Patellar tendinopathy is a common diagnosis in runners and other athletes. It is important to distinguish the difference between patellar tendinopathy and other common diagnoses of the knee in order to establish the best course of treatment. Keep reading to understand the differences between common diagnoses and how you can address patellar tendinopathy to get back to your running regimen.
**This is not medical advice. Please consult your medical provider for more information.
Common Causes of Knee Pain
Patellar Tendinopathy
Patellar tendinopathy, aka jumper’s knee, is characterized by pain in the front of the knee along the inferior pole of the patella. This is the bottom-most region of your kneecap. Pain is worse when there is repetitive loading of the quads – the muscle group that extends (straightens) the knee. It is very common in athletes in sports such as volleyball, basketball, jumping events, running, and tennis.
The patellar tendon acts as a pulley system to extend the knee. When the quadriceps contract, it creates a pull down to the tibial tuberosity by way via the patellar tendon. Every time the quads contract, this load travels through the tendon to create the knee extension motion.
Stress to the patellar tendon is normal, but too much can lead to injury. Patellar tendinopathy can occur very quickly or over a length of time. When this pain comes on quickly, it is typically due to excessive repetitive loading of the quad in a short amount of time. This is commonly seen in the weekend warrior or someone who is returning to working out or participating in a sport after a long break.
Loading the patellar tendon over a length of time can eventually lead to inflammation. This is usually a low load over a long period of time. This pain comes on much more gradually.
Specifically, there are two types of pathologies that can generate this anterior knee pain – patellar tendinitis and tendinosis.
Patellar Tendinitis vs Patellar Tendinosis
Patellar tendinopathy is a general term that encompasses patellar tendon health. It can be further separated into two main conditions: patellar tendinitis and patellar tendinosis. Patellar tendinitis refers to inflammation of the patellar tendon. Patellar tendinosis refers to degenerative changes within the collagen fibers that make up the patellar tendon.
While both refer to pain at the inferior pole of the patella during quadricep loading, patellar tendinosis is a more progressive form since degeneration of the collagen protein fibers has occurred.
Patellofemoral Pain Syndrome (PFPS)
It is important to distinguish the difference between patellar tendinopathy (jumper’s knee) from patellofemoral pain syndrome (aka PFPS).
PFPS is a general term that refers to pain arising from the patellofemoral joint and surrounding tissues. It is an umbrella term because there is usually not one cause for this syndrome and is most likely multifactorial.
While PFPS can come from trauma to the patella, it is most likely a combination of muscular imbalances, poor patellar tracking, and excessive loading of the patellofemoral joint.
Differential diagnosis is important when dealing with anterior knee pain because the treatments are different.
Symptoms of Patellar Tendinopathy
The symptoms of patellar tendinopathy are pain at the inferior pole of the patella during loading activities. This can involve squatting and going down stairs. The pain usually stops when the load is removed. Deeper squat depths are going to be more painful as this places a greater load on the quads. Repetitive loading can sometimes reduce pain levels. Overall it is important to note that the degree of pain usually increases with the magnitude of the load.
How Do I Fix Patellar Tendinopathy?
Evidence shows that eccentric loading of the tendon has been most beneficial with reducing pain and returning to function. Heavy slow eccentric exercises load the patellar tendon and help with collagen tissue normalization.
Multiple studies have tested different protocols for tendon loading. A single-leg decline squat was shown to be more beneficial than a single-leg flat squat. Heavy slow eccentric exercises were also beneficial and had greater long-term outcomes than decline eccentric exercises alone.1
When training for return to sport, it is important to continue to progressively load the tendon with sport-specific tasks. Alternating between medium and high load days can be helpful for not loading the tendon too much, too quickly.1
When Can I Return to Running?
Returning to running should start with incremental loading (aka shorter distances and on flat terrain if possible). This will help minimize changes of flare ups. Continuing to progressively load the patellar tendon between running days is also crucial. As long as symptoms are managed and flare ups are not occurring, it is safe to return to running. Remember, patellar tendinopathy typically develops from excessive loading. Thus, managing the load when returning to sport is critical to prevent reoccurrence of pain.
How to Reduce Chances of Developing Patellar Tendinopathy
Movement analysis and kinetic chain loading should be prioritized with all athletes. Ensuring proper form and appropriate muscle recruitment will help with longevity in sport and reducing chances of reoccurring injuries.
Muscular imbalances are one of the biggest drivers for this type of injury. Are the major muscle groups around the knee stiff? If so, take some extra time to stretch and use the foam roller. When you squat, are your heels coming off the ground? This can place extra stress on the front of the knee. Or are you jumping into high intensity activities too quickly without proper training or adequate warm-ups? Implementing a few of these examples could be helpful, though remember this is not an all inclusive list and may not be geared towards your particular issue at hand.
Try Out Exercises and Tips For Your Knees Here:
- Knee Pain Hiking Downhill: Prevention and Treatment
- Physical Therapy Exercises for Knee Pain: How to Reduce Arthritic Pain
- Knee Pain Walking Down Stairs? This Can Help!
Related Articles For Runners:
- 5 Reasons Why Balance Exercises are Important for Runners
- Pain When Walking First Thing in the Morning? Try These 7 Exercises for Plantar Fasciitis
- Weak Ankles Running? Stabilization and Strengthening for Pain Free Running
References
- Rudavsky A, Cook J. Physiotherapy management of patellar tendinopathy (jumper’s knee). J Physiother. 2014;60(3):122-129. doi:10.1016/j.jphys.2014.06.022
TL;DR
Patellar tendinopathy is a common overuse injury characterized by anterior knee pain at the inferior pole of the patella due to excessive loading of the quads. It is important to distinguish jumper’s knee from other diagnoses in order to ensure proper treatment and recovery. Eccentric tendon loading is most beneficial for patellar tendinopathy and a slow progressive return-to-sport plan is needed to help reduce instances of flare ups in runners and other athletes.
