Patellar tendinopathy

Irritation of the patellar tendon

Patellar tendinopathy

What is the patella tip syndrome and how does it develop?

The patella tip syndrome (jumper’s knee, patellar tendonitis) develops when the patellar tendon (patellar ligament) is irritated by unaccustomed or excessive tension forces. For example, in sports that involve intensive jumping (basketball, volleyball), activities that involve many stop-and-go movements (tennis, badminton) or quick changes in direction (football).

The patella tip syndrome is also widespread among runners, which is why it also called jumper's knee or runner's knee1. Thepain is felt around the tip of the kneecap.   

What is patellar tendinopathy and how does it start?

The following synonyms are used for patellar tendinopathy:

  • Patella tip syndrome
  • Runner's knee
  • Jumper's knee

Anatomy of the knee joint

The knee joint is one of the most used joints in the human body. The thigh bone (femur), the shinbone (tibia) and the kneecap (patella) form the bony elements of the joint.

The patellar tendon (patellar ligament) connects the lower end of the kneecap (patella) to the shinbone. Its main function is to transmit forces from the thigh to the lower leg, which is why it is exposed to permanent stress during sports.

Risk factors and causes

Anatomical factors

  • The elasticity of the tendons diminishes with increasing age
  • Malalignment of the knee
  • Foot deformities
  • Shortened tendons or muscles
  • Anatomical anomalies, for example bowlegs, knock knees or a movement disorder (dysmetria)
  • Congenital ligamentous weakness (lax ligaments)
  • A previous history of Osgood-Schlatter disease, a painful condition of the knee joint at the level of the shin bone.

External factors

  • Unsuitable footwear
  • Wrong sporting techniques
  • Excessively hard surfaces, for example asphalt
  • Excessively intensive training sessions
  • Unusual stress, for example. when learning a new sport or when training is started too enthusiastically and the knee is subjected to extreme forces.

Sports

  • Sports that involve intensive jumping– volleyball, basketball, some disciplines in light athletics such as long jump or high jump – which is how it got its name, jumper's knee
  • Jogging – which is why it is also called runner's knee1
  • Sports with rapid changes of direction – football, handball
  • Sports with abrupt stop-and-go movements – tennis, squash, badminton

The various degrees of severity of the patella tip syndrome

Doctors do not normally divide the patella tip syndrome into different stages. This four-part classification helps patients understand the clinical picture better.2

Initially, the pain is usually only felt after sports. In the further course, the patient develops "start-up" pain and feels pain during exercise, or even during everyday activities such as climbing stairs or after sitting for long periods. The persistent character of the symptoms is typical. It is often a chronic clinical picture that persists for many months or even years. Phases with relatively little pain are repeatedly followed by phases when pain develops again after exercise. Patellar tendinopathy can affect both knees, this occurs in 20 to 30% of patients. The following techniques are used for diagnostic investigation: ultrasound examination of the blood vessels, magnetic resonance imaging (MRI), X-rays.

How patellar tendinopathy is treated

Patellar tendinopathy is usually treated conservatively, i.e. without an operation. Surgical intervention is only needed if the patellar ligament actually ruptures. The following methods relieve pain and can stop progression of patellar tendinopathy.

Physiotherapy exercises

Special exercises strengthen the muscles and increase mobility. They can also boost the healing process when carried out regularly. A doctor can prescribe physiotherapy. Depending on the findings, ultrasound treatment, electrotherapy (TENS), transverse friction (a special form of massage of the affected muscle and tendon fibres), shockwave therapy or manual therapy may be advisable as add-ons.

Stretching

Regular stretching of the muscles over the front of the thigh reduces the tension that acts on the kneecap.

Supports

Special medical supports stabilise the knee joint. Knee supports with a strap system, such as medi's Genumedi PSS, are particularly suitable for a specific reduction of the peak pressure and tension forces that act on the patellar ligament.

Cooling

Mild cold treatments with cold packs relieve pain (refrigerator temperatures of about 7°).

Warmth

A heat pad, a hot water bottle or a massage with a warm towel roll (towel immersed in warm water) promote the circulation around the tendon insertion.

Medication

If necessary, patients may take an anti-inflammatory drug such as ibuprofen or diclofenac for a week or two. But always ask the doctor treating you first.

Ointments

Anti-inflammatory creams or ointments can be massaged into the affected site several times a day. This promotes recovery.

Insoles

Orthopaedic insoles (for example igli Allround Light) correct the body's posture and support the knee joint at every step.

Massages

Massages ease muscular tension and relieve pain. Experienced physiotherapists can relax the muscles with just a few massage strokes and increase the circulation.

Treatment should be adapted to each patient individually to suit his special needs and the exact clinical picture. Patients with postural problems are advised to consult an osteopath.

The "Patella tip syndrome" guide – download

All-in-one physiotherapy programme for patella tip syndrome

Besides the single-leg squats on a 25° decline board described above, further exercises can be done to stabilise the knee joint and strengthen the patellar ligament in the long term. medi has joined Dr Matthias Marquardt, sports doctor and active sportsman, to compile a training programme. It contains eleven exercises, including the single most important exercise described above, that can be done quickly and simply at home. In the videos, Dr Matthias Marquardt teams up with the professional triathlete and physiotherapist Laura Philipp to show how the exercises are done correctly – ideally three times a week.

Please ask your doctor first whether the exercises are suitable for you.

Coordination

Exercises on the stabilisation pad are perfect for developing balance and coordination skills. Do these barefoot. Thanks to the soft foam material, you sink into the mat a little and have to compensate for the resulting instability. This improves proprioceptive skills (proprioception = awareness of the body in space) and strengthens the deeper muscles.

Standing on one leg

Jumping-jack

Mini knee bend

Strengthening

A dynamic exercise consists of two different movement phases: the eccentric and the concentric phase.

During the concentric (take-off phase, positive-dynamic) phase, a resistance is overcome. In the case of single-leg squats, this would be the knee straightening movement, during which the body weight is pushed upwards. The muscle – in this case the thigh muscle – shortens. The origin and the insertion of the muscle move closer together during the movement. Concentric movements are also often called positive movements.

During the eccentric (relaxing, negative-dynamic) phase, the muscles give way to gravity. In the case of single-leg squats, this would be the knee bending movement, during which the body weight is slowed down (deceleration movement). The muscle – in this case the thigh muscle – is stretched. The origin and the insertion of the muscle move further apart. The muscles stretch under the load. Eccentric movements are also often called negative movements.

Doing eccentric exercises has proved to be particularly successful in the treatment of patella tip syndrome.

Single-leg knee exercises

Single-leg knee bend with decline board

Lunge

Lunge with decline board

Bridging

Calf raise

Stretching & fascia training

Stretching and fascia training can ease the tension on the painful patellar ligament. Fasciae are connective tissue structures that surround and stabilise the muscles. A fascia roller stimulates the circulation to the tissues to improve tissue tone.

Iliopsoas muscle

Front of the thigh

Thigh rolling

Calf rolling

Supports from medi

medi has developed the knee support Genumedi PSS for conservative therapy of patellar tendinopathy. It combines the tried-and-tested properties of a support with the additional benefit of a patellar support strap: the support safely and reliably guides and stabilises the knee joint and relieves tension on the insertions of the patellar ligament.

Click here for more information about medi's Genumedi PSS knee support.

Click here for an overview of all topics covering diagnosis and treatment

Sources

1 The term "runner's knee" is often also used as a synonym for the iliotibial band syndrome (ITBS) or iliotibial tract friction syndrome. ITBS is considered the most common cause of pain over the outside of the knee. It occurs predominantly in long distance runners. The iliotibial tract is a fibrous band. It runs from the anterior superior iliac spine on the front of the pelvis over the hip joint and the knee joint to the outer border of the tibia. Due to the constant flexion and extension of the knee joint when running, the tract rubs against the epicondyle of the thigh – like a rope over the edge of a rock – and this irritates the fibrous band and thus leads to ITBS.

2 Roels et al., 1978

3 Eccentric training means loading a muscle or a tendon by slowing down a weight or a resistance.