Patellar Tendonitis (Jumper’s knee)

Jumpers knee

Jumper’s knee is also known as patellar tendonitis or patella tendinopathy. It is an overuse injury causing pain at the front of the knee, specifically at the bottom of the kneecap (patella). Here we explain the symptoms, causes and treatment of Jumper’s knee.

Symptoms

Causes

Treatment


Patellar tendonitis symptoms

Symptom of Jumper’s knee are:

  • Pain at the bottom of the patella (kneecap) known as the lower pole of the patella.
  • Symptoms usually occur gradually over time. You will be unlikely to be able to pinpoint an exact time of injury. However, at times pain can flare up and be acutely painful.
  • Pressing in over the bottom of the patella will be tender.
  • Your patella tendon may appear larger or thicker than the uninjured knee.
  • Aching and stiffness after exercise, and in acute cases, pain when contracting your quadriceps muscles or squatting.
  • In particular, jumping activities are likely to cause most pain or discomfort, hence the term Jumper’s knee.

Patellar tendonitis can be a tricky condition to treat and requires a substantial period of rest and a thorough treatment and rehabilitation program. If you do not look after this injury then you may end up needing surgery.

Mike Walden, Sports Therapist


How bad is my Jumper’s Knee?

Jumper’s knee injuries are graded from 1 to 4 depending on how bad your pain is.

Grade:

  • 1: Pain only after training.
  • 2: Pain before and after training but pain eases once warmed-up.
  • 3: Pain during training which limits your performance
  • 4: Pain during everyday activities

Other signs will include a thickening of the affected tendon which may also have redness over the area. It is likely that an athlete with patella tendonitis will have a weak vastus medialis oblique (VMO) muscle on the inside of the thigh as well as significant weakness in the calf muscles. VMO is important in keeping the kneecap tracking correctly which in turn affects the direction of the forces through the patella tendon.


VISA pain questionnaire for Patellar tendonitis

The VISA pain questionnaire is excellent for monitoring symptoms which can often be difficult to describe or measure with a long-term chronic condition. The lower your score, the worse your injury. Do this regularly, for example, once per week to measure progress.

Download Jumper’s Knee pain questionnaire

Jumper's knee

Warning!! – This injury may seem like a niggling injury that is not that bad. Many athletes continue to train and compete on it as it may not be a debilitating injury and recovers after a short period of rest. However, neglect jumper’s knee at your peril! If left to become chronic it can be very difficult to treat and may require surgery.



What is Patellar tendonitis/tendinopathy?

Jumpes knee

Patella tendonitis is inflammation of the patella tendon at the front of the knee. In chronic, long term cases, wear and dear or degeneration is more likely than acute inflammation, hence then term ‘tendonopathy’ is often more appropriate.

Anatomy

The patella tendon, also known as the patella ligament, is extremely strong. It joins the kneecap (patella), to the shin bone or tibia. The large quadriceps muscles at the front of the thigh pull on the kneecap producing huge forces through the patella tendon, especially when jumping and stabilising the landing. The patella tendon also allows the quadriceps muscle group to straighten the knee.

As such this tendon comes under a large amount of stress especially in individuals who actively put extra strain on the knee joint such as those who regularly perform sports that involve direction changing and jumping movements.


What causes Jumper’s knee?

Jumper’s knee is an overuse injury. With repeated strain, micro-tears and collagen degeneration may occur in the tendon. This is known as patellar tendinopathy or Jumper’s Knee.

In practice, the majority of chronic cases are more likely to be degeneration of the tendon rather than acute inflammation, which should settle down after a few days rest.

Although it is an overuse injury there are a number of factors which may make people more likely to suffer from this injury including poor foot biomechanics, weak quadriceps muscles, and incorrect training practices.


Q angle of the knee & VMO

normal and abnormal q angle of the knee

The Q angle of the knee refers to the angle of the femur (thigh bone) to the tibia (shin bone).

q angle knee rehabilitation

Often athletes with patella tendonitis will also have poor Vastus medialis obliquus (VMO) function. This is the muscle on the inside of the quadriceps near the knee.

They may also have significant weakness in the calf muscles.

More on Q angle


Jumper’s knee treatment

The aims of treatment for Patellar tendonitis are to reduce pain, stretch the quadriceps muscles and gradually increase the load through your knee.


Cold therapy

Cold knee wrap
Cold knee wrap

Apply the PRICE principles of protection, rest, ice compression and elevation. Apply cold therapy on a regular basis, especially during the first 24 to 48 hours and after any form of exercise.

A cold therapy wrap or gel ice pack is ideal. If the tendon is painful then ice can be applied for 10 minutes every hour reducing the frequency as your symptoms improve.

Buy Cold Knee Wrap (USA)


Jumpers knee taping

A simple patella taping technique can help relieve the symptoms of patella tendonitis. It works by changing the direction of forces transmitted through the tendon.

By compressing your patella tendon just below the knee, the angle at which the tendon pulls on the patella is varied, therefore reducing strain on the painful area.

More on Patella tendon taping


Patella tendon strap

Jumpers knee brace

Wear a knee support, or jumper’s knee strap to reduce pain and ease the strain on the tendon.

A jumper’s knee strap wraps around the tendon just below the knee changing the angle of the tendon against the patella which changes the part of the tendon the forces are transmitted.

Buy Patellar tendon strap (USA)


Medication

A doctor may prescribe anti-inflammatory medication e.g. ibuprofen. Do not take ibuprofen if you have asthma and check with a doctor before taking any medication.

It is thought that anti-inflammatory medication may help in the short term with acute inflammation and pain but may even hinder healing later on.


Electrotherapy

A professional therapist may use electrotherapy in the form of ultrasound or laser treatment to reduce pain and inflammation and aid the healing process


Massage

Patella tendon massage

Cross friction massage to the tendon after the initial acute phase may also be beneficial, particularly for more chronic cases. Frictions are applied across the tendon to help realign new fibres.

Deep friction massage may trigger an acute response, stimulating the healing process. Thigh massage may help loosen thigh muscles and increase the effectiveness of stretching exercises.

How to apply cross friction massage


Injections

Aprotinin injections may help tendinopathies by restoring enzyme balance in the tendon. If the knee does not respond to conservative treatment, surgery may be required.


Exercises

Quadriceps stretching

Both stretching and strengthing exercises are important. Stretching exercises for the quadriceps muscles at the front of the thigh should be done regularly. This will lengthen the muscles and place less stress on the tendon.

Eccentric strengthening exercises are the most important and thought to stimulate healing. Drop down slowly into a squad, or single-leg squat. Then push up more quickly, using the good leg to help.

More on Patella tendonitis exercises


Surgery

video

The surgical procedure for treating jumpers knee can vary depending on the individual and the surgeon’s preference. The success rate of about 60-80%. You may not ever return to the level of sport you had before the operation – many do though. It could take 6 to 12 months to return to competition after surgery.

Surgery may be indicated (needed) only after conservative methods have been properly tried first.

Surgeons differ in their approach to treating Patellar tendonitis. In most cases, a longitudinal or transverse incision is made over the patella tendon. Abnormal tissue is then removed. Some prefer a longitudinal cut into the tendon and some prefer a transverse one. They may take out the abnormal tissue. Some will do the operation by arthroscopy (keyhole surgery) and others may prefer open surgery.


video

References

This article has been written with reference to the bibliography.
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