What is the Patella Tendinopathy?
Patella Tendinopathy is a common injury affecting the tendon at the front of the knee just below the knee cap (patella). It can sometimes be known as "jumpers knee" as it is common in people who play sports such as football, basketball, Volleyball, Badminton, and Athletics but it can affect both athletic and nonathletic people.
What causes Patella Tendinopathy?
Even though The Patella tendon is very strong, it can still get injured. There are many theories for the pathogenesis of Patella Tendinopathy but chronic overloading is the most common. For example, if we overload the tendon from too much activity, sport or other recreational tasks we can then suffer from Patella tendonitis which is a short period of inflammation and pain. This normally settles down if we rest and stop the irritable activity.
If we continue to irritate and overload the tendon, it becomes what is known as a Tendinopathy, which is a degenerative tendon. Tendinopathy occurs through ongoing micro-tears and the tendon cannot repair, thus staying in a state of disrepair. In Tendonopathies It’s seen that there is increased cellularity, collagen disorganization, ground substance accumulation and neurovascular ingrowth causing this degenerative tendon.
It is most common in men as we age, and may present as pain, swelling and stiffness. You may notice the tendon also looks or appears thickened. In the early stages of tendinopathy, you may have variable pain. So it can sore be at the beginning of an activity and then reduce or disappear during the activity itself once warmed up, only to reappear when cooling down and the activity has stopped. Over time the tendon will become painful throughout and not improve with warming up. You may also feel stiffness in the morning and pain with descending stairs
Common Training Errors:
Too much volume too soon
Increased jumping/plyometric training
Increased hill running
Lack of variation in training- New sports or activities.
Walking up and Downhill often,
What Treatments can I do?
If you have Patella Tendonitis or Tendinopathy these injuries can be treated successfully by a Physiotherapist. This will involve a course of specific rehabilitation for the level of irritation you have on the tendon. In Tendinopathies it is seen that, Isometrics, Eccentrics and slow heavy resistance training are very beneficial in helping cause reduction in pain and also regeneration to the tendon over time. However, to cause any regeneration of a tendon is a slow process as it can take at least 90 days for the tendon to mature and progress. Thus it is advised recovery may be between 3-6 months or longer in some cases.
If the tendon has ruptured which is very rare it is important to be seen as soon as possible by an orthopaedic consultant and/or a Sports Physician. This will ensure a better recovery. Normally a scan is undertaken to confirm the level of tear and then the decision as to either treat with surgery or conservatively is undertaken.
How do I recover?
Following your diagnosis of a Patella Tendinopathy you will have to follow strict rehabilitation guidelines to reduce irritation and then to help improve the loading capabilities of the tendon.
The rehabilitation may start with Isometrics to reduce pain and improve muscle activation and then a progress to Slow heavy resistance or Eccentrics may be utilised. Once there is enough progress then a Tendon is hen subjected to energy storage loading that will incorporate jumping and landing. This ability to then load will then help the individual to return to sport or recreational activities pain free.
Phase 1- Isometric
Phase 2- Isotonic Loading
Phase 3- Energy Storage Loading
Phase 4- Return to Sport/Activity