee. The reason for this is that the structure of the patella tendon, which runs down from the quads (the muscles in the front of your thigh) and attaches below your knee to the shin bone, has undergone changes that result in it not being as good at tolerating certain loads. 

While it is common to assume that something you did on the day you first felt the pain caused it, this is unlikely to be the case. The changes that occur to the tendon occur gradually and can progressively worsen over time – particularly when the activity you love involves regularly or forcefully bending and straightening the knee.

Like any tendon in your body, your patella tendon responds to load. Usually, you load the tendon with physical activities like running and jumping. Essentially tendons don’t like underloading or overloading! That is, any change in load, whether it be less load, sudden changes in load, or overload, can start a cascade of events in the tendon with the end result being pain. Factors that may contribute to tendinopathy include:

  • One-off intense training sessions or activities that place a high demand on the knee
  • Not giving your body enough time to recover between training sessions
  • Starting a new activity or an activity that you are not accustomed to
  • Having a stiff knee position when landing from jumping
  • Muscle tightness – especially the quadriceps and hamstrings
  • Limited ankle mobility, specifically the ability to point your toes up towards the sky
  • Some reactive arthritic factors and medication use (e.g. Quinolone antibiotics)

You may notice:

  • Morning stiffness in the tendon/ankle
  • Your pain started as a dull ache but has gradually been worsening
  • Your pain being aggravated by physical activity and movements that bend your knee
  • Your pain may linger during rest
  • Symptoms may warm up with activity

Remember: everyone’s ‘load limit’ before changes in the tendon occurs is different and can alter as you strengthen your lower limbs, modify your flexibility, and so on. Hence, both training and recovery programs should be created specifically for you and your body, and not those in your sports team or family.

How To Manage Patella Tendinopathy

Patella tendinopathy can be difficult to treat – especially when you’re trying to do it on your own. It’s common for us to see patients who have been struggling for weeks or months – hoping that the pain would settle on its own, but without success. For some, this has meant significant downtime from sports or physical activity, while not feeling confident if they’ve made any genuine longlasting progress towards recovery.

Effectively treating this condition happens in stages, moving into the next stage when certain milestones are achieved. It is important that your rehabilitation program is structured and you must ensure you’re not skipping steps and overloading the tendon before it’s ready – this may set you backwards. This is where your physio will walk you through every step, and review you regularly to ensure we’re seeing the right signs and getting the right outcomes. Your recovery may include:

  • Eccentric rehab exercises – those that lengthen the muscles while they’re under load
  • Isometric exercises – those that create tension without changing muscle length, which has been shown to help with pain reduction in patella tendinopathy
  • Slow resistance exercises – enough weight to stimulate healing and repair within the limits of what it can safely handle as assessed by your physiotherapist
  • Modifying your current activity (controlled rest) – adjustments to match your knee’s current load capacity in its injured state and limiting specific activities and movements that place high loads on the knee (super important not to accidentally overload based on your pre-injury capacity!)
  • Stretching program – addressing lower limb muscle tightness that may be contributing to the problem

Should I consider an injection or surgery to help alleviate my symptoms?

Research has demonstrated that there is no long-term advantage of injection therapies and surgery for patella tendinopathy compared to strength training alone. As both of these interventions carry many more risks and potential complications, it is recommended that strength training is utilised initially. With an appropriate program, you are likely to experience improvements over the first 2-4 weeks. Your physiotherapist will discuss with you how you are progressing throughout these initial stages.

Recovery Starts With Physiotherapy

Recovering from patella tendinopathy effectively, without wasting time and effort, starts with partnering with a physio team that has a comprehensive understanding of sports medicine. This is one of our areas of expertise here at Allsports Physiotherapy. 

We’re with you every step of the way, monitoring your progress and making appropriate adjustments to your recovery plan so you can get the best results in the best time. We don’t use general one-size-fits-all plans but uniquely create each treatment plan for each patient, their circumstances, and from the results of their comprehensive assessment. Once you’ve recovered, we’ll also teach you how to help prevent this problem from returning in the future.

Ready to get back on track? Book in with your local Allsports Physiotherapy team online here or call the clinics near you here to find your closest sports physio.

References

[1] https://meridian.allenpress.com/jat/article/54/9/953/420925/Prevalence-of-Patellar-Tendinopathy-and-Patellar

[2] https://bjsm.bmj.com/content/48/7/672.1

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/

[4] https://pubmed.ncbi.nlm.nih.gov/25979840/

[5] https://pubmed.ncbi.nlm.nih.gov/16882889/