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About patellar tendinopathy

What is patellar tendinopathy?

Patellar tendinopathy is a soft tissue condition that develops in the tendon at the front of your knee. The patellar tendon is at the end of your thigh muscles (quadriceps). It attaches to your shin bone (tibia) and can be felt just below the knee-cap (patella). It is involved in any activity that uses the thigh muscle such as running, jumping and climbing stairs. Repeated tiny injuries to the tendon from overuse can lead to it becoming stiff and painful. Additionally chronic underuse of the tendon can also cause these changes.

What are the symptoms?

pain with jumping, landing, running, walking up and downhill or stairs, and squatting
pain when sitting for long periods with the knee bent
pain or stiffness first thing in the morning or after periods of rest
pain may temporarily improve during an exercise, but then become painful afterwards
the tendon (just below the knee-cap) may feel sore to touch, and may be swollen

What causes patellar tendinopathy?

Often related to a change in exercise routine for example:

a sudden increase in exercise levels
a different type of exercise that you are not used to doing regularly
restarting exercise following a period of rest

You might have a higher chance of developing tendinopathy if you:

have weak or tight muscles in your legs
are overweight
Inadequate recovery from exercise: tiredness, lack of sleep, poor diet, smoking and too much alcohol can all affect recovery from injury
have certain medical conditions, such as diabetes, kidney problems and high cholesterol. Also some conditions related to the immune system such as rheumatoid arthritis or ankylosing spondylitis increase the risk of tendon injuries.
take certain medications, antibiotics called Fluoroquinolones can cause tendon problems

What treatments can help?

Reduce or rest from the activity that aggravates your pain
Try a different type of activity to keep up your fitness whilst your pain is settling, for example, cycling, swimming or walking
Ice for pain relief, bag of ice or frozen veggies wrapped in damp tea towel, applied for up to 10 mins in 2 to 3 hourly intervals, taking care not to cause ice burn
Painkillers: simple over the counter painkillers can help in the short term
Weight loss
Exercise: Exercise programmes that aim to gradually strengthen the tendon have been shown to improve the condition

Recommended exercises

Isometric wall sit 70 degrees

Isometric wall sit stretch demonstration

Reps: 5 Frequency: 3 to 5 per day.
Hold: 30 to 45 seconds.
Rest: 1 to 2 minutes between sets.

This exercise is useful exercise to start with if you are in a lot of pain with the patellar tendon
Squat down against a wall, stopping the motion when your knees are bent 70 degrees.
Keep your back flat against the wall and hold the position for the prescribed amount of time.

Bodyweight squat

Bodyweight squat stretch demonstration

Sets: 2 to 3.
Reps: 10 to 15.
Frequency: Every other day.
Rest: 1 to 2 minutes between sets.

Only progress to to this exercise if you can do exercise number 1 with less than 3/10 pain

Stand tall and place your hands on your hips and your feet hip width.
Initiate the squat by pushing your hips back, as if you were sitting on a chair.
Continue the movement by bending the knees, keeping them directly over the feet.
Lower yourself until the thighs are about parallel to the ground or to the point where you begin to lose the neutral spine by rounding your lower back.
Lift back up and repeat.
Make sure to keep the spine neutral and knees aligned with the feet at all times

Split squad

Split squad demonstration

Sets: 2 to 3
Reps: 15
Frequency: Every other day
Rest: 1 to 2 min between sets

Progress to this exercise if you can do exercise number 2 with less than 3/10 pain

Stand in a split stance with affected leg in front
Drop back knee down towards the floor aiming to get to 90 degrees knee bend
Keep back straight and head up
You can progress this by holding dumbbells

Stiff leg dead set

stiff leg dead set demonstration

Sets: 2 to 3
Reps: 10 to 15
Freq: Every other day
Rest: 1 to 2 minutes rest between sets

This exercise is to strengthen and lengthen your hamstring muscles and gluteal muscles
Stand with your arms on each side, holding a weight in each hand and your knees slightly bent.
Keeping your back straight and your buttocks pushed back, bend forward from your hips until you feel a stretch behind your legs.
Return to the standing position using your glutes and hamstrings.
Keep your back straight, chin in and shoulders back at all times.

Standing calf stretching

Standing calf stretching demonstration

Reps: 1 to 2
Freq: 2 per day
Hold: 30

Stand and place both hands on a wall, with your feet about half a meter from the wall.
Place one leg behind the other and lean your body forward without bending the back knee until you feel a stretch in your back calf.
Maintain the stretch and relax.

Standing soleus stretching

Standing soleus stretching demonstration