Patella Tendinopathy Overview.
What is it?
Patella tendinopathy is defined as pain and dysfunction in the patella tendon. The patella tendon (which is sometimes referred to as the patella ligament) sits at the front of your knee and attaches your kneecap to the top of your shin bone. When the quadriceps (front thigh) muscles contract, the patella tendon acts as a pulley and helps extend or straighten the knee.
A tendinopathy usually develops when the tendon is overloaded or subjected an abnormal amount of load the supporting muscles and tendon cant tolerate.
The tendon is overloaded when subjected to increased tensile or compressive loads such as a sudden increase in jumping activity, sudden increase in deeper and heavier squats etc.
This overload causes small cells in the tendon called tenocytes to be stressed. In turn, this can lead to a release of cells called proteoglycans. The proteoglycans attract water into the tendon which can cause the tendon to swell and thicken. This increased water content pushes apart the collagen fibres, causing microdamage and/or leaving them predisposed to damage. The body reacts by increasing blood flow to the injured area which is thought to be possibly be an inflammatory process. This whole process can be painful and cause dysfunction.
Its important to note, that several other factors as well as overload can predispose someone to developing a tendinopathy. These include genetics, BMI, hormonal changes, psychosocial factors, age etc.
The tendon is overloaded when subjected to increased tensile or compressive loads such as an increase in jumping activity, sudden increase in deeper and heavier squats etc.
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Signs and symptoms of a Patella Tendinopathy
Patella tendon pain is very localised and pain is felt below the kneecap. Pain is rarely felt at rest and usually felt when the tendon is under load during activity such as squats, jumping, stairs, getting out of a chair (particularly after prolonged periods of sitting).
With a sustained activity such as hill walking, discomfort might be felt for the first few minutes, but then it might ease off later in the walk. The following morning, symptoms may be more prevalent.
Some local swelling/thickening may be evident in the tendon itself, but patella tendinopathy is not usually associated with global swelling of the knee.
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Who typically gets patella tendinopathy?
This condition is more prevalent in younger athletes (typically aged 15-30) that participate in explosive sports such as volleyball, basketball, high jump. Runners and those that partake in sports require repetitive loading of the patella tendon are also prone to this condition. Amongst elite volleyball and basketball players, the prevalence of the condition is thought to be upto 40%. The biggest extrinsic risk factor is thought to be an overload due to an increased training volume, (intensity, frequency and/or duration).
Males are more likely to suffer and an increased BMI and weight is also thought to be a contributing factor. Other intrinsic factors such as muscle length discrepancies, reduced ankle range of motion, leg length issues and reduced arch height have also been shown to predispose individuals to patella tendinopathy.
(All these can be conducted in a virtual capacity via an online physiotherapy assessment. See our services page for more info)
Differential Diagnosis of Patella Tendinopathy
Other conditions can appear similar to a patella tendinopathy and through subjective history and objective examination, they can be ruled out. These include:
· Patellofemoral joint pain
· Fat pad irritation
· Illiotibial Band Syndrome.
· Infrapatellar Burisits
· Plica syndrome
Patella Tendinopathy is thought to be prevalent in upto 40% of elite volleyball players.
What will Physiotherapy involve for patella tendinopathy?
Physiotherapy is the first choice of treatment for patella tendinopathy. At Physiohub, we have found that we can effectively assess and manage patella tendinopathy in a telehealth setting/via online physiotherapy.
Your physiotherapist will first need to complete a thorough subjective history to identify aggravating activities, easing factors, loading history. This will enable the physio to accurately diagnose and get a better understanding of the irritability of your tendon and your current load tolerance. You maybe asked to complete a short questionnaire too which is specific for patella tendon pain and will help us monitor progress (Visa-P).
A full objective examination will then need to be conducted. At Physiohub, we have produced bespoke online physio assessment videos for a series of movements and tests that will guide you through the assessment process. This will enable us to accurately diagnose your condition in a remote setting (or via a telehealth setting). The online physiotherapist will guide you through a series of tests including:
· Joint Range of Motion
· Muscle length tests
· Functional tests
· Load Capacity tests
· Balance tests
· Control tests
· Kinetic chain/Biomechanical evaluation
· Self palpation
Physiotherapy Management of Patella Tendinopathy.
The treatment for patella tendinopathy in a clinical setting or remote setting is always exercise based with an emphasis on the load management. Exercise based therapy is supported well with evidence. The main aim of exercise therapy and load management advice is to improve the load tolerance of the tendon and supporting muscles to facilitate healing and a return to activity. Other factors will be addressed too including other strength/control/kinetic chain deficits.
Depending on a number of individual factors (such as the stage of your tendinopathy your irritability and current load tolerance) the physiotherapist will guide you through a rehab program similar to the one outlined below (taken from Malliaris et al 2015). Advice will also be provided when and if to rest.
Physiotherapy management on Patella Tendinopathy as proposed by Malliaris et al 2015.
How long does it take for patella tendinopathy to get better?
There is no answer for this, but unfortunately patella tendon issues can be particularly stubborn and research and anectodal evidence show they can take a while to resolve. A study by Bahr and Bhar (2014) showed that only 46% of athletes had returned to full training and were pain free at 12 months.. Managing expectations and understanding recovery timeframes for this complaint is vital to help manage Patella Tendinopathy.
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If you feel you may have a Patella Tendinopathy and would like to speak to one of our online physiotherapists, feel free to contact us to discuss this.
Similarly, for some training tips or advice on how to reduce your risk of Patella Tendinopathy, get in touch
Physiohub is an online physiotherapy company. We offer a 100% virtual service providing remote physiotherapy assessments, online physiotherapy treatment, online rehabilitation sessions and online DSE assessments. To learn more about the services we provide, see our services page.