A Google search of, “patellar tendonitis,” gets around 48,600 hits. “Jumper’s knee,” about 148,000. Most people get the two confused, but it’s one of those “the same but different” situations. Patellar tendonitis is an acute inflammation of the patellar tendon, the strong rectangular band that connects the knee cap to the shin. It’s not much of an injury, just a temporary problem. On the other hand, jumper’s knee is a chronic condition. The tendon is no longer inflamed, and it’s technically not tendonitis, but rather tendinosis or tendinopathy, which means the tissue is degrading.
The patellar tendon is the tendon that connects the kneecap to the front of the shin. It transfers a significant amount of force each time we jump and can get damaged if we overuse it. This condition is also referred to as “Jumper’s Knee”. The umbrella term for damage to the patellar tendon due to overuse is patellar tendinopathy. Depending on how far the problem has progressed, you’re either dealing with patellar tendonitis or patellar tendinosis. The difference between the latter two is that tendinitis is used to describe inflammation of a tendon that has not degraded (yet) and tendinosis is a condition in which the tendon has already degenerated. In other words, you develop patellar tendinosis by ignoring the symptoms of patellar tendonitis.
- Symptoms of Patellar Tendonitis
- Main Causes
- Diagnosis of Patellar Tendonitis
- Personal Experience
- Recommended Training Schedule
If you’re going to play a game of hoops it will shake out like this:
Patellar Tendonitis – no problems before or during game, but some soreness, pain, or flare ups after.
Patellar Tendonosis – you have to warm up an extra 20 minutes so your knees feel good, and even then you’re playing through pain.
With tendonitis, pain usually nestles below the knee cap in the tendon itself. With tendonosis, however, it’s common for the pain to creep above the kneecap. Regardless, it all happens in the same band of tissue that forms from the rectus femoris and the convergence of the quadriceps. Most resources say both conditions are caused from overuse, and cured by rest-ice-compression-elevation (RICE), quadriceps exercises, stretching, and painkillers.
If it were only that easy.
Sometimes your kneecap gets pulled in a direction that displaces it from its normal groove. Because of this, it doesn’t glide where it is supposed to. The body responds with a lot of pain, and a lot of noise (usually crepitus). Don’t confuse tracking problems with a true dislocation. Your steering wheel may be misaligned, but your tire didn’t fall off.
Tendonitis and tracking problems are a small portion of a category called “patellofemoral pain”, which translates to pain around the kneecap.
Chondromalacia, an irritation of the knee’s cartilage, is another common problem. Once again, Google consultation reports symptoms of pain in or around the knee and treatment by strengthening exercises, RICE, and pain killers. It’s sad to say, but the name is arbitrary when it comes to patellofemoral pain. Treatment is the same.
Initially, patellar tendonitis will make itself felt as the pain accompanying the inflammation in the tendon below the kneecap, but with repeated tissue damage, cellular degradation will set in. The body is unable to repair the damaged tissue and patellar tendonitis turns into patellar tendinosis: a painful chronic condition that will take months to heal, especially if the athlete lacks commitment to getting healthy before competing again. Ignore patellar tendonitis and your pain will get worse, your condition will become more permanent and your weakened patellar tendon will be more prone to tearing.
Causes of Patellar Tendonitis
One reason why the patellar tendon can get overworked is tightness in calves and hamstrings. Tight hamstrings can be the result of weak gluteals and overactive hip flexors. Under these conditions the knee is more likely to travel forward when cutting or landing from a jump, which leads to higher tendon stress. Additionally, every time you fully straighten your leg you have to do so against the added resistance of your tight calves and hamstrings.
Medical opinion is divided over the exact cause of Patellar Tendonitis or jumper’s knee. What is pretty certain though is that it is usually caused by overuse.
The activities responsible for bringing about the problem include the following:
1) Intense Running (especially long distances with a great deal of ascending and descending)
2) Jumping (e.g. basketball, high jump and long jump)
3) Constant stop-starting (e.g. football, tennis, badminton, squash)
4) Squatting (e.g. working in confined spaces, lifting)
5) Kneeling (e.g. floor layer, ground worker)
More than Overuse
Overuse alone though cannot fully account for the problem, otherwise every trained runner or jumper would develop it over time.
You may find that a physiotherapist will quickly decide the cause is overuse, especially if you partake in any repetitive activity. In this case they will likely advise complete rest and some treatment to reduce the inflammation.
For anyone who is even vaguely serious about their sporting activity though, complete rest for an indefinite period of time seems an excessive reaction, especially if the injury is relatively new.
In the vast majority of cases patellar tendonitis can be treated and recovered from without the need for long periods of complete rest. Whilst I completed my own treatment I was increasing my training at the same time as I dealt with the root cause. If this is done in the right way patella tendonitis can be trained or worked through.
Very Common Cause
In my case the injury was caused by a muscular imbalance in my quadriceps and this seems to be a very common catalyst.
Tell-tale signs of this problem would include aching muscles in one leg much sooner than the other leg when doing an activity which stresses the muscles. The weaker leg muscles give in to fatigue much quicker and also take longer to recover after an activity.
Tell Tale Signs
In my case the left quadricep muscles, especially the vastus medialis, began to ache much sooner than any other muscles when running. I began to realise my left quadricep muscles were considerably weaker than my right. When i stood in front of a mirror this slight imbalance was visible – the right muscle group was better developed than the left.
My physio at the time confirmed the imbalance but unfortunately suggested nothing useful to rectify the problem. I attempted to redress the imbalance myself but without knowing which muscles to target, or how hard to work the knee whilst inflamed, my efforts didn’t bear much fruit and the problem worsened.
As well as causing muscles tightness and continued stress on the patella tendon a muscular imbalance may also cause leg misalignment’s and raised kneecaps.
Dealing with the Cause
If a muscular imbalance sounds like the cause of your own patellar tendonitis it is very likely that the treatment which worked for me will also work for you. If the injury is being caused by overuse alone it is likely that you have done too much of a repetitive activity too soon.
The obvious course of action in such a situation would be to reduce your workload until your muscles have adjusted to the new demands being placed on them. In either case my advise would be to read the information on this site regarding causes and symptoms to determine the root cause of your own patellar tendonitis.
Diagnosis of Patellar Tendonitis
If you have recurrent pain in the front knee area along with tenderness between the knee cap (Patella) and the shin bone (Tibia) it is possible you have patellar tendonitis (jumper’s knee).
The likelihood of this being the case increases significantly if you regularly partake in a sport which places stress on the quadricep muscles and also requires repetitive bodyweight movements.
If you suspect that you may have developed the problem it is necessary to see your G.P or a physiotherapist.
They will likely ask questions about your regular activity and make an examination of the tender area by placing pressure on the patella tendon. The degree of discomfort you experience will give some indication as to how advanced the injury is.
They will also check whether the kneecap is raised which would result in additional strain on the tendon.
These simple steps are usually sufficient to make a strong diagnosis.
If there are other factors which become apparent during the examination it may be necessary to undergo further tests in order to rule out other possible injuries. These tests may include an MRI scan or ultrasound which would simultaneously confirm the extent of the patella tendon involvement.
- Osgood Schlatter disease which is an inflammation of the tibial tubercle – the bony lump below the knee
Once each of these possibilities has been ruled out and the probable causes of your patellar tendonitis have been ascertained it is time to use the treatment and rehabilitation information on this site to ensure a swift and final recovery.
Common Treatments for Patellar Tendonitis
Common treatment for patellar tendonitis tends to focus on reducing the inflammation of the tendon and then taking gentle steps to reduce the likelihood that the tendon will become aggravated again during exercise. In my experience each of the measures discussed below will help to get rid of patellar tendonitis in the short term whilst the leg is rested.
1. Complete rest from the sport or activity which is likely to be responsible for the injury.
2. Ice treatment 2-3 times a day for 10-20 minute periods to alleviate any swelling and ease the soreness.
3. Anti-Inflammatory Medication to speed your recovery. These could include Ibuprofen, Aspirin, Motrin, Naprosyn, Celebrex or others.
4. You may be advised to wear a patella tendon strap or knee support wrap until the tenderness is alleviated.
- Strengthening of Quadricep muscles: This would include specific exercises to strengthen the muscles which provide the key support for your knee during exercise. Eccentric strengthening exercises can often help treat and prevent patellar tendinitis if the root cause of the problem is inadequate conditioning. Eccentric strengthening exercises and other helpful techniques are shown here.
- Strengthening of other supporting muscles: The calve and buttock muscles also provide much needed support to the knees during rigourous exercise. It is advisable to incorporate some of the exercises found here during your recovery.
- Changing your body mechanics: It may be necessary to learn new ways of walking, running or jumping, depending on the cause of your tendonitis. This will change the way that stress is placed on and through your joints.
- Iontophoresis: This technique involves the use of a small device which delivers medication through the skin and onto the tendon using an electrical charge. It is likely that this treatment may be repeated several times throughout the recovery period with a small amount of corticosteroid medication delivered each time.
- Corticosteroid injection: A Singular injection into the area around the patella tendon can significantly decrease the tenderness and allow you to perform the strengthening squats and leg extensions which may not be possible otherwise.
- Massage Therapy: This would involve regular transverse (cross) friction massage on the patellar tendon. This increases blood flow to the tendon and helps to remove scar tissue which increases the propensity of the knee to become inflamed. Massage therapy is a key aspect of the treatment that worked for me and is described in greater detail here.
A thorough treatment of patellar tendinopathy includes abstinence from competition, improving your posture,working on your tissue quality, correcting low tissue length, enhancing ankle, as well as hip mobility and retraining your posterior chain. Movement quality and force absorption skills should also be addressed. All of these are taken care of by the program at the end of this book. Additionally, the dietary and lifestyle advice will improve your recovery, allowing a faster healing process. It will not happen overnight though. Additionally, eccentric squats on a decline board can be used to speed up the healing process of the patellar tendon.
Prevention of Patellar Tendonitis
Since the primary causes of patellar tendonitis tend to be overuse, muscular imbalance or pronation, it is advantageous to anticipate these problems before they cause the injury.
There are a number of key ways to do this, each of which is explored in much greater detail elsewhere on the site:
1. Adequate Warm Up before sport
2. Careful monitoring of incremental training – listen to your body!
3. Exercises to strengthen the muscles surrounding the knee
4. Wearing the correct footwear for each sport or activity
5. Possible use of orthotics to control pronation
6. Corrective strength training if a muscular imbalance exists
7. Weight loss if necessary
8. Wear a patella tendon strap before the injury becomes severe
Each of these measures will provide some protection against patellar tendonitis, though the most effective preventative measure will depend upon the individual cause of your injury.
If you are already suffering with patellar tendonitis please refer to the causes and diagnosis sections of the website to further explore why the problem has arisen. As you begin to treat the root cause you can also use the most effective preventative measures listed above to prevent a repeat of the issue.
If you do not yet have the injury but feel it is something that may develop through sporting activity or work you need to consider the usual causes of the injury in this area. Again, please refer to the causes section in order to determine how the problem may arise and commence the necessary preventative steps noted.
Prior to commencing any strengthening treatment to rectify the underlying cause of patellar tendonitis it is essential to have 3-5 days complete rest. During this period it is advisable to begin taking some medication and several important supplements which will really pay dividends once treatment starts.
Listed below, in the order of importance, are the recommended products:
Anti-inflammatories are strongly recommended during the initial complete rest period to alleviate the tenderness of the tendon before treatment. I suggest taking the full allowable dose of a nonsteroidal anti-inflammatory for the 3-5 day period, such as Ibuprofen, Motrin, Naprosyn, Celebrex or one of the many others.
Taking this medication will decrease pain and swelling quickly. Be sure to talk to your doctor before starting these medications for the 3-5 day period. You can choose from a wide-range of low price anti-inflammatories from the excellent stores below:
Glucosamine and Mega Cissus
Glucosamine supports the structure and flexibility of joints, helping to alleviate tenderness in the knee during treatment and making a recurrence much les likely.
Mega Cissus is a product I have also found extremely effective when treating patella tendonitis, significantly reducing the pain in the patella tendon and definitiely speeding up the process of strenghtening the tendon itself.
Both are available at very low prices from ‘my protein’ on the link below:
Since the success of the treatment hinges largely upon strengthening the quadricep muscles to provide additional support to the knee it of course depends upon building the key muscles above the knee. To boost this process I recommend taking a serving of whey protein 2-3 times a day whilst carrying out the treatment.
Both LA muscle and Maximuscle stock high quality, low cost protein, with next day delivery:
High quality creatine monohydrate is well known to seriously decrease recovery time between exercise sessions, ensuring that your quadriceps have recovered sufficiently between sessions, enabling the exercises to have their optimum effect.
There are a number of recovery aids which can make a real difference to your mode of treatment, your recovery time and the permanence of the recovery. I have found the following products and lifestyle changes to be the most useful:
The most important item you will need before undertaking any strengthening programme, to initially reduce the inflammation, is a support strap with an ice pack inside. This will be used during the recovery exercises also.
You will need two of these so as to replace the ice pack several times during exercise and stop the tendon inflaming as the ice pack warms. These are available at an excellent price from Physio Room or Physio Supplies on the banners below:
Leg Extension Machine or Bench:
You will also need a bench or machine on which to carry out leg extension exercises which are essential to strengthening the outside muscles on the quadricep, especially the vastus medialis – the muscle most likely in need of strengthening to provide support to the patella tendon.
If you are a member of a gym you will be able to use the leg extension machine, otherwise I can highly recommend the top quality, low price weights benches on offer at Powerhouse Fitness:
One of the major causes of patella tendonitis is excessive walking or running without adequately cushioned footwear. Even if you’ve developed the injury through everyday activites you need to switch to well-cushioned shoes to reduce the likelihood of a recurrence. If you’re a runner or a sportsperson the chances are your footwear will have played a part in developing the injury.
I recommend doing your general everyday activity in well-cushioned running shoes if at all possible. If this is not possible at least ensure that all sporting activity is carried out in reasonably new running trainers.
Nike not only have an elite cushioned system in their shoes but also sell cushioned socks to further reduce the impact to the knee. Check out their offers on these products below:
Patella Tendon Braces/Straps:
If you intend to continue training for a particular sport whilst undertaking strengthening exercises it is extremely advisable to wear a patella tendon brace or strap to maintain maximum stability through the knee. The price of these braces may vary, but in many cases the IRS allows the cost of the brace to be deducted at tax time. There are an array of tax calculators online that can assist you.
When you’re exercising the quadricep muscles with the intention of reducing shock through the knee in the long term, it is at its most vulnerable due to fatigue. The risk of inflaming the tendon further is drastically reduced if exercise is carries out with a brace or strap.
Both Physio Room and Physio Supplies have a wide range at great prices, or you may wish to consider one from among the huge variety at Amazon:
Exercises to treat Patellar Tendonitis
Eccentric strength exercises tend to be particularly beneficial for patellar tendonitis as they gently stretch the tendon at the same time as targetting the muscles that support it. I therefore advocate a variety of these movements. Below is listed the most effective knee strengthening exercises to ensure a swift recovery:
Body Weight Exercises:
Single Leg Eccentric Squats or Slant Board Squats:
This exercise tends to suit extreme or long-term cases of patellar tendonitis. This is due to the fact that conservative treatments haven’t resolved the root cause of the injury so it persistently returns each time high impact exercise or activty is undertaken.
The patellar invariably requires additional support and greater elasticity in the quadricep. This can be gained through eccentric loading on the patellar tendon. This is achieved through the use of a slant board which allows the patella tendon to be targetted whilst squatting.
To carry out the exercise stand on the injured leg on the slant board. Perform a slow squat, lowering yourself to almost a right angled position. Return to the upright position again.
You may use two legs to raise yourself if you wish as the important phase of the exercise for treatment purposes is the lowering stage. Lower yourself as slowly as possible to enhance the benefit of the movement. Build up to five sets of 15-20 repetitions on the afflicted knee every other day.
Quads Over Fulcrum:
This movement targets the area surrounding the patella tendon directly and should be done in a controlled fashion if the tendon is still tender.
Lie flat on your back with your injured leg on an object that raises your leg 4 to 6 inches off the ground. Relax your knee and let your lower leg fall over the raised object. Slowly tighten your quadricep muscles and raise your lower leg while keeping the top of your foot perpendicular to your shin bone. Continue to hold your leg up for five seconds, and repeat the exercise up to 10 times.
Ankle mobility is an important aspect of safeguarding against a repeat of patellar tendonitis, as it reduces the likelihood of the knee twisting awkwardly during exercise. This exercise quickly improves ankle mobility when it is carried out a couple of times a week.
Kneel upon a mat on your right knee with your left foot in front. Place a stick perpendicular to the floor by your left little toe. Keeping your foot flat on the floor, push your knee to the outside of the stick until you can no longer keep your heel on the ground. Repeat up to 15 times before switching sides. Perform up to three sets on each ankle
Static Quadricep Contraction:
Like the quads over fulcrum exercise above these quadricep contractions really target the muscles which offer direct support to the patellar.
Sit on the floor with a rolled-up towel under your knees and legs lying straight in front of you. Slowly tighten the quadriceps muscle of your injured leg and push your knee backward into the towel. Put your fingers on the vastus medialis obliquus, or inner quadriceps muscle, to feel it tighten as you perform the exercise. Hold the leg flat for five seconds and repeat up to 10 times
Exercises Using Weights:
Vertical Shin Exercises:
When carrying out exercises to treat the knee it is important to simultaneously strengthen the shins to reduce the probability of them twisting during exercise and putting strain on the patella tendon.
To strengthen the lower leg you should try and incorporate 2-3 sets of exercises such as the deadlift, the pull-through or the split squat into your treatment regimen. Please us the links provided to see videos of each movement.
Since these movements use weights to provide resistance they should be used lees frequently than body weight exercises.
Try and complete 3 sets of one of these exercises once a week. Complete sufficient repetitions in each set so that the third set is very tough. Maintain good form throughout each movement for the best results.
You will require a home gym with leg extension machine or a weights bench with a leg extension on it. You need to work the quadriceps as intensively as possible throughout each set of this movement.
Put enough weight on the machine to ensure that 3 sets of 10-12 repetitions is as tough as possible.
Sitting Knee Extension Vs. Resistance Band:
If the leg extensions above are too intensive due to the patella being tender you can carry out the same movement with a resistance band to reduce the stress on the knee.
Sit in a chair and tie a resistance band around the ankle of the patellar tendon that you are trying to strengthen. Tie the other end of the band around the front chair leg of the same side. Tighten your quadriceps muscles, and keep the top of your foot perpendicular to your shin bone and slowly raise the leg into the air in front of you. Perform one to three sets of eight to 12 repetitions of this exercise.
This exercise also improves the mobility and strength of the ankle to provide additional support for the patella tendon.
Put anke weights just above the foot and in a sitting position, with your leg suspended straight in front of you, point your foot forwards outwards and inwards. Repeat these three movements 10-12 times for 3 sets.
Complimentary Therapies for Patellar Tendonitis
As you undertake your rehabilitation from Patellar Tendonitis you may wish to include some complimentary therapy to increase the likelihood of a swift and permanent recovery.
The following activities are known to assist in recovering from patellar tendonitis if utilised in addition to the other treatments described on this site:
Radial Shockwave Treatment:
This involves the application of sound waves transmitted into the injured area. Many physios now offer this in addition to more traditional methods.
Radial Shockwave Treatment increases the metabolic activity around the tendon, stimulating the reabsorption of irritative calcium deposits and thereby assisting the body’s natural healing process,thereby reducing pain.
If the injury has been caused by running it will significantly aid the athlete’s recovery and the speed of their return to normal fitness levels if they include some supplemental training throughout the treatment period.
This could include sessions on the cross trainer, cycling or swimming to maintain aerobic fitness. It would also prove beneficial to incorporate daily exercises or a couple of circuit training sessions a week to improve overall body conditioning.
It is important not to aggravate the injury unnecessarily when cross training by staying clear of high impact activity.
If the injury has been exacerbated by over-pronation it would be prudent to be fitted for orthotics. Orthotics are a specially fitted insert for the training shoe which correct pronation and relieve stress through the shins. This will in turn reduce stress on the patella tendon during high impact exercise.
Pronation can be confirmed through a running gait analysis which is now freely available in many running equipment shops.
Many sufferers of patellar tendonitis report a considerable improvement in the condition following acupuncture around the tendon area. Acupuncture is believed to be effective due to the release of pain killing substances such as endorphins and the pain-gate theory which states that stimulation in one area of the body will override the pain sensations in another.
The benefits of this are obvious in allowing needed strength training to be undertaken at an earlier stage.
My experience treating Patellar Tendonitis
In this section I want to tell you in detail how I got rid of Patella Tendonitis once and for all.
The muscular imbalance that caused my patellar tendonitis will also be the cause of the problem for many other people reading this.If this is the case the treatment programme that I describe below will resolve the underlying cause of your patellar tendonitis, as it did mine, and make for a swift and permanent recovery.
The exercises and treatment methods used in this treatment are described in detail in the relevant sections of the site. These can be accessed through the links provided below.The treatment that allowed me to recover from patellar tendonitis uses a combination of the techniques described on this site in a very specific way.
Some elements of the treatment I describe here may seem pretty tough but they are designed to allow you to continue exercising whilst recovering.Most importantly though, they work.
Dealing With Inflammation
The first thing to do before you can treat the cause of your tendonitis is to reduce the inflammation.
The best way to do this is to use an ice wrap at least twice a day for a minimum of ten minutes each time. When you begin this treatment I would recommend that you have a complete rest from exercise for at least 3 days, although you may need much longer if the patella tendon is very tender.
You will need a wrap which will hold the ice pack in place whilst you exercise the knee. These can be purchased very cheaply online from the store links on the left.
Once the inflammation has been dealt with and the soreness in the knee has significantly reduced it is time to begin rectifiying the weakness which has caused the problem.
Keeping the Tenderness Down
The important thing initially is to ensure that the tendon doesn’t become sore again once you start strengthening the quadriceps. The exercises which you will be doing to build up the inner and outer thigh muscles will place significant stress on the patella tendon, so it is necessary to keep the area cold whilst doing the movements. To manage this you should wear the ice wrap around the knee whilst you carry out the exercises.
It will probably be necessary to get a couple of ice wraps and have a spare plastic cold pack in the freezer to put into the wrap halfway through the movements when the first has warmed.
All the recovery aids you will need are described in the relevant section of the site along with a description of their individual benefits at each stage of recovery. I also describe the impact various supplements can make to a permanent recovery in the supplements section.
Time to Exercise
With the ice wrap on you are going to be doing a range of exercises according to the programmes below. How many repetitions of each exercise you need to do in each session will depend upon a number of factors, not least your level of fitness, the severity of your patella tendonitis and the strength of your quadriceps.
A range of body-weight and weighted exercises should be undertaken 3-5 times a week to minimise the chances of a recurrence once the affected leg has been strengthened. This frequency and intensity is very similar to that which enabled me to make a complete recovery within 6 weeks.
The most important factor when strengthening the quadriceps to better protect the patella tendon is to ensure that the exercises don’t fatigue the leg so much that the knee in fact becomes more vulnerable in everyday life or when taking part in sport.
Since this is far from an exact science I have provided guidelines below for two strengthening programmes: the first is for a relatively sedentary person who has developed patellar tendonitis in their everyday life, possibly through repetitive movements at work. The second programme is aimed towards a reasonably fit person who trains regularly for a sport. Most athletes who develop patella tendonitis are likely to be doing a significant amount of running as part of their training.
Both programmes are not to be adhered to rigidly, but must rather be used as guidelines only, altering the frequency of the sets and reps to suit the way you feel. If you begin exercising the leg on any given day and feel fatigued in the quadriceps it is always better to leave it for another day.
Everyday Strengthening Programme: 14 days then repeat
Monday: Leg Extensions
Wednesday: Static Quadricep Contraction
Friday: Double leg Eccentric Squats (Same movement as single leg squats, but squat on both legs)
Sunday : Ankle Mobilizations
Tuesday: Leg Extensions
Thursday: Quads over fulcrum
Saturday: Vertical Shin Exercises
Sports Strengthening Programme: 14 days then repeat
Monday: Leg Extensions
Tuesday: Vertical Shin Exercises
Wednesday: Single Leg Eccentric Squats
Friday: Ankle Mobilizations
Saturday: Quads Over Fulcrum
Sunday : Rest
Monday: Leg Extensions
Tuesday: Single Quadricep Contraction
Wednesday: Ankle Mobilizations
Saturday: Single Leg Eccentric Squats