Bodyworks: Patellar Tendinitis

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
Just because it is also known as ‘jumper’s knee’, runners are not immune from this sudden pain that strikes at the base of the patella (kneecap) because of a partial rupture of the ligament below it.

Signs
You may not be able to touch the painful area, as it is the back of the tendon near the patella which is most commonly affected. If you bend your knee, your doctor may be able to stretch the injured part – and it will hurt!

Medical investigations
A soft-tissue x-ray may show swelling and calcification of the tendon, while a scan will give more detail if required.

What else could it be?
You need to be sure that the injury is not to the patella itself, such as a stress fracture or a congenital defect, and that it is not caused by a cyst on the tendon. Osgood Schlatter’s disease can occur at the lower end of the patellar tendon in younger athletes.

Self-treatment
Whilst rest, ice and anti-inflammatories may give temporary relief, self-treatment is usually ineffective in the long term because the tendon heals slowly.

Medical treatment
A particularly acute case may require weeks in plaster before rehabilitation can begin. Laser treatment may be more effective than ultrasound therapy, while deep massage and steroid injections are sometimes used to control the condition. A small number of people require surgical removal of the scarred area of tendon before they recover fully.

Can you run through it?/Recovery time
Although it varies, recovery is likely to take months rather than weeks. Running through it, especially on hilly ground, is likely to make things worse.


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Bodyworks: Peritendinitis
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Bodyworks: Osgood-Schlatter's Disease

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Discuss this article

I have been wrestling with (self diagnosed) patellar tendonitis for the last six months. I originally went to a physio who suggested cross training and stretching.

This largely hasn't worked and I'm now getting frustrated and without a cure I can't run quickly.

I have been reading on the Web about tendon straps and wondered if anyone has experience of trying one and whether it worked. Alternatively, anyone recovered from this injury who has any tips?
Posted: 25/11/2002 at 13:28

No experience of tendon straps , but I have this at the moment - too stubborn to not run, but climbing stairs can be painful at times! Anyone else out there that can help?
Posted: 25/11/2002 at 17:12

Mr Stumpy I had exactly the same problem with pain climbing stairs. My physio won't let me run and I am sticking with his advice as things have been getting better the last couple of weeks.

I am having one session of physio a week where the main treatments are ultrasound and the thingummy where you have electric currents passed through electrodes at the injury site. He has also given me a infrapatellar band to wear which basically applies pressure to the tendon area. I don't wear this to exercise which mainly consists of swimming and light cycling.

I would be interested to hear from people who have made a complete recovery. This would definately boost my morale as not running is a drag.
Posted: 26/11/2002 at 01:11

MartinH

By tendon strap do you mean strapping to correct the movement of the patella into the right 'grove'? If so, the only advice I can give is that this can be different for each individual and corrections can be in opposite directions. Which I guess if you get it wrong would worsten the problem.
Posted: 26/11/2002 at 12:04

My understanding is that the strap works in a couple of ways,

Firstly, it spreads pressure across the patellar tendon and relieves individual stress points.

Secondly, it lifts the patellar slightly again relieving pressure - as a subset of this it can help tracking.

Finally it reduces vibrations across the tendon (caused by running).

That the theory anyway! Personally I have no confidence that it will work but am getting desperate.


Posted: 26/11/2002 at 16:48

I wear my patella strap EVERY time I run. It helped with patella tendinitis almost immediately but did not comepletely cure the problem (that was with stretching!).

They are comfortable to wear and only cost a tenner (phone PhysioMed on 01457 860444), so you have nothing really to lose by trying it, and no I don't work for the company.

I was told the whole point of the strap is to help with the tracking.

Cheers
Rob
Posted: 27/11/2002 at 08:39

Thanks Rob - I have ordered one and will give it a try. The most annoying thing is the injury is variable, one day it can be quite painful and the next almost non-existent. I also find that during running the pain is almost gone e.g. I ran two marathons in October with no pain at all!

Let see how I get on.
Posted: 27/11/2002 at 11:38

Rob - what particular stretching helped the most - I do all the usual after a run, maybe not for as long as i should, but I now pay particular attention to stretching my thighs and it helps partially. Will probably try a Patella Strap if things don't improve this week.
Posted: 27/11/2002 at 12:30

Mainly the hamstrings & calf - my physio used to spend the whole time stretching these, by me laying on my back with one leg flat and the pained leg raised and her pressing down the raised foot towards my chest.

However, I think stretching all muscles rather than just one area is what's needed (unfortunately).

Good luck,
Rob

PS - I also got orthotics to solve the tracking problem as I'm very flat-footed and while these are not cheap I truly believe that most of my problems from tight muscles is caused by the pronation problem I have. I'm not a doctor - it's just my humble opinion.
Posted: 27/11/2002 at 12:34

Thanks for the tips - looks like I'll be doing a lot of stretching....
Posted: 27/11/2002 at 15:19

As with a lot of tendinitis problems, the best cure is rest for a few weeks but this doesn't always sit well with your activities and plans. I've exoperienced plantar and achilles versions which rest cured but not patella.
Posted: 27/11/2002 at 16:10

Boing!
Posted: 16/12/2002 at 09:46

I've had a recurrent knee bursa on the lateral side of the knee - which I thought was patella tendonitis. Rest did nothing - physio treatment cured it overnight but it keeps coming back every 3 weeks.

Stretching like mad at the moment - quad stretches - where you raise your foot behind you but hold it with the opposite hand - so you're pulling it across.

Thing that really makes the difference for me tho - and which I do the day after every long run - is going to the gym and having a strap behind the knee - suspended from a point attached to a pulley just a bit higher than the knee - with upto 20lbs weight on it - then just straightening the knee and slightly bending it again. You could do this with a rubber band thingy - max reistance - suspended from a door knob (door closed!!)

This exercises the inside quad muscle - which if weak allows the knee cap to be pulled to the outside - hence the rubbing on the o'side of the knee and the soreness.

Running for me works the lateral quads only so I have to artificially work the inner ones to stop them being overpowered and literally pulled out of place.
Posted: 16/12/2002 at 20:39

Hi SS, if you're only working the lateral quads when you run are you in the right shoes?
Posted: 17/12/2002 at 08:51

I have similar problems,I am doing one leg raise and curl to strengthen the quads. Very surprised at the weakness in the quads doing one leg raise after being an avid squatter. Intersted in Shattered Shins exercise but don't follow the instructions. Can you be a bit more explicit. I have a rubber band thingy!!
Posted: 17/12/2002 at 10:02

My patella tendonitis started niggling in March 2000 and became aggrevated a few months later after a long sponsored walk. When I started extended training for a trail race in Dec 2000 it eventually became so bad I could only hobble around - missed the race.
I then had physio for 3 mths (electro. and massage) and it seemed to cure it. I promptly started training again and it went completely again.
In short, I lost a whole year's training and my exercise regime went from 40 miles/wk. to 6 mls /wk. max.
The only cure is total rest for several months, then gradually build up your training again (preferably on soft ground). I feel only now am I almost back to normal after 2 years. I still wear a knee strap for re-assurance but don't really think it does anything.
Posted: 17/12/2002 at 13:59

Further to my earlier contribution to this thread I am still having the physio once a week and do not expect to start training again until early February and that might be optomistic. Today I have seen the doc and he gave a steroid injection to the tendon which is now of course sorer than before and will probably be worse again tommorrow.
Posted: 20/12/2002 at 18:21

HURRAH!!!! IAM RUNNING AGAIN -PAIN FREE AS WELL!

The Cortisone injection followed by another couple of weeks rest has done it.
Posted: 14/01/2003 at 19:02

I don’t know if this is the same as what you are all talking about but my physio tells me that I have slightly torn my patella tendon, I have had physio now for two weeks and no running and it is much better, he says I can start running again in a few weeks does this sound right or do I need a second opinion.
Posted: 14/01/2003 at 19:45

I've just started wearing the strap again (originally I didn't use it as it seemed to make the problem worse). Now though wearing the strap means I can run almost pain free.

I have also been doing lots of cross training and this combined with regular stretching seems to be gradually relieving the problem.

Glad to see you're running again Keith - be careful though.
Posted: 15/01/2003 at 06:54


Gav
Yeah, at the tendor age of twenty I have been diagnosed with patella tendonitis. I got the scan results back yesterday. The specialist said that it was only minor though but that doesn't lessen the disappointment. He also said however, that a little bit of running is good but not too much. I have been to the physio over the last few weeks (as deep down I didn't really need the scan results- I already knew it was gonna be tendonitis) and the exercises have helped with getting up and down the stairs and even with faster running. I think that it is important to understand that the tendons are a part of the body that do not heal quickly at all and therefor it is important to stay focussed and just keep believing that it will get a little better if not completely better. I might try this strap idea but I am not that enthusiastic about it. I hope that everyone else is feeling that their injury is getting better and that you all continue to enjoy your running even though it might be a little painful.
Posted: 04/11/2003 at 11:21

Ran a marathon recently and knee went at 9 miles (knew it was patellar tendonitis as had had it diagnosed in previous 3 weeks) hopped 11 miles then knee pain stopped at 20-26 miles. Don't really understand this, am desperate to run again, am doing everything but running to keep fit. Want to do another marathon in April, any advice would be really appreciated.
Posted: 13/11/2009 at 12:12

Well, i'm joining the PT Club.  After 5 months of mild pain at the front of my knee, my physio is quite certain i have PT and im sheduled in for some ultrasound and stretching over the next few weeks; however, the advice seems a bit varied here, with some people saying rest for a long period, others doing light training - my physio said i should just keep exercising as normal including everything up to 10 mile runs.  does this sound like bad advice?
Posted: 14/01/2011 at 08:44

I am in the the PT club too having had it pretty bad since VLM in April and its in both knees but I am over twice your age Gav. Whenever I mention it to GP friends  they say find a new hobby! and they arent joking. Tried rest, physio , had a kneedle procedure and whilst its improved its still there and Ive not run since early October.I am wearing knee straps which provide a bit of relief -they seem to spread the pressure off the main area in the tendons where the inflamation is ,but they arent fixing them.Basically it seems that the inflamation wont go because the blood supply there is so poor and its even worse for degenerating old ones like me. My physio wants to start me off running in about four weeks but the days of 40-50 miles a week are probably over.If anyone comes across the magic cure please let me know.
Posted: 14/01/2011 at 09:56

Another PT club member. Been suffering for 2years and am now showing very very slow improvement due to lots and lots of stretching. Been told by phyio to concentrate on stretching quads (building strength later) but greatest revelation was stretches for glute med. Basically i overpronate and am built with lopsided! Best advice I can give is stretch, stretch, stretch every muscle you have. Pair this with a core programme (like pilates) It's going to take me a good while yet but I'm getting there.

As for knee straps I have one and I'm not convinced. 


Posted: 16/01/2011 at 23:25

HI Ra Ra a familiar tale -are you still running and if so to what extent?
Posted: 18/01/2011 at 12:05

Varies. 2009 managed to do Warrington Half withminimal training (and I mean minimal!!) but 2010 was a write off...less than 100 miles in total. Now feeling more stable and so far this year have done 2miles and 2x 3miles virtually a week apart. Hoping to try a couple of short runs next week.

Have failed at first hurdle so many times...slowly,slowly,slowly this time. Even leaving my watch at home and running with my very fat, lazy, slow labrador as a pacer!


Posted: 18/01/2011 at 18:44

Ra Ra-that doesnt sound good .Maybe Im too impatient and need to rest for a lot longer.Hope the short runs went ok.I tried a slow 5k today and whilst being aware of tingling it went ok but this is a long way off where I would like to be
Posted: 24/01/2011 at 15:35

Try doing one legged squats on a slanted board, worked for me. You face out- so that you are facing downward. It is better than squats on flat which is what is usually prescribed for PT.
Posted: 27/01/2011 at 13:58

With 13 miles accumulated this year I now have slight discomfort in OTHER knee! Resting again. Grrrrrrr.

Think I may have overdone it with lunges/squats/pilatesy type stuff. I'm honestly taking it so so easy though. 

Keep looking at those boards. Where did you get yours?


Posted: 28/01/2011 at 09:54

Wow just been looking at the links. I must admit I've seen stuff on slant boards a while ago but now I seem to fit into the chronic category so it may just be for me. How effective was it for you Alexandra? How long before you saw improvement?

Other PT sufferers- sure I'm not fit yet but here are some things that I've tried along the way...

I can recomend Treat Your Own Knees book - I saw a def improvement quite quickly. A good place to start to understand the injury and basic fixes.

Now trying Myrtle Plan as recommended on another thread to improve hip flexors - figured can't do any harm.

...off to buy a slant board now!!


Posted: 29/01/2011 at 21:28

Hi everyone. Hope you had a nice Xmas. I am looking for advise, I do have patella tendinitis and I have a operation planned for the 06.01.2012 and I am thinking, is the operation the best way for ward. Now I really do love my running and I have not run for a year now because of my injury and I am worried about this operation, will my knee recover fully after the operation. Help please.
Posted: 26/12/2011 at 14:15


Patella tendonitis! Pain right?

Have a break from running for a week! Still train on the cross trainer,cyle.just no running.

What happens is Your quadricep muscle that controls the movement in your knee, is being over used and straining the tendon that goes from your patella and joins on to your tibia, when the quadriceps are over used this put a lot of stress on the tibia. And is effectively pulling your tendo away from you tibia causing pain.

Ice treatment is a good way to control the pain, and anti inflammatory tablets.

( keen runner, med student )
Posted: 05/01/2012 at 20:46

hi just wondering what the systoms are for patella tendonitis ? because im joining the army in two months and have a very weak knee seems like its just under the knee cap and at the top of the shin bone , had an MRI scan done and my knee come back 100 per cent fine. I dont have pain when i run just get a weak knee after running and sum times a burning sensation is this PT ? 


Posted: 17/05/2012 at 11:34

hi everyone, here is my experience: im 31 years old, 10 months ago I started feeling discomfort under the kneecap while running, afterwards I started using a strap and the pain was the same. One day I didnt use the strap an ran for 6 miles and the injury got really really bad so I coudnt run anymore (I didnt realize the extent of the injury while running because of the heat in muscles you produce during exercise)  rested for a month and the went on to climb two large volcanoes in mexico and had some pain on the descent. I decided to rest for a while since the knee hurt while walking, bending, stairs etc. Havent been to the doc but the location of the pain right at the bottom of the kneecap where the tendon attaches to it has me convinced it is a PT. x rays shows no damage to bone. After resting for 4 months it felt better so I went running 3 miles and reinjured it again immediately. I have been resting 3 months from then and its improving but when i press with my finger the injury is small but it is there. I only stretch and massage lightly, and hopeffuly will start running really short and slow on the next few months.... any suggestions??


Posted: 08/06/2012 at 21:35

Love this blog, thanks. I have learnt so much.
I bought a slant board from Physiofoam. co.uk because at £20 it seemed much cheaper and lighter than the wooden ones, and so far it's been great. I think that 90% of my knee pain is gone.   Eccentric squats have definitely led to a massive improvement.  

But is this as good as it's going to get for me?   Can this slight remaining pain be eliminated if I carry on with the decline board?    I'm mulling over the injection but I can run again now and don't want to risk that.


Posted: 03/01/2014 at 11:58

Hi all,

The condition you are describing is inflammation of the patella tendon. But what is the root cause of the inflammation and is wearing a strap going to address this?

Most knee conditions (patella tendonitis, knee bursitis, cartilage loss, patella femoral syndrome etc.) are all caused by the knee being out of correct alignment, which means it is not being used the way it was designed, which puts excessive pressue on the surrounding tissues - tendons, bursa, muscles, cartilage etc. - which causes a 'condition'.

Remember a properly aligned knee joint is NOT weak. It's designed to withstand enormous daily pressures and to withstand them well all your life. But if its not properly aligned then you develop a condition which equals pain which equals your body's way of telling you that something is not right and needs to change.

Try a little test for yourself:

Stand in front of the mirror and see if your knee caps and your feet point straight ahead or do they face in or outwards at an angle. 

They should point straight ahead. Them being at an angle means the legs will not operate as they were designed to - the foot will not strike the ground correctly and your knee joint will not open and close correctly

Over weeks and months and years you will do damage to the knee which will cause pain, but this is not because of overuse per se, but rather due to overusing an incorrect pattern. Muscles position the hips, knees and ankle so therefore you need to work on balancing these muscles to address your problem.

You can wear straps, or alter your running technique, or change shoes and more often than not this will give you temporary relief. Unfortunately it hasn't addressed the ROOT cause, the postural misalignment, and so the pain either returns in the same place eventually or at a different location as the strap, shoe or altered running pattern has transferred the excessive forces and dysfunction to a different location in the body.

So what can you do? Spend as much time as possible barefoot, walk and move as much as you can. But most importantly balance your muscles, so that your posture is aligned, so that your joints work and you become pain free.

Feel free to ask me any questions.

Ameet Bhakta

Postural Alignment Specialist

www.healththroughposture.com


Posted: 04/01/2014 at 15:44

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