Treat Patellar Tendinitis

The patella tendon connects the shinbone (tibia) and the kneecap (patella). Collagen breakdown in the tissue due to repetitive stress, chronic hamstring tightness, or poor healing over time can lead to patellar Tendinitis, but it can, and often does, occur in isolation due to overuse and improper conditioning. While the condition can resolve itself, in some cases, it may worsen without proper treatment. It may eventually result in degeneration of the tendon. This condition is common in many athletes and affects more than 20 percent of all jumping athletes. Full recovery takes anywhere from six to 12 months with physical therapy.

Steps

Diagnosing Patellar Tendinitis

1. Assess your knee pain. Tell-tale signs of patellar tendinitis include tenderness in front of the patella at the inferior (lower) portion of the kneecap or the tendon itself when the leg is extended but not when it is fully bent (Basset’s sign), or pain in the area when rising from a deeply seated position (Movie Theatre sign). It will likely be a persistent burning or warmth type of pain.
   • Increased pain with use is a telltale sign of tendinitis.
2. Look for swelling around the patellar tendon. If you have this condition, you may experience swelling in your knee. It might also be tender or sensitive to the touch.
   • Many cases of patellar tendinitis do not have swelling, so this symptom may not be present in your case.
3. Schedule an appointment with your doctor. While not a specialist on the knee, your primary care provider knows normal anatomy and can diagnose typical ailments, as well as rule out more serious issues, and make referrals to a specialist when necessary. Patellar tendinitis is most often diagnosed with a physical exam. In some cases, an MRI may be necessary to obtain accurate images of the knee to fully diagnose the condition.

Relieving Immediate Discomfort

1. Rest the injured patellar tendon. Take a break from any activities that require you to run, jump or squat. Don’t ignore your nagging pain and try to exercise through it. It will not go away. In fact, it will only get worse the more you exercise. Continuing to exercise may lead to further injury.
   • If you experience a lot of pain, you should stop exercising and rest your leg from activities that aggravate the condition.
2. Try icing your knee. If you feel pain or swelling, you ice your knee. Create an ice pack by adding ice into a plastic bag and placing the bag inside a towel. Apply the ice to relieve pain and possible swelling that you might be experiencing.
   • Apply ice for 10 minutes after exercise for pain relief, but note that ice will not help the underlying condition.
3. Buy a patellar tendon strap. This strap is a band that goes around your leg just under the patella. The strap puts pressure on the tendon, thereby redistributing the load throughout the tendon and reducing pain.
   • This is a good support device to use during rehabilitation.
   • A patellar tendon strap can be purchased at most drug and medical supply stores.
   • Even if you use a strap, you still need to give your tendon time to heal.
4. Immobilize your leg. If you experience pain when resting your leg, you probably need a brace to immobilize your leg. Once pain subsides while you’re resting, you can gradually increase your activity. Only do as much as your leg will allow without the pain returning.
   • If you are experiencing enough pain that you need to immobilize your leg, you definitely need to see your doctor. You will likely need to rest your leg until you are fully recovered.

Trying Conventional Treatment Options

1. Work with a physical therapist. Your doctor may refer you to a physical therapist. This specialist will recommend exercises for stretching and strengthening your muscles, including the patella tendon.
   • Your physical therapist may focus on stretching your hamstrings. Overly tight hamstrings is thought to be a major cause of patellar tendinitis.
   • These include exercises such as isometric quad contractions, single leg extensions, eccentric squats, lunges or step backs.
2. Try eccentric squats. Your doctor may recommend certain exercises for rehabilitating your leg. If your doctor gives you the go-ahead, try eccentric squats. These help strengthen the hamstring, glute and quad muscles.
   • Stand on a 25-degree slant board with your feet parallel, hip-width apart and your heels on the elevated side. You can improvise a slant board by placing a piece of wood on the curb, but you can also buy one online.
   • Keep your lower back straight. Squat slowly until you are parallel to the ground by sitting back instead of dipping down. Never bounce or move with momentum.,,
   • Take three seconds for the way down, and take two or three seconds for getting up again.
   • Do three sets of up to 15 repetitions.
   • If the exercises are effective, you should feel less pain and more able to function in a shorter amount of time.
   • Other than skin irritation, no other side effects are known. However, this is a newer procedure so long-term effects are not yet known.
3. Talk to your doctor about iontophoresis. Iontophoresis is the local delivery of drugs (pain medicine, anti-inflammatories) using an electrical current. Some studies have shown that iontophoresis with corticosteroid improved the recovery time when compared to a placebo.

Exploring Advanced Treatments

1. Consider surgery. If chronic patellar tendinitis is suspected, surgery maybe an option to help clean up debris in the tendon. Depending on the severity of your injury, your doctor will repair tears found in your tendon.
   • The surgeon may need to reattach the tendon by first drilling holes in the patella. Then a suture is placed through the tendon and tied to the top of the patella. A newer surgical procedure involves reattaching the tendon using an anchor.
   • Most patients are able to go home the same day of surgery.
   • You will need to attend physical therapy as directed after surgery.
2. Try patellar platelet-rich plasma injections. Platelet-rich plasma injections are thought to help otherwise weak tendon tissue to regenerate and repair quicker.,
   • To administer an injection, a specialist will first take a blood sample from you. Then, the sample is put in a centrifuge to separate the platelet-rich plasma from the rest of the blood. The plasma is then injected into the tendon. The entire process takes about 20 minutes.
   • These injections are not covered by insurance as they have not yet been proven to be any better than placebo.
3. Ask your doctor about extra-corporeal shock wave therapy. This alternative therapy option relies on sound waves to relieve tendon pain.
   • Studies show that extra-corporeal shock wave therapy can help with recovery and with pain by stimulating cells to repair the tendon.
   • This therapy is usually used when all other options are exhausted. It is not considered the first or best option because it is used with more chronic pain.<

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Sources and Citations

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