This condition commonly presents with anterior knee pain at the lower border of the kneecap (the inferior pole of the patella). Tendinopathy of the patellar tendon is also known as ‘jumpers knee’ due to its close association with the athletic population. For a long time, we called tendinopathies ‘tendinitis’ in a similar way to other tendon issues such as Achilles tendonitis, tennis elbow and golfers elbow. This was because we believed there was a lot of inflammation involved in the condition leading to treatments such as steroid injections and strong anti-inflammatory medication (such as Diclofenac or Naproxen). Over the past 15 years research has shown that there is not as much inflammation as we thought, and tendon degeneration seems to be a key element.
Treatments such as steroid injections are now not advised as they appear to cause much more harm than good in tendon issues. Our understanding of the best way to manage tendon problems is developing rapidly and it’s not unusual for patients to be working on outdated and less effective treatment approaches. We review the information on our website continually to ensure we are giving the best advice by integrating current research evidence with our clinical expertise.
Symptoms are localised to the inferior pole (bottom) of the patella and exacerbation of pain will come from activities that require repeated utilisation of the ‘spring action’ of the tendon. Squatting, prolonged sitting with the knees bent, and stairs, are common actions that are reported as aggravators.
Tendon pain is ‘dose–dependent’, which means the pain will be aggravated based on the amount of load and the volume it is subjected to (5). Essentially, if you load the tendon excessively by exposing it to higher tensile forces or by performing many repetitive movements in a relatively short period of time, the tendon cannot adapt quickly enough and may begin to break down, leading to pain and ultimately the risk of developing a tendinopathy. Gradually progressing load and training is the best way to avoid developing tendinopathies.
Symptoms usually develop alongside an increase in load or activity and therefore most prevalent in young sporty adults. The power needed for jumping, landing, cutting, and pivoting when participating in these sports requires the patellar tendon to repetitively store and release energy, placing considerable load through the tendon (7). Energy storage and release (like a spring) from the long tendons is vital to us as this can reduce the energy consumption through human movement. Repetition of this spring-like activity over a single exercise session, or with insufficient rest to enable repair & remodelling between sessions, can induce pathology and a change in the tendon’s mechanical properties, which is a risk factor for developing symptoms (7, 4).
This is not an exhaustive list. These factors could increase the likelihood of someone developing patellar tendinopathy. It does not mean everyone with these risk factors will develop symptoms (4, 6).
In the general population, it affects less than 1% of people.
It is more common in young athletes (between the age of 15-30) who are heavily involved in sports such as basketball, volleyball, athletic jump events, tennis, and football. In this higher risk category, less than 6% of patients with knee pain may present with patellar tendinopathy.
A musculoskeletal physiotherapist can provide you with an accurate and timely diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other structures involved, get a greater understanding of your mobility and strength, and to help facilitate an accurate diagnosis.
Your physiotherapist will want to know how your condition is affecting your day-to-day so that your treatment can be tailored to your needs and will mean personalised goals can be established. Intermittent re-assessment will ascertain if you are making the best progress towards your goals and will allow adjustments to your treatment to be made. Imaging like magnetic resonance imaging (MRI) or ultrasound scans are usually not required to achieve a good working diagnosis, but in unusual presentations, they may be warranted.
As part of your treatment, your physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your patellar tendinopathy. This will include activity modification strategies and useful treatments reducing discomfort.
A rehabilitation plan developed by an experienced physiotherapist plays a key role in the recovery of this condition. However, it is important to have a realistic expectation regarding the recovery time frame for a return to full capacity and sport.
Research is very clear that modifying the load (pressure) that goes through the tendon is the key element that stimulates the recovery of the tendon. Recovery can take some time as the speed of regeneration in a tendon is much slower than many structures in the body for example muscle can take weeks whereas tendons can take months to repair. Therefore, you should expect to work on tendon rehabilitation for several months to get solid and sustainable improvements.
Below are three rehabilitation plans created by our specialist physiotherapists targeted at resolving patella tendinopathies. Although a one-to-one assessment would be best placed to target the exercise level most accurately to your needs the below rehab plans will give you a good idea of what to do.
This plan is focusing on maintaining range in the knee joint, loading the tendon in a supported way and maintaining the quadriceps (thigh muscle) power and stability. We suggested carrying this out once a day over for 2-6 weeks as pain allows. Pain should not exceed 4/10 on your perceived pain scale whilst completing this exercise programme.
This is the next set up in the plan. More focus is given to progressive loading of the tendon and strengthening the quadriceps muscles which power the kneecap and tendon. This plan is likely to give some pain which is expected and nothing to worry about (3). Pain level should be manageable around 5/10 on a pain scale.
This plan is more challenging and is target at progressive loading of the tendon and supporting structures. This plan is likely to give some pain which is expected and nothing to worry about (3). Pain level should be manageable around 5/10 on a pain scale.
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to sport a rehabilitation program should incorporate plyometric based exercises this might include things like bounding, cutting, and sprinting exercises (5, 7).
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
Podiatry referral to address gross biomechanical alignment issues may be helpful in the short term. Although there is a lack of evidence of any long-term value for tendon issues.
Injections of steroid (cortisone injections) are not recommended for tendon issues as research shows they are likely to provide little or no long-term benefit and have been linked to tendon damage and even rupture in some cases
Surgery – this could be the last option if the patient has exhausted all other pathways. Surgery has poor outcome when done in less active patients and is now carried out in very few cases.
Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.
We have Pure Physiotherapy clinics across the country including Norwich, Great Yarmouth, Manchester, Stockport, Sheffield and Rotherham. Please view our clinics to find the closest physiotherapy clinic for you.
Structural knee injury, triggered either by a tear or through wear and tear.
Seen to be normal as we age, but in some situations can result in knee aches, pain or joint swelling.
A rare condition affecting the adipose (fat) tissue that sits under the kneecap (patella) between the joint spaces of the knee.
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