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Definition
Patellar tendinitis is an injury that affects the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon plays a pivotal role in the way you use your legs. It helps your muscles extend your lower leg so that you can kick a ball, push the pedals on your bicycle and jump up in the air.
Patellar tendinitis is most common in athletes whose sports involve frequent jumping — for instance, basketball, soccer and volleyball players. For this reason, patellar tendinitis is commonly known as jumper's knee. However, anyone can suffer from patellar tendinitis, whether a frequent jumper or not.
For most people, treatment of patellar tendinitis begins with conservative approaches.
Symptoms
Pain is the first symptom of patellar tendinitis. The pain usually is located in the section of your patellar tendon between your kneecap (patella) and the area where the tendon attaches to your shinbone (tibia). During physical activity, the pain may feel sharp — especially when running or jumping. After a workout or practice, the pain may persist as a dull ache.
The pain in your knee may:
- Initially be present only as you begin physical activity or just after an intense workout
- Increase as you step up the intensity of your activity
- Progress to be present before, during and after physical activity
- Make going up and down stairs painful
- Become a constant ache that can make it difficult to sleep at night
When to see a doctor
If you experience knee pain, try self-care measures first, such as icing the affected area and temporarily reducing or avoiding activities that trigger your symptoms.
Call your doctor if your pain:
- Continues or worsens
- Interferes with your ability to perform routine daily activities
- Is associated with swelling or redness about the joint
Causes
Patellar tendinitis is a common overuse injury. It occurs when you place repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon become more numerous, your body can't keep up, causing the inflammation in your tendon to worsen.
A combination of factors may contribute to the development of patellar tendinitis, including:
- Intensity and frequency of physical activity. Repeated jumping is most commonly associated with patellar tendinitis. Sudden increases in the intensity of physical activity or increases in frequency of activity also put added stress on the tendon.
- Being overweight. Additionally, being overweight or obese increases the stress on the patellar tendon, and some research suggests that having a greater waist circumference or higher body mass index may increase the risk of patellar tendinitis.
- Tight leg muscles. Reduced flexibility in your thigh muscles (quadriceps) and your hamstrings, which run up the back of your thighs, could increase the strain on your patellar tendon.
- Malalignment of your leg bones. The way your leg bones line up could be off slightly, putting strain on your tendon.
- Raised kneecap (patella alta). Your kneecap may be positioned higher up on your knee joint, causing increased strain on the patellar tendon.
- Muscular imbalance. If some muscles in your legs are much stronger than others, the stronger muscles could pull harder on your patellar tendon. This uneven pull could cause tendinitis.
Patellar tendinitis is commonly known as jumper's knee. However, because anyone can suffer from patellar tendinitis, whether a frequent jumper or not, this term may be misleading. Terms that doctors sometimes use to describe recurring patellar tendinitis that causes further degeneration of the patellar tendon include patellar tendinopathy and patellar tendinosis.
Complications
If you try to work through your pain, ignoring the warning signs your body is sending you, you could cause further tendon damage and other complications, such as:
- Weak leg muscles. As your leg compensates for the pain in your knee, your thigh muscles (quadriceps) and calf muscles can weaken.
- Torn tendon. Your body can't keep up with the continued wear and tear on your tendon, leading to larger and larger tears in the patellar tendon.
- Chronic knee pain. Knee pain can persist if the factors contributing to patellar tendinitis are not addressed.
Preparing for your appointment
If you have knee pain during or after physical activity, and it doesn't improve with ice or rest, make an appointment with your doctor. After an initial exam, your doctor may refer you to a sports medicine specialist or to a doctor with advanced training in the treatment of joint disorders (rheumatologist).
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- List any symptoms you've been having, and for how long.
- Write down your key medical information, including other conditions with which you've been diagnosed and all medications and supplements you're taking.
- Log your typical daily activity, including the length and intensity of sports practice or other exercise. Your doctor also will be interested to know if you've recently changed the frequency, intensity or method of your workouts.
- Note any recent injuries that may have damaged your knee joint.
- Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
Below are some basic questions to ask a doctor who is examining you for possible patellar tendinitis. If any additional questions occur to you during your visit, don't hesitate to ask.
- What is the most likely cause of my signs and symptoms?
- Are there any other possible causes?
- Do I need any tests to confirm the diagnosis?
- What treatment approach do you recommend?
- With treatment, do you expect I will eventually be able to return to my current sport?
- How long will I need to avoid my current sport?
- What kind of workout routine can I safely follow while I'm healing, if any?
- What other self-care measures should I be taking?
- What is the likelihood that I will need surgery?
- How often will you see me to monitor my progress?
- Should I see a specialist?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in depth. Your doctor may ask:
- What are your symptoms?
- When did you first notice these symptoms?
- Have your symptoms been getting worse?
- How severe is your pain?
- Does your pain occur before, during or after your workouts - or is it constant?
- Is the pain associated with any knee swelling, locking or instability?
- What is your regular exercise or sports-training routine?
- Have you recently made any changes to your training routine, such as training harder or longer, or using new techniques?
- Are you still able to perform your sport or preferred exercise at a satisfactory level?
- Are your symptoms affecting your ability to complete normal, daily tasks, such as walking up stairs?
- Have you tried any at-home treatments so far? If so, has anything helped?
- Have you recently had any injuries that may have caused knee damage?
- Have you been diagnosed with any other medical conditions?
- What medications are you currently taking, including vitamins and supplements?
What you can do in the meantime
In the time leading up to your appointment, try self-care measures at home. Until your doctor sees you, avoid using your joint in ways that cause or worsen pain. Icing the affected area also may help.
Tests and diagnosis
Your doctor may be able to determine that you have patellar tendinitis based on your signs and symptoms. If the diagnosis isn't as clear, he or she may conduct tests to rule out other conditions. Tests and examinations might include:
- Physical exam. Your doctor may apply pressure to different parts of your knee to determine exactly where you're experiencing pain. Pain associated with patellar tendinitis usually concentrates on the front part of your knee, just below your kneecap.
- X-rays. X-rays don't show the patellar tendon, but they do help to exclude other bone problems that could contribute to knee pain.
- Ultrasound. This test uses sound waves to create an image of your knee, revealing the location of tears in your patellar tendon.
- Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to create images that are more detailed than ultrasound images. MRI can reveal more subtle changes in the patellar tendon.
A combination of tests may help your doctor rule out other conditions that can cause knee pain similar to patellar tendinitis, such as:
- Pain behind your kneecap (patellofemoral pain syndrome)
- Tears in the cartilage (meniscus) that cushions your knee joint
- Breakdown of the cartilage underneath your kneecap (chondromalacia patella)
Treatments and drugs
Patellar tendinitis treatment is a long process, no matter what type of treatment you've chosen. Recovery may take a few weeks or months if the injury isn't too severe, or as long as a year or more for people who undergo surgery.
Most people with patellar tendinitis find pain relief and improvement using conservative treatment — meaning treatments other than surgery. Surgery for chronic patellar tendinitis (often called patellar tendinopathy or patellar tendinosis) is rarely performed. However, if you have persistent signs and symptoms for over a year, you may want to discuss the potential benefits and risks of patellar tendon surgery with your doctor.
Conservative treatment
The conservative approach to treating patellar tendinitis aims to reduce the strain on your tendon and then gradually build up the tendon's strength. Your doctor may suggest several techniques to accomplish this, including:
- Rest. Rest doesn't mean giving up all physical activity, but avoid running and jumping. Your doctor can suggest other ways of staying active without stressing your damaged patellar tendon. It's especially important to avoid any activity that gives you pain.
- Adjusting your body mechanics. A physical therapist can help you learn to better distribute the force you exert during physical activity. For instance, an athlete who jumps frequently might learn proper takeoff and landing techniques.
- Stretching your muscles. Inflexible muscles, especially inflexible thigh muscles (quadriceps), contribute to the strain on your patellar tendon.
- Strengthening your tendon. A physical therapist may recommend specific exercises to strengthen your patellar tendon and the muscles around it. Exercises can also help strengthen your quadriceps. A specific type of exercise for strengthening the quadriceps called eccentric strengthening has been shown in some studies to help treat and prevent patellar tendinitis. This strengthening exercise involves lowering weight slowly after raising it, such as a seated knee extension exercise.
- Patellar tendon strap. A strap that applies pressure to your patellar tendon can help to distribute force away from the tendon itself and direct it through the strap instead. This may help relieve pain.
- Iontophoresis. This technique involves applying a topical corticosteroid medication to the area affected by tendinitis. A small device then uses an electrical charge to deliver the medication through your skin. Your physical therapist can assist you in the application of iontophoresis.
- Corticosteroid injection. An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon can help relieve pain and make it possible to perform strength exercises that otherwise may be too painful. You'll need to follow activity restrictions for at least three weeks after the injection, including avoiding jumping or running activities.
- Massage. Massaging the patellar tendon may help encourage tendon healing.
If you've recently developed patellar tendinitis, you can expect at least several weeks or months of conservative therapy before you'll be able to fully resume physical activity, including jumping. If you've re-injured your patellar tendon, the time for healing may be even longer.
Surgery
You and your doctor may consider surgery for your patellar tendinopathy in select cases if more conservative approaches aren't helping after 12 months of treatment. There is little research into the best surgical techniques for patellar tendinitis, so the procedure you undergo often depends largely on your injury, as well as your surgeon's preferred method. Surgery may include repairing any tears in your tendon or removing any badly damaged parts of your tendon.
Most people who have had patellar tendinitis surgery are able to resume athletic training within about six months. In some cases, however, recovery may take up to 18 months.
Other approaches
Other types of therapy may provide relief from pain associated with patellar tendinitis. Though these methods haven't been thoroughly researched, your doctor might consider trying:
- Pain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may provide short-term relief from pain associated with patellar tendinitis. However, because the benefit of these drugs for patellar tendinitis don't outweigh the risks of associated side effects, they're not generally recommended for long-term pain management.
- Platelet-rich plasma (PRP). In this experimental approach, your own blood plasma is injected into the affected area. Although small studies have found this technique helpful in reducing the pain of patellar tendinitis, large, controlled studies are needed.
- Extracorporeal shock wave therapy. This form of therapy uses sound waves to promote healing of the tendon. Some research suggests this type of therapy may be effective in relieving the symptoms of patellar tendinitis.
- Other physical therapy treatments. This category includes treatments using ultrasound and laser stimulation. These can help to provide pain relief, though it's not known if these treatments can help heal the tendon.
Lifestyle and home remedies
If you think you're experiencing patellar tendinitis, consider these approaches to pain relief at home:
- Avoid activity that causes pain. This may mean reducing how often you practice or temporarily switching to a lower impact sport. Don't try to work through the pain, as this can further damage your patellar tendon.
- Ice. Apply ice after activity that causes pain. Place ice in a plastic bag and wrap the bag in a towel. Or try an ice massage. Freeze water in a plastic foam cup and hold the cup as you apply the ice directly to your skin. The cold will help to relieve your pain and reduce swelling.
Prevention
To reduce your risk of developing patellar tendinitis, take these steps:
- Don't play through pain. When patellar tendinitis is diagnosed in its earliest stages — when pain is noticeable, but doesn't limit your ability to perform — you're much more likely to be helped by conservative treatment. If your sport is causing knee pain, rest, apply ice to the area of pain and try a different type of exercise until your pain is gone.
- Strengthen your muscles. Strengthening the quadriceps muscle will help it be able to handle the load that you put on it. Eccentric strengthening exercises are especially effective in preventing and treating tendon problems.
- Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
Last Updated: 2010-01-08
