The patella or the kneecap is the small and freestanding bone that lies between the thighbone (femur) and the shin bone (tibia).
Patellar Tendinitis (Jumper’s Knee) is an injury to the patellar tendon, due to undue stress on the knee joint. This injury is more common in sports people or athletes than in ordinary people. The patellar tendinitis is more common in men than in woman. Its incidence is high in teens or young adults.
What is Patellar Tendinitis?
The patellar tendon is an attachment that connects the muscles of thigh with the lower leg bone (shin bone). The patellar tendon helps to straighten (extend) the knee and is present on the front of the knee joint. It helps in the activities like jump or kick during a sport.
Causes of Patellar Tendinitis:
Repeated injury to the patellar tendon causes tendinitis. Both external and internal factors contribute to patellar tendinitis. They are:-
External Factors: Use of improper footwear, too much of sports or play, improper sports training, playing on hard surfaces (and not in the ground), underlying primary diseases like diabetes, chronic kidney problem, rheumatoid arthritis.
Internal Factors: Any weakness in muscles (due to overuse or ageing), tightness in muscles, and malalignment of knee or ankle joint; Any foot disorders like flat foot that causes more pressure on the patella and the shin bone.
Obesity and any muscle imbalance have an impact on the patellar tendon and make it prone to tendinitis.
Chronic tendinitis is significant problem; degeneration of the tendon is the reason for this condition.
Symptoms of Patellar Tendinitis:
Symptoms of tendinitis are not much prominent in the early stages. The symptoms begin to progress, as the condition worsens. Some of the symptoms include:
- Pain on palpation (tenderness) in the area below the kneecap
- Pain initially, only after a sport or work-out
- Pain in daily activities like climbing stairs
- Swelling of the knee joint
- Redness around the knee
- Pop sound on bending of the knee
- Difficulty in walking due to loss of muscle strength
Symptoms worsen as the patient puts on constant pressure on the knee and this can also lead to movement restriction of the knee joint.
Risk Factors for Patellar Tendinitis:
The occurrence of patellar tendinitis is most common in sportsmen. Any factor that causes stress on the knee joint can lead to patellar tendinitis. The possible risk factors include:
- Physical activity without a trainer
- Stiff leg muscles
- Weakness in leg muscles
- Diseases like osteoarthritis and rheumatoid arthritis
- Medications like steroids
- Surgeries like total knee replacement
Patient, who has an acute tendon injury, should give proper rest and time, for the tendon to heal naturally.
Complications of Patellar Tendinitis:
Patellar tendinitis should be treated at the earliest possible, to avoid further damage to the knee joint and its muscles.
Continuous pain and weakness are the most common complications of patellar tendinitis. This pain hampers the participation of the person, in his routine sports activities.
Patellar tendinitis if not diagnosed correctly, can lead to complete loss of the muscle tone and make walking difficult for the patient.
Diagnosis of Patellar Tendinitis:
Accurate diagnosis of patellar tendinitis leads to early recovery. Following tests are involved in the diagnosis of this condition:
Detailed evaluation of the patient by a complete physical examination of the knee joint is essential. Palpation of the knee joint on the lower part of the kneecap may elicit pain. Detailed past medical history and daily routine are also significant, to understand the extent of knee activity in the patient’s life.
The ultrasound scan uses sound waves, to get the explicit images of the knee. It also helps to observe any tear in the patellar tendon.
Magnetic Resonance Imaging (MRI scan):
Magnetic resonance imaging uses magnetic and radio waves, to reveal any small changes in the patellar tendon. This scan gives different cross-sectional images of the knee.
X-ray does not give any clear picture of the tendon injury. But, it is crucial to diagnose other knee problems like fracture of the patella (kneecap).
Treatment of Patellar Tendinitis:
Treatment of patellar tendinitis depends upon the extent of tendon ruptured and the extent of usage of the knee by the patient in his daily activities.
In case of acute injury to the knee, for example, after a volleyball match, the line of treatment includes (RICE) rest, ice and compression or immobilization with a brace. Drugs are used for controlling pain and swelling.
Role of physical therapy in the management of patellar tendinitis is very crucial. The aim of physiotherapy treatment is, to restore the complete range of movement of the knee joint.
Physiotherapy Treatment: Techniques include both, treatment with a electrical modality and exercises.
Ultrasound: Ultrasound treatment helps in decreasing the swelling around the knee and is also helpful in tendon repair.
Exercise Program: Stretching and strengthening exercises may help strengthen the knee muscles. This program should be performed under the supervision of a physiotherapist.
Stretching Exercises help to reduce the muscle tightness and maintain the flexibility of the tendon.
A strengthening program for thigh muscles to improve the muscle strength and to avoid consistent pressure on the patellar tendon. Exercises like leg press, which involves constant knee straightening and bending is advised, to improve the strength of the knee muscles.
In patients with moderate to severe injury of the tendon, physiotherapists also advise knee supports or braces.
Physiotherapists also use techniques like taping of the knee joint, placement of surgical tape on the knee joint in a particular direction (based on muscle structure), to give rest to the patellar tendon.
Physiotherapy plays a significant role in the post-surgery cases. It helps in improving the strength and function of the knee joint.
Prevention of Patellar Tendinitis:
Sports people are to be adequately trained to avoid frequent injuries to the patellar tendon. For those people, with acute tendon injury, knee should be given proper rest for at least two or three days.
People should go for warm-up sessions before they start a new workout or sport. Lack of knowledge about, how to jump or run correctly in a sport, could result in serious tendon injuries.
Any foot abnormalities like flat foot are to be taken care of, by usage of proper footwear, to avoid constant stress and damage to the patellar tendon.
Patellar tendinitis is a common type of sports injury. Use of proper knee supports in sports, can prevent this condition. Regular fitness is also important, to maintain the strength of the knee muscles.