Understanding Patella Tendinopathy: Assessment and Management

Patella tendinopathy, sometimes known as jumper's knee, is a common injury affecting athletes and active individuals. It involves load-related irritation in the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). This condition is particularly prevalent in sports involving repetitive jumping, running, or sudden changes in direction. Understanding the assessment and management of patella tendinopathy is crucial for effective treatment and recovery. In this blog post, we’ll explore the latest evidence-based approaches to assessing and managing patella tendinopathy, providing valuable insights for individuals dealing with this condition.

What is Patella Tendinopathy?

Patella tendinopathy occurs when the patellar tendon becomes overstressed by load. The condition is often characterised by pain and stiffness in the front of the knee, just below the kneecap. Athletes involved in sports such as basketball, volleyball, football, and running are especially at risk due to the high demands placed on the knee during jumping and pivoting.

Key Symptoms of Patella Tendinopathy

The primary symptoms of patella tendinopathy include:

• Pain localised to the patellar tendon, typically just below the kneecap.

• Pain with activity, especially jumping, running, or squatting.

• Stiffness and discomfort in the knee after periods of rest.

• Swelling or thickening of the tendon (in some cases).

• Tenderness to touch or pressure directly on the tendon.

While these symptoms may vary in severity, they often interfere with an individual’s ability to perform sports-related movements and daily activities.

Assessing Patella Tendinopathy

A thorough assessment is essential for an accurate diagnosis and to guide effective treatment. The assessment should be multifaceted, taking into account the patient’s clinical history, physical examination findings, and relevant imaging if necessary. Below is an overview of the evidence-based approach to assessment:

1. Clinical History

A comprehensive clinical history is crucial for identifying risk factors and understanding the onset of symptoms. This includes:

• Activity level: Understanding the type and intensity of physical activity the individual participates in can help pinpoint the origin of overload or excessive stress on the tendon.

• Duration of symptoms: Identifying the duration and progression of pain helps classify the condition.

• Previous injuries: A history of previous knee injuries or surgeries can contribute to the development of patella tendinopathy.

2. Physical Examination

Physical tests can assist in confirming the diagnosis. Key physical examination findings include:

• Palpation: Tenderness over the inferior pole of the patella or along the patellar tendon is common.

• Functional movement assessment: Evaluating how the individual moves during sports or daily activities can reveal abnormal loading patterns and weaknesses in the quadriceps, hamstrings, or hip muscles that may contribute to the condition.

3. Imaging

While imaging is not always necessary for diagnosis, it may be useful in cases where the diagnosis is unclear or if there is concern for additional pathology. Ultrasound and MRI are often used to visualize tendon degeneration and assess the extent of damage, though these tools are most valuable in chronic cases.

Management of Patella Tendinopathy

The management of patella tendinopathy should be individualised and evidence-based, focusing on reducing symptoms, promoting tendon healing, and preventing recurrence. Below are key treatment approaches based on current research:

1. Load Management and Activity Modification

The cornerstone of managing patella tendinopathy is controlling tendon loading. The tendon needs time to heal and adapt to progressively increasing loads, but excessive loading can exacerbate the condition.

• Relative rest: Individuals should reduce activities that exacerbate pain, such as jumping or squatting, while still maintaining overall physical activity. Modifying activity intensity is key to preventing overload.

• Gradual reloading: As pain decreases, gradually increasing the load on the tendon is essential to stimulate healing. This can include exercises aimed at strengthening the quadriceps, hamstrings, and hip stabilisers.

2. Exercise Therapy

Contemporary evidence consistently supports exercise therapy as the most effective treatment for patella tendinopathy. Eccentric exercises, in particular, have shown strong evidence for reducing pain and improving tendon function.

• Eccentric exercise: A regimen of eccentric (lengthening) quadriceps exercises is well-supported by research. These exercises help promote tendon remodelling and alleviate pain by improving the tendon’s ability to tolerate load.

• Strengthening: Strengthening exercises for the quadriceps, hamstrings, gluteals, and calf muscles are crucial in addressing any muscle imbalances and preventing further strain on the patella tendon.

• Neuromuscular training: In certain cases, correcting movement patterns through neuromuscular training can sometimes help alleviate abnormal stress on the tendon and prevent future injury.

3. Patellar Taping and Orthotics

Patellar taping and the use of orthotics may provide temporary relief by offloading stress from the patellar tendon. Patellar taping, in particular, has been shown to reduce pain during activity, and the combination of taping with exercise therapy can improve outcomes for some individuals.

4. Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) is an emerging non-invasive treatment for patella tendinopathy. Research suggests that shockwave therapy can stimulate tendon healing by enhancing circulation and promoting tissue regeneration. While more research is needed, ESWT may be considered for chronic cases that do not respond to conservative treatments.

Conclusion

Patella tendinopathy is a challenging condition, but with proper assessment and evidence-based management, most individuals can recover and return to their desired level of activity. The key to successful treatment lies in a comprehensive, individualised approach that focuses on managing load, strengthening the tendon, and addressing any contributing factors such as muscle imbalances or faulty movement patterns.

If you’re experiencing knee pain or think you might have patella tendinopathy, consulting with a physiotherapist can help you develop an effective treatment plan tailored to your specific needs. Early intervention and a proactive approach to rehabilitation are crucial for a successful recovery.

At Physio on Patterson, we’re committed to helping you manage and recover from patella tendinopathy with the latest evidence-backed treatments. Reach out today for an assessment and to discuss how we can help you get back to doing what you love, pain-free.

References:

• Bahr, R. (2016). Jumper’s Knee (Patellar Tendinopathy). In: Textbook of Sports Medicine, Springer.

• DiBartolomeo, T., & Menzies, M. (2020). Eccentric Exercises for Patella Tendinopathy: A Meta-Analysis. Journal of Orthopaedic and Sports Physical Therapy, 50(9), 526-535.

• Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a factor in patellar tendinopathy? British Journal of Sports Medicine, 43(7), 474-478.