Patellar Tendinitis
...mpletely different surfaces and place different stresses on the knee joint, and this has an effect on the knee. Factors in these athletes getting injured include: increased amounts of continuous running and/or jumping and the pounding of their feet on the ground that is associated with football.1 Soccer players and volleyball players both put a lot of weight on their knees. Knee loads up to 7 times body weight occur in soccer players during kicking and between 9 and 11 times body weight occur in volleyball players during landing.4 Up to 80% of all overuse injuries involving volleyball players can be blamed on patellar tendonitis.2 Patellar tendonitis does affect many runners, especially those who train hard on hills, and especially those runners who run the down hills hard. The forces sustained by the patellar tendon during downhill running are large and far surpass those found in flat ground or even uphill running. This is due to the "braking action" of the quadriceps muscles, which control the knee bending movement. This controlling action is known as an "eccentric contraction," which means that even while the muscle is contracting to provide force, it is actually increasing in length. These opposing forces magnify the potential for injury to the muscle and to the patellar tendon. Anyone who runs hills regularly knows that the "braking" on the down hills is more stressful than the "take-off" of the uphills.5 SIGNS AND SYMPTOMS There are many signs and symptoms associated with patellar tendonitis. Some of these symptoms may include: pain and tenderness around the patellar tendon, swelling where the patellar tendon attaches to the shin bone or around the knee joint due to repetitive knee extension activities, pain with jumping, running, or walking, pain with bending or straightening of the leg, the athlete complains of the knee feeling “tight”, some swelling of the tendon and the athlete may feel that the tendon is “squeaking”.10 Patellar tendonitis can be divided into four stages of pain. During stage one, there is pain after activity and no functional impairment. During stage two, there is pain at the beginning of activity, but the pain disappears after warm-up and reappears with fatigue. During stage three, there is pain during and after activity that impairs function and the athlete is unable to participate in sports and their previous level. During stage four, there is complete rupture of the tendon.8 DIAGNOSIS To be properly diagnosed, a physician should examine the athlete. The doctor will examine the knee for clinical signs and symptoms as mentioned above. They will then ask the athlete to perform various activities to see their physical limitations such as running, jumping, and squatting.6 The doctor may also evaluate the athlete’s feet to assess if they have any biomechanical issues that may be contributing to their problem. The doctor could also take x-rays of the athlete’s knee to make sure the injury is not something else.9 Most of the examination performed by a physician is aimed at determining the extent of muscle impairment, if any. After visual inspection and palpation, the flexibility of the quadriceps is assessed by passive flexion of the knee. The flexion angle is normally 135° or greater. Hamstring flexibility is similarly determined by performing a passive straight-leg lift. The flexion angle of the hip is generally 70° or greater, but for athletes, the norm is 90° or greater.6 Other tests such as diagnostic ultrasound or Magnetic Resonance Imaging (MRI) are sometimes used to rule out more extensive damage to the patellar tendon. But the problem with MRIs is that the tendonitis will only show up in extreme cases where there is significant tendon damage and degeneration. Because most cases of patellar tendonitis are not advanced, and therefore not diagnosable with an MRI scan, physicians and even orthopedic surgeons may sometimes fail to identify this common problem.3 www.sagewoodwellness.com To evaluate the stage of the injury, the physician of athletic trainer can perform a special test. 1. Ask athlete to lie on unaffected side on treatment table. 2. Passively flex athlete’s knee A positive sign for tendonitis will be if the athlete feels pain at 120 degrees passive flexion.9 TREATMENT Treatment of this condition starts with a continuing general fitness and flexibility program. But, the best treatment for patellar tendonitis is prevention.8 If the injury goes untreated, eventually prolonged sitting or standing will cause pain and stiffness. Those athletes who play multiple sports should properly condition themselves for the transition from one sport to another.6 Proper conditioning should include: aerobic fitness, lower body strengthening, and lower body flexibility training. Flexibility is an important factor to keep in mind in the prevention of overuse injuries. Some other exercises that can be done for rehabilitation include having the athlete do plyometrics, hopscotch, or hopping.9 Some other exercises and stretches that can be done are: hamstring stretch, Achilles stretch, knee extension, and step-ups. (see Exercises for Patellar Tendinitis). Preventative measures for patellar tendonitis include strengthening and stretching exercises. The following is an example of a strengthening exercise: FIGURE 3 – Advanced case of patellar tendonitis. This MRI scan image shows a close-up, side view of the frontal region of an actual patient's knee, with the lower half of the patella ("P", above) resting against the frontal portion of the femur ("F", to the left). Below the patella one can see the patellar tendon, running downward toward the tibial tubercle (not seen). The normal portion of this patellar tendon is solid black, and looks thin and straight (double arrow). The afflicted, upper segment of tendon that attaches to the patella is swollen and has lost its normal black appearance (single arrow). The lighter shaded tendon tissue in the swollen zone represents degenerated and broken down tendon fibers. If very heavy stress is applied to a tendon in this condition, it can rupture through the degenerated zone, suddenly and unexpectedly. Urgent surgical repair would then be necessary. www.kneeandshoulder.com - Minisquats done while holding on to a table or chair for support: The athlete bends at the knee to about a 45-degree angle, and then returns to the standing position. Rehabilitation progresses to no support and using only the involved leg.5 Once the athlete is properly diagnosed with patellar tendonitis, they should begin rehabilitation and treatment immediately. Some treatments include: in the early inflammation stage icing the area for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days (or until the pain goes away), taking anti-infl...