Patellar Tendinopathy and Physical Therapy By: Heather Stewart, MSPT

Patellar tendinopathy, commonly known as jumper’s knee, is a condition characterized by pain and dysfunction in the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). This condition is prevalent among athletes, particularly those involved in sports that require frequent jumping, running, and changes of direction, such as basketball, volleyball, and soccer. It is a chronic overuse injury, resulting from repetitive stress and inadequate recovery, leading to microtears and degeneration of the tendon.

Patellar tendinopathy is different from acute tendonitis, which is an inflammatory condition. Tendinopathy is not necessarily inflammatory processes of the knee but more a breakdown of the collagen and change in blood-flow to the tissue. The primary symptoms include localized pain at the front of the knee, tenderness at the bottom of the kneecap, stiffness- particularly after periods of inactivity, and pain during activities that load the tendon.

At Advanced Rehabilitation, our physical therapists specialize in knee pain including patellar tendinopathy. An evaluation with one of our therapists involves a combination of a detailed patient history, clinical examination, balance and gait evaluation. Key factors in the history include the nature of the sport, training load, changes in activity, and previous injuries.

Effective management of patellar tendinopathy involves a comprehensive approach, with a significant focus on loading strategies. These strategies are designed to progressively load the tendon to stimulate healing, improve the tensile strength of the tendon, and reduce pain. Recent evidence-based approaches have found the key is to apply a controlled and graded load that challenges the tendon without exacerbating symptoms. The program should be adjusted based on the individual’s response, gradually increasing the load and complexity of exercises as tolerance improves.

Typical options of treatment progression include:

1. Isometric exercises involve muscle contractions without joint movement, which can reduce pain and build tendon strength without excessive strain. For patellar tendinopathy, exercises like isometric knee extensions can be used. These exercises are typically performed at varying angles to target different portions of the tendon.

2. Eccentric exercises, which focus on lengthening the muscle-tendon unit while it is under tension, are considered a cornerstone in the treatment of tendinopathies. This approach helps to remodel the tendon by promoting collagen synthesis and alignment.

3. Heavy slow resistance training combines the principles of both concentric and eccentric loading but with heavier weights and slower movements. This method has been shown to be effective in reducing pain and improving function. Exercises like leg press, squats, and lunges can be utilized, with a focus on controlled, slow movements and progressive overload.

4. Plyometric and sport-specific training can be introduced once pain levels have decreased and the tendon has demonstrated the ability to handle higher loads. These exercises help in the final phase of rehabilitation by improving the tendon’s capacity to handle rapid loading and unloading, mimicking the demands of athletic activities. Examples include box jumps, tuck jumps, and cutting drills.

5. Adjunct therapies including electrical stimulation and manual therapy may be used to manage symptoms and facilitate recovery. However, these should complement rather than replace a well-structured loading program.

Preventing recurrence involves addressing underlying factors such as biomechanics, muscle imbalances, and training errors. Proper warm-up, cool-down, and recovery strategies are essential. Educating athletes on load management and encouraging a gradual increase in activity intensity can help minimize the risk of future episodes.

Patellar tendinopathy is a challenging condition that requires a multifaceted approach for effective management. By carefully designing and implementing a progressive loading program, our physical therapists at Advanced Rehabilitation help patients return to their sport or daily activities with reduced pain and improved performance. Contact us today for a detailed evaluation.

References:

Patellar Tendon Load Progression during Rehabilitation Exercises: Implications for the Treatment of Patellar

Tendon Injuries. SCATTONE SILVA, RODRIGO et al., Medicine & Science in Sports & Exercise 56(3):p

545-552, March 2024.