Anterior knee (front of knee) pain is a common and prevalent knee complaint treated and managed by physiotherapists. Patella tendinopathy, commonly referred to a as jumper’s knee is one of the more common causes behind anterior knee pain.
Patella tendinopathy is localised pain and dysfunction over the patella tendon typically reported during jumping and landing, squats, stairs, running and kneeling on the tendon. It can affect people across the lifespan from adolescence to middle age. It is a classic overuse injury and typically has a gradual onset of symptoms. This injury is most common in the sporting population due to over training but is also prevalent in the general population due to compression or increased load on the tendon.
Diagnosis of a patella tendinopathy will be a result of clinical testing by your physiotherapist and can be, but is not essential to be confirmed with imaging. It is very common to see degeneration to the tendon under imaging without the symptom report of pain from the subject.
When diagnosing Patella tendinopathy it is important to rule out other causes of anterior knee pain such as patellofemoral joint pain, patella bursitis, patellofemoral OA and fat pad irriation.
CAUSE OF PAIN
The cause of the anterior knee pain is due to the patella tendon having undergone either compression or loading force greater than the usual force it experiences. When we say usual, this means the force the tendon is subject to in one’s everyday activities. When a tendon is subjected to higher loads it will react and become painful. It is at this point that specific loading management is vital for a successful and timely recovery. If the tendon is continually loaded whilst reactive it will continue to undergo dysfunction and degeneration. The diagram below describes what happens with ongoing loading of a pathological tendon.
RISK FACTORS FOR PATELLA TENDINOPATHY
There are 2 types of factors that will increase your risk on developing a patella tendinopathy. Extrinsic and Intrinsic.
EXTRINSIC FACTORS:
- Increased training volume and frequency
- Hard surfaces
- Footwear
- Blunt force trauma or direct contact
INTRINSIC RISK FACTORS:
- Research has found males 4 times more likely to develop patella tendinopathy.
- Landing technique
- Research has found in men, foot arch, leg length differences and knee angle were contributors
- Lower limb biomechanics of hip and knee control and dynamic postures can contribute to patella tendinopathy
TREATMENT AND MANAGEMENT OF PATELLA TENDINOPATHY
EDUCATION
It is important to be educated and advised on the likely time frames around the injury and how to effectively manage load. Depending on the severity of the tenon dysfunction and pain, it is possible to continue training and playing sport, however, it may require taking 4-6 weeks of relative rest and decreased loading before commencing back at training. Tendons typically take 6-12 months to heal fully and have a delayed response to load of around 24 hours. It is vital that load is managed through the tendon long term to ensure it heals.
EXERCISE
Exercise has been well researched in the literature with isometric holds and eccentric load being the most supported. Sustained quadriceps holds at 45-60 sec for 4-5 reps have been proven to have an analgesic effect (pain relief) on the tendon for up to 5 hours. It is important that the progressive exercise rehabilitation program is prescribed by and progressed by a physiotherapist.
OTHER TREATMENTS
Passive treatments such as joint mobilisation can be helpful in the short and long term. Ultrasound and transverse friction massage were shown to be less effective than exercise in the short and long term and braces and splints were also demonstrated to have no clinical benefit. Extracorporeal shock wave therapy, plasma rich platelet injection and corticosteroid injections lack evidence for their use in patella tendinopathy. Corticosteroid injection especially in degenerate tendons are not indicated and are associated with poorer outcomes.
As always it is recommended to seek the advice of an experienced physiotherapist to ensure a successful recovery from patella tendinopathy.
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