The patella tendon is located between the bottom of the knee cap and the tibial tuberosity (the bony bit on the front of your shin just under the knee). It’s job is to help attach the knee cap to the shin. Tendinopathies are generally classed as overuse injuries where the tendon has been irritated repeatedly over a period of time, this can cause pain and a lack of range. Patella tendinopathy is usually caused by jumping/ change of direction sports such as long jump or basketball due to the forces being put through the knee (Brukner and Khan, 2017). However, it is also a common running injury as it is repetitive impact on the knees similar to jumping.
Patella tedinopathies present as pain/ tenderness when pressing the patella tendon, potentially some thickening of the patella tendon, no clicking/ locking/ crepitus in the joint itself (this is not to say the joint itself won’t have any just that it is not related to this condition), in serious cases the knee may give way due to quadriceps weakness/ inhibition, knee extension with quadriceps contraction would be painful, no joint swelling and decline squats would aggravate the tendon (Brukner and Khan, 2017).
Van der Warp et al. (2011)Found that there were nine factors that can increase the risk of developing patellar tendinopathy - weight, BMI, waist to hip ratio, leg length difference, arch of foot height, quadriceps and hamstring flexibility, quadriceps strength and vertical jump performance. However, although these factors may increase your likelihood of developing patella tendinopathies, you could develop them without any of these factors being present.
Quadriceps tightness is very important when looking at patella tendinopathies as the quadriceps attach to the top of the kneecap and therefore have a direct effect on the patella tendon and vice versa. For this reason foot and hip positioning when running is very important. For example if you have an anterior pelvic tilt it is likely that it is partially caused by tight quadriceps, this has then been exacerbated in recent times by more people working from home and spending more time at a desk. This in turn then shortens the hips flexors which makes the quadriceps more tight which therefore pulling excessively on the patella tendon causing the pain. Phew what a mouthful!
So, getting something like a gait analysis would be really useful as your foot positioning can be assessed and you can get the correct supportive trainers for your feet which should ease the excessive stress being placed on the patella tendon.
As well as addressing some of the bio mechanical issues mentioned above, eccentric exercises, stretching and retraining of movements are also really important when rehabbing a patella tedinopathy (Reinking. M. F. 2016). Malliaras et al. (2015) looked at rehab programs used as the sole treatment for return to sport after a patella tendinopathy, and found that 45% of patients didn’t improve significantly with exercise programs alone. This shows that exercise programs need to be one part of a whole treatment plan to achieve significant results. A treatment such as massage to the quadriceps could be really helpful for this injury as it will lessen the pressure being put on the tendon higher up the chain. Strengthening the quadriceps would also be useful as the quadriceps would be able to deal with the load they are being put under better without tightening up. Looking at the hips would be beneficial as the quadriceps could be getting tight due to another muscle group not doing their own job properly.
There are many reasons why this could be happening and most of the reasons are either higher or lower up the chain. If I were you I would just go and see a sports therapist and they can do all the hard work for you!
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Beth Roberts BSc (Hons)
Brukner and Khan Clinical Sports medicine (2017)
Van der Worp et al. (2017)https://www.researchgate.net/profile/Gert-Jan-Pepping/publication/50891661_Risk_factors_for_patellar_tendinopathy_a_review_of_the_literature/links/55a4824e08ae5e82ab1f3e97/Risk-factors-for-patellar-tendinopathy-a-review-of-the-literature.pdf
Reinking. M.F. (2016)- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095939/
Malliaras et al. (2015)- https://www.jospt.org/doi/pdfplus/10.2519/jospt.2015.5987