Patella Tendonitis

Patella tendonitis describes the inflammation and irritation of the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). Our podiatrists see it more commonly in those aged between 14 - 40 years*, though it can affect anyone at any age - particularly those involved in jumping sports like basketball (one in three players), high-level volleyball (one in two players) and even rugby (one in ten players).

Sustaining this injury to the patellar tendon can be a devastating blow to social sports enthusiasts and athletes alike. Depending on the severity of the injury, those injured can lose weeks, months or years to the recovery process, at worst forcing an early retirement. This is why prompt treatment once you start developing knee pain is highly recommended.

Patella tendonitis feels like pain at the front of the shins that may have originally started as a dull ache, but has gradually been worsening over time. You may notice swelling, stiffness or weakness in the knee. As the injury worsens, your pain may linger during rest, and is generally aggravated by movements that bend your knee, alongside general physical activity.

Sources:

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

**https://bjsm.bmj.com/content/48/7/672.1

Like any tendon in your body, your patella tendon can only take on so much load before damage occurs. Usually, you load the tendon with physical activities like running and jumping, after which the tendon is left at a reduced strength and load capacity until you have downtime to rest and recover, after which the patella tendon will return to its full functional capacity. Tendon damage occurs when you repeatedly overload the tendon, demanding more from it than it can handle, before it has a chance to recover. This causes tiny tears and damage to the tendon fibres, which result in the knee pain symptoms.

Factors that may contribute to overloading include:

• Poor training technique, such as having a stiff knee position when landing from jumping, which adds stress to the patellar tendon
• One-off intense training sessions or activities that place a high demand on the knee, or suddenly increasing your frequency of exercise without giving your body enough time to get used to it
• Not giving your body enough time to recover between training sessions
• Muscle tightness, especially the quadriceps, glutes and hamstrings, which can cause the knee joint to compensate, placing extra strain on the patellar tendon
• Limited ankle mobility, specifically the ability to point your toes up towards the sky
• History of knee injury, which may have left the patellar tendon in a naturally weaker state

If you’re experiencing patella knee pain, start by limiting movements and activities that bend your knee and aggravate your pain to help you get some temporary relief. You can also try:

• Icing your knee (through a towel or cloth to protect the skin) for no more than 15 minutes at a time, four times per day. This may help reduce your pain and inflammation.
• Periodically elevating the knee at or above heart level to help reduce swelling
• Using a compression bandage or knee brace to help reduce swelling and keep the knee supported while improving blood flow and joint proprioception
• Using non-steroidal anti-inflammatories to help you manage any pain and swelling
• Switching to supportive footwear, like running shoes with built-in arch support, or your orthotics if you already have a pair from your podiatrist

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with patella knee pain, and utilise a range of evidence-based treatment methods to help you get the best outcome. Our goal is not only to make you comfortable now, but to understand the root of the problem so you can exercise and stay active without being held back by knee pain.

Every appointment starts with a comprehensive assessment to uncover the causes of your knee pain, which includes analysing your gait, testing for muscle imbalances, assessing joint stiffness or tightness, analysing your foot posture, and more. We’ll then create a tailored treatment plan based on the results. This may include:

• Strapping or bracing the knee if required, to offer the best results during the initial stages of healing and pain reduction.
• Activity modifications: we want to ensure the activities you’re continuing to do throughout your recovery are supporting your healing, and not making your injury worse.
• Strengthening exercise program: as an injured patella tendon will have reduced strength and function, it’s important to gradually and progressively work on rebuilding your knee strength. This will be done in stages, and will include a combination of eccentric exercises (those that lengthen the muscles while they’re under a load), isometric exercises (those that create tension without changing muscle length, which has been shown to help with pain reduction in patella tendinopathy)***, and slow resistance exercises.
• Stretching program: as muscle tightness in several areas of the body can increase the load on the patella tendon, you’ll receive a tailored stretching program if we identify areas of tightness during your biomechanical assessment
• Orthotics (insoles): as issues with foot posture and alignment can result in added stress on the knee joint, where indicated, our podiatrists can prescribe custom foot orthotics that will work to add the right support to help reduce this stress to best support your recovery, while reducing the risk of the injury recurring in the future.
• Footwear recommendations: your footwear plays a vital role in preventing knee pain and injury, supporting your everyday foot health, housing your orthotics, and keeping your legs and feet comfortable. This is why we make custom footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions. We can also provide advice on sports-specific shoe options to support your sports performance, too.
• Gait retraining: we may work with you to help retrain your gait and work on your technique to address biomechanical issues that may be contributing to your pain and injury.

Sources:

***https://pubmed.ncbi.nlm.nih.gov/25979840/