June 2022

Can physio help with your patella tendon pain? It sure can!

What is patella tendinopathy / Jumper's KNEE?

Patella tendinopathy, also known as jumper’s knee, is an overuse injury that causes pain and tenderness at the front of the knee.

The patella tendon connects your knee cap to your shin bone.

Stress on the tendon causes tiny tears, which are usually small enough for the body to manage, however an increase in training, commonly caused by sports involving a lot of jumping, can lead to patella tendinopathy.

Symptoms

Pain and tenderness around your patella tendon
Swelling
Tenderness behind the lower part of your kneecap
Pain with jumping, running, and walking

Causes of Patella Tendinopathy / Jumper's Knee?

Jumper’s knee is a common overuse injury, caused by repetitive stress on the patella tendon. The stress of increased training results in stress within the tendon, which the body attempts to repair.

These tears in the tendon multiply, resulting in pain and inflammation and weakening of the patella tendon. When the tendon damage persists for a few weeks, it’s called tendinopathy.

Risk factors

Even if you aren’t a professional volleyball player, you should keep an eye on your knees as anyone can develop patella tendinopathy. Other risk factors for developing patella tendinopathy include sudden increases in training load which can add stress to the tendon.

Individuals with chronic illnesses such as diabetes, kidney failure and rheumatoid arthritis can be at increased risk of developing patella tendinopathy. Additionally, tight thigh muscles and muscle imbalances in your legs could impact stress on the patella tendon.

The treatment of jumper’s knee is often specific to the degree of injury

Stage 1

During stage 1, there is often pain only after activity and you are not impaired functionally. During this stage you may benefit from using cryotherapy whereby ice packs should be used after activity.

Stage 2

During stage 2, you will experience pain during and after activity but are still able to participate in sport. Activities that increase load on the patella tendon should be avoided and a comprehensive physical therapy program should be commenced.

Stage 3

During this stage, the pain is sustained and performance in sport may be adversely affected. Relative rest may be necessary for an extended period during this stage.

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How do YOU treat knee tendon injuries or complaints?

Most people will respond to conservative management program which can involve:

1. Relative rest

Patella tendinopathy is one of those cases where saying “no pain no gain” does NOT apply. A period of initial rest from sport can be beneficial for patella tendinopathy, however complete rest can often make the problem worse. Speak to a physiotherapist at Melbourne Sports Physiotherapy to find the perfect balance between rest and exercise for your patella tendinopathy.

2. Understand & monitor pain

Jumper’s knee is thought to be caused by an increase in intensity, frequency and volume of patella tendon loading and the tendon is unable to recover and adapt appropriately. It Is important to understand and monitor your pain levels during the rehab process. You’re not only going to monitor your pain during exercise, but also immediately after and the following day. Ask yourself these 3 questions and record your answers for your next physiotherapy session:

Is my pain tolerable during this exercise?
Is my pain better, worse, or the same after exercise?
Is my pain better, worse, or the same the day after exercise?

3. Cryotherapy

Ice packs can be applied for 10 – 15 minutes every couple of hours, after activity. This can help reduce swelling, inflammation and pain.

4. Stretching

The medical research used think that stretching tight hips, quads and hamstrings could reduce the risk of developing jumpers’ knee, so it was important to stretch out these muscles regularly.

Recently, this has been shown to be ineffective, and short lived at best. Stengthening is the real solution to your Jumper's Knee problems.

There's no harm in trying to stretching to reduce pain and stiffness around the knee, as well as reducing the chances of symptoms returning once you return to playing sport, though it's only short term at best. You need to load your tendon!

5. Strengthening

Strengthening the muscles around the knee can help with patella tendinopathy.

Isometric exercises have been shown to reduce patella tendon pain. Isometric exercises are when the muscle doesn’t noticeably change length and can include wall sits or Spanish squats. Doing these heavily actually helps settle tendon pain down. It sounds counterintuitive, though it's the best thing for a grumpy tendon!

Additionally, weak glutes can affect the position of the knee, resulting in increased force going through the patella tendon, leading to patella tendinopathy. The simplest way to strengthen the glutes is to perform exercises such as bridges, clams, and crab walks – visit a sports physiotherapist to help with your exercise technique.

What are my options for jumpers’ knee when rehab stalls?

Shockwave therapy

A shockwave machine produces soundwaves that can heal tendons by reducing pain and remodeling the tendon. There is some evidence for shock wave therapy when tendon pain is chronic, especially if all other treatments have failed. Speak to one of our physios at Melbourne Sports Physiotherapy to see if shock wave therapy is right for you.

Tendon injections

Tendon injections are often only reserved for complex cases whereby you are not responding to physiotherapy treatment. There is limited evidence for successful use of cortisone and platelet-rich plasma injections for patella tendinopathy.

Surgery

Surgery is sometimes indicated in stage 3 patella tendinopathy when pain continues during rest and activities. There is inconclusive evidence on the effect of surgery on patella tendinopathy and therefore should be reserved for specific patients who have attempted all other treatment options.

Unfortunately, tendons can take weeks or months to settle.

However, the long-term prognosis is often good if a strong and detailed exercise rehabilitation program is prescribed.

At Melbourne Sports Physiotherapy, our physiotherapists can help identify causes of your patella tendon pain and devise a personalised treatment plan to decrease pain and get you back to doing the things you enjoy doing pain free.

If you suspect you have patella tendinopathy, don’t wait! Book in for an assessment to find a solution to your pain! You can make an appointment by calling or booking online.