Your junior athlete and star of the basketball team is complaining of pain in the front of their knee. They complain that it hurts when they sprint, or jump. You may see a little swelling just at the bottom of the kneecap. After a short period rest, they try to go back and the pain returns! What’s going on? Why is that one area so painful? Patellar tendonitis is a common cause of pain in the front of the knee. Patella tendonitis is seen in athletes participating in jumping or sprinting sports. It is also referred to as a “Jumpers Knee”. The most common cause of a jumpers knee is chronic repetitive stress from hard training. The younger athlete appears to be more susceptible to this than an older athlete. The pain of patellar tendinitis occurs just at the bottom of your kneecap or patella (see below). There is always one small area that is very tender to touch. If the area below your patella is swollen, then severe inflammation is present.
Athletes with patellar tendonitis (or tendinosis) who are involved in jumping sports will notice that their knee hurts when they sprint, jump, run upstairs or run uphill. They will commonly notice that they cannot jump as high or as far because of pain in the front of their knee. For some the pain of patellar tendonitis is an annoyance, for others the pain can be very severe. This commonly occurs in young athletes more than older athletes. Typically the student athlete starts to complain of pain in the front of the knee with jumping of quick sprints. Eventually the pain might worsen to the point where they ask their coach to sit, and ask their parents if they can see a doctor.
Why Does Patellar Tendonitis Happen?
Patellar tendinitis is a relatively common overuse injury. Explosive jumping puts a lot of force on the front of your knee. It also occurs in runners who perform a lot of hill work. All the energy of the quadriceps muscle becomes concentrated along the lower part of your patella. If you have been training for a while, then your muscles and tendons have grown in size to deal with the stress of sports. When improperly trained, your tendons and ligaments can respond by breaking down or becoming inflamed.
As your thigh or quadriceps muscles contract to force you upward or forward, all that force concentrates at the bottom of the patella. The patella tendon connects the patella or kneecap to your tibia or shin bone. If the tendon starts to develop micro injuries and doesn’t have time to heal itself, then over time that can lead to patellar tendonitis and severe pain. That pain will diminish your ability to jump, run, sprint and push off. The pain is due to micro-tears, inflammation, and tendinopathy (degeneration or wearing out).
Luckily, the pain of patella tendonitis is usually a self-limiting problem for many. That means that your pain should improve by itself over time as the condition heals. You may need to take a few weeks off from hill training, or basketball, etc. Proper rehabilitation under the care of a physical therapist or athletic trainer can improve your chance of a return to sports a little quicker and stronger. Most athletes can continue to cross-train during the rehab process for patella tendonitis. That allows you to maintain your cardiovascular status and strength.
An athlete requires a short period of rest when severe pain and inflammation is present. Moist heat, gentle stretching, and limiting jumping, stair climbing and sprinting is critical. When the pain has started to improve, performing eccentric quadriceps exercises, stretching out tight hip and knee flexors all have a role in the recovery process from patella tendonitis.
Surgery is rarely needed to treat patellar tendonitis. Certain knee compression sleeves can help minimize the pain of patellar tendonitis. Most of you will respond to rest and physical therapy. PRP or platelet rich plasma injections can be considered if you fail to improve with non-invasive treatment and proper rest and recovery techniques. If the non-surgical measure fails to improve your pain, surgery is an option. Surgery involves removes the diseased or inflamed portion of the tendon through a small incision on the front of the knee. A very good reference for exercises you can share with your doctor to see if they feel they may be appropriate to treat your case of patella tendinitis. There has been relatively new research (2018) in the physical therapy literature showing that Heavy Slow Resistance, or HSR type exercises might actually be more beneficial than eccentric exercises. Heavy slow resistance training for patella tendinosis has been shown to be as effective or more effective than eccentric training in some studies.
Recovery from patellar tendonitis
Most athletes will recover within 6-12 weeks. This will include a short period of rest (if necessary) followed by a training period with an Athletic Trainer or Physical Therapist. We need to make it very clear :-). REST does not mean lie down on a couch, or a bed and do nothing. Rest does not imply using a brace. Rest is relative term. In this case rest means not playing basketball. No explosive jumps, no quick sprints. You should start simple “isometric” exercises, and progress to HSR and eccentrics as the tendon pain cools down. Complete rest is almost never the right treatment for an overuse tendon problem.
Finding a good therapist is critical. Quality PT for a jumpers knee does not include “stim” or utrasound… it involves load, and exercise. It involves carefully monitoring the athlete to determine what type of load or exercise to start with, and how to progress them to allow them to recover, without causing too many setbacks. Setbacks can and will occur during the recovery. But as the weeks progress you and your physical therapist will find the proper amount of load that your patella tendon will handle. That will minimize the setbacks later in the treatment process.
Surgery for a jumpers knee is very rarely necessary. If surgery is necessary it will take up to 12-16 weeks to be able to return to play. In young athletes, this may become a recurrent problem. That means that it can come back again in the future. Keeping up with your eccentric quadriceps strengthening in the off-season is important to minimize the risk of recurrence.