Participation in sports can be hard on the body. Sports that involve jumping, landing, cutting, and pivoting places large amounts of stress on the legs, especially on the tendon that runs from the kneecap to the shinbone. This tendon is known as the “patellar tendon”. Many athletes will report pain right below their kneecap, which can prevent them from participating in their desired sport/activity. With appropriate load management and strengthening, physiotherapy can help you return back to sport and/or activity as soon as possible!

What is Patellar Tendinopathy?

Patellar tendinopathy, also known as “Jumper’s Knee”, is an overuse injury that arises due to repetitive stress on the tendon. It can also be due to changes in your regularly scheduled activities – a sudden increase in activity/training, starting a new activity, or change in equipment such as footwear. The role of the patellar tendon is to provide extra assistance to the quadriceps – the muscles on the front of your thigh – to help straighten the knee. With different ways of activating/loading the quadriceps, you end up continuously pulling on the tendon, which contributes to irritation within it. As a result, you experience pain at the bottom of the kneecap. Young athletes between ages 15-30 who participate in sports that place high stress onto the patellar tendon (eg. basketball, volleyball, high/long/triple jump, tennis, football, downhill running, etc.) are most prone to developing this injury.

What are common symptoms of Patellar Tendinopathy?

People with this condition will experience pain located at the bottom and below the kneecap. They will also experience pain when actively contracting their quadriceps muscle. Loading activities will aggravate the tendon. This can include jumping, changing directions, and deceleration. People with Patellar Tendinopathy tend to find a pattern with their pain: it gets worse before and after activity but subsides during the activity. After 24 hours, the same level of pain experienced post-activity will still be present.

What can physiotherapy do for Patellar Tendinopathy?

The first step is working with a physiotherapist to modify your everyday activities and training schedule. It is very important to “deload” the tendon so that it has time to repair itself from the accumulated damage. However, tendons are funny structures that are very particular in what they want. They don’t like to be rested completely, but they also don’t like to be overloaded either. Ultimately, tendons like to be loaded to a certain extent. Let’s put it this way, imagine the shape of a bell – starts low, curves up high, then drops back down low. At the beginning of the bell shape (low end #1), this is where the tendon is underloaded or completely rested. Now move to the end of the bell shape (low end #2), this is where the tendon is overloaded. Notice how both ends are low? This means that rather than increasing the strength within the tendon to assist the muscle, both under or overloading it can actually result in further breakdown of the tendon! Yikes, we don’t want that! On the contrary, the highest part of the curve is where the tendon wants to be, which means that optimal loading for a tendon is just slightly greater than normal loads. This may vary from person to person based on how much the tendon is able to withstand. Within this area of the curve, the tendon is able to adequately adapt to the load provided and therefore, builds up the tendon to make it stronger.

The second step involves the physiotherapist observing your jumping and landing techniques. This is to see if there is anything they can improve to decrease the amount of load going through the patellar tendon and instead, utilize other parts of the body to absorb the pressure.

The last step includes gradually “reloading” the tendon. Once the tendon has had some time to calm down and repair itself, it’s time to start strengthening and reintroducing more sport-specific activities! Strengthening muscles along the leg (such as quadriceps, calves, gluteals) will be important to ensure that they are working together to provide as much support to the limb as possible. If one muscle is weaker than the other, it will lead to an imbalance and might cause one muscle to work harder than another, increasing the risk for injuries.

At Boost Physiotherapy, our physiotherapists are well-equipped to assist you with your injuries. We will work with you to explore different treatments to find the best option that suits your needs! If you have any further questions about Patellar Tendinopathy, book an appointment online or call us today at 587-635-5555 (South Edmonton) or 780-591-5555 (Stony Plain). Our physiotherapists will be happy to assist you in any way!