Patellar tendonitis is a condition we see many of our clients self-diagnosing themselves with. There’s lots of information all about it on the internet and because the pain is in quite a specific point it is quite easy to conclude that you have patellar tendonitis. Whilst patellar tendon degeneration is clearly a thing it is rarely the culprit of all of our pain.
In this article we aim to give you hope and an alternative way of looking at your patellar tendon, to enable you to start putting in place the appropriate conditions to aid a full recovery and how we may be able to help you with that.
What Is Patellar Tendonitis?
Well it’s not technically tendonitis for a start! Tendonitis implies inflammation and whilst that can be a symptom it is more often not a symptom. Many years ago the label was changed to patellar tendinosis suggesting degeneration of the patellar tendon but that’s not right either
In fact it’s really important not to put negative or false beliefs about the quality of our structure as this will make things worse not better. We talk about this in a previous article: What Is Pain? This opinion based on experience with our clients and latest thoughts in pain science is backed up in this excellent and all-encompassing piece of research. Citing inaccurate beliefs and fear-avoidance behaviour are factors that may mean you struggle to get better.
To continue the story it is now termed patellar tendinopathy which means there is something wrong with the patellar tendon but we don’t know what it is. We have clients who have confirmed evidence of degeneration of tendons with no pain. Even one client who has a hole in his patellar tendon which he used to think of as causing his pain. Not anymore.
Even if you have been diagnosed with something very physical there is a lot of hope for you.
Patellar Tendonitis Causes
It can affect anyone. From the elite athlete to the couch potato. As with most conditions it is most likely to affect the elite athlete and the obese / inactive. But anyone in between can have the condition too.
It is thought to be due to an increased load on the patellar tendon. That can be due to increasing the intensity of training too quickly or coming back from a relative period of inactivity too quickly. Whether that is at elite level sport or just someone walking to or from the shops.
We saw a lot of patellar tendon issue post lockdown with people suddenly getting out a bit more. Equally during the various lockdowns as some people had more time on their hands to do running instead of sitting commuting.
Other than sudden changes in volume that’s about it. This piece of research suggested that there was no strong evidence for mechanical causative factors. Which is unusual. It did say the following things might be slightly related causative factors but it was a very weak correlation: weight, body mass index, waist-to-hip ratio, leg-length difference, arch height of the foot, quadriceps flexibility, hamstring flexibility, quadriceps strength and vertical jump performance.
In short no matter how good or how bad an athlete you are when increasing what you do take it steady and give your body time to adapt. I could pretty much right that for every condition I write about.
What Are The Symptoms Of Patellar Tendonitis
Normally patellar tendonitis is obvious as it is specific well localised pain at the bottom of the knee cap or indeed where the tendon inserts in the shin bone (tibia). It’s normally aggravated by jumping, periods of inactivity or intense training. It can however co-exist with other kind of knee problems and so the symptoms can be somewhat confusing.
A similar but different label can affect the quadricep tendon which attaches to the top of the knee cap.
Patellar Tendonitis Treatments
So what should we do about patellar tendonitis? Well according to this research not a lot. It suggests primarily that more research needs to be done. Which is true. But it suggests there is no strong evidence for surgical or operative treatment.
This could be alarming to any sports therapist or physiotherapist. But for us we don’t mind this. It’s more evidence that for this and pretty much any condition there is no one size fits all treatment. No single exercise will definitely make all your pain go away, It really doesn’t work like that. It’s just too complicated.
We base all of our treatments on the individual findings for the person in front of us. A bespoke action plan if you will that will of course include the physical aspect of what we find but may also involve correcting any unhelpful beliefs or fears plus potential wellbeing advice to reduce our overall sensitivity.
Patellar Tendonitis Rehabilitation
Our rehabilitation is based on our findings. An important factor in this can be explained using the following diagram below:
This picture shows the path of the femoral nerve through the body. There is a very important terminal branch just underneath the patella. Right at the patellar tendon. Interesting hey? What we find is that if we can ‘calm’ this nerve down we will change the sensation in that patellar tendon.
This can take two forms. One calm the whole system down, that is calm us down. This can be through relaxation breathing, yoga, taking some time out from work, taking more breaks, looking after yourself better, flogging yourself a bit less in training or conversely doing a bit more activity. We have to work it out for the individual.
Secondly, releasing the specific structures that are causing the tension, or increased sensitisation of the branch of the femoral nerve that gives sensation at the patellar tendon. This can be hip flexors, quadriceps, adductors and diaphragm (hence breathing work above) amongst other things.
Finally we then look to integrate this new calmer knee if you like back into increased load through the tendon and continue to build the intensity from here. This starts to look a bit more like your traditional physiotherapy.
For the first parts we’d recommend our favourite exercises to avoid knee pain. Then from this research that we mentioned earlier progress the rehabilitation exercises and load from here. It’s a bit technical so this YouTube video is much more accessible and easy to follow and also has good explanation of the points I make above.
Interestingly this research makes the point that you don’t need to focus on how you strengthen the knee you just need to do it appropriately. A nice easy to follow measure is what we call the goldilocks approach, not too much and not too little.
Start with a realistic aim whether that is distance walked or number of jumps onto a box and amount of isometric holds or split squats. Whatever you decide, or we decide with you, is the most appropriate for the sensitivity of your condition and your current fitness levels. Once you have done this if you have less pain the following day you got it right and can progress, if you have more you did too much and you need to reduce the load next time you try.
Patellar Tendonitis Is Over Diagnosed
From the above hopefully you can see that there are many possible causes of pain in the patellar tendon not just the patellar tendon itself. And even if there are signs of degeneration within the tendon itself then chances are you can still do everything you need to do in life pain free.
Which is why we don’t necessarily agree with the need to MRI or X-ray for such a condition as we talk about in our previous article: Can X-Ray or MRI Hinder Your Physio Treatment. In our opinion x-ray and MRI are invaluable in ruling out more serious conditions that may be masquerading as patellar tendinopathy but they can be harmful if we start overly worrying about a bit of wear and tear over the course of our lives.
Patellar Tendonitis Conclusion
We find that if we can achieve some or all of the following goals then we can make any patellar tendon issues ease and then disappear:
- Calming the nervous system down as a whole with greater focus on overall wellbeing
- Easing local sensitivity by correcting any fearful beliefs and protective movement patterns about the knee
- Reducing load on the tendon through biomechanical improvement and temporary reduction in load
- Finding the sweet spot for activity level and building resilience back in from here
Hopefully this article has given you inspiration and hope for the state of your patellar tendon and confidence that if you do have patellar tendinitis it’s not something to fear for the rest of your life.
We’ve given you a sneak peak of things that work for many of our clients but would urge you to get your condition professionally assessed by ourselves or any other practitioner to give you that bespoke rehabilitation plan and the confidence to move freely and without pain once again.
If you’d like to chat about patellar tendonitis or any other condition for that matter click here and fill out the form to request a call from one of our therapists.