Download Patellar Tendonitis

Patellar Tendonitis
Anatomy:
The Patella (kneecap) is the moveable bone on the
front of the knee, and it is wrapped inside a tendon
that connects the large muscles on the front of the
thigh to the tibia (shin bone) in the lower leg. The large
quadriceps muscle ends in a tendon that insets into
the tibial tubercle, the bony bump at the top of your
shin just below the patella. The tendon and the patella
make up the extensor or quadriceps mechanism.
Tightening up the quadriceps muscles places a pull on
the tendons of the quadriceps mechanism. This action
causes the knee to straighten. The patella acts like a
fulcrum to increase the force of the quadriceps
muscles. The long bones of the femur (thigh bone)
and tibia (shin bone) act as lever arms, placing force
or load on the knee joint and surrounding soft tissues.
The amount of load can be quite significant.
Causes/Mechanism of Injury:
Patellar tendonitis occurs most often as a result of stresses placed on the supporting structures of the
knee. Running, jumping and repetitive knee flexion into extension (i.e. rising from a deep squat)
contributes to this condition. Overuse injuries from sport activities is the most common cause but
anyone can be affected, even those who do not participate in sports or recreational activities.
Outside/Extrinsic Factors:
• Inappropriate footwear
• Training errors – frequency, duration, intensity
o Too much, too far, too fast, too long
• Surface or ground used for sport or event
Internal/Intrinsic Factors:
• Age
• Growth Spurts
• Flexibility
• Joint Laxity
• Malalignment of foot, ankle and leg
o Increased Q-Angle – the angle formed by the patellar tendon and the axis of pull of the
quadriceps muscle. Varies among sexes and is larger in women compared to men.
! Angles more than 15° create more of a pull on the tendon, creating painful inflammation
o Femoral Anteversion – a condition in which the femoral neck leans forward with respect to
the rest of the femur, causing the leg to rotate internally (the knee and foot are twisting
inward).
• Flat foot position
Norman
2475 Boardwalk
Norman, OK 73069
PH (405) 447-1991
Newcastle
2340 N.W. 32nd
Newcastle, OK 73065
PH (405) 392-3322
www.TherapyInMotion.net
Purcell
2132 N. Green Ave
Purcell, OK 73080
PH (405) 527-1500
Patellar Tendonitis
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Tracking abnormalities of patella
Rotation of the tibia (tibial torsion)
Leg length difference
Muscle Imbalance – from the hip down the toes can impact the quadriceps muscle and
affect the joint.
Symptoms:
Pain is usually located in the section of your patellar tendon between your kneecap (patella) and the
area where the tendon attaches to your shinbone (tibia). The pain is most noticeable when moving the
knee or trying to kneel. During physical activity, the pain may feel sharp, while after activity the pain
may persist as a dull ache.
The pain in your knee may:
• Initially be present only as your begin physical activity or just after an intense workout
• Increase as you step up the intensity of your activity
• Progress to be present before, during and after physical activity
• Make going up and down stairs painful
• Become a constant ache that can make it difficult to sleep at night
Treatment/Management:
Most patients see improvement and relief with conservative non-operative treatment. This aims to
reduce the strain on your tendon and then gradually build up the tendons strength. This can be
accomplished with several techniques along with physical therapy.
! Rest – avoiding aggravating activities, such as running, jumping and squatting.
! Ice – the use of an ice massage for 5-7 minutes or an ice pack for approximately 15 minutes to the
affected area is recommended to reduce the initial signs and symptoms of inflammation.
! Adjusting Body Mechanics – learning how to better distribute the force exerted during physical
activity. Such as proper takeoff and landing techniques for jumpers.
! Stretching – Quadriceps, hamstrings, iliopsoas, and adductors
! Strengthening – using specific exercises to strengthen your patellar tendon and the muscles
surrounding it. Including quadriceps (thigh muscles), core or abdominals, ankle, calf and hip
musculature. Concentric (muscle shortening) and eccentric (muscle lengthening) exercises will be
used to strengthen this musculature. Eccentric exercises and control will be key to patellar
tendonitis rehabilitation. Jogging, elliptical and gentle plyometric exercises will also help strengthen
these muscle groups.
! Iontophoresis – a technique that involves applying a topical corticosteroid medication to the area
affected by the tendonitis to help reduce the inflammation in the patellar tendon. The medication is
delivered through the skin through a device that uses electrical charges.
! Patellar Tendon Strap – with activities of daily living and upon the return to vigorous activities is
recommended to help reduce the stress placed on the patellar tendon.
! Shoe Insoles/Orthotics– Shock-absorbing insoles placed in the shoe is often advised to reduce
stress on the affected patellar tendon.
Exercises:
• Standing hamstring stretch: Place the heel of your leg on a stool about 15 inches high. Keep
your knee straight. Lean forward, bending at the hips until you feel a mild stretch in the back of your
thigh. Make sure you do not roll your shoulders and bend at the waist when doing this or you will
stretch your lower back instead. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
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Quadriceps stretch: Stand an arm's length away from the wall, facing straight ahead. Brace
yourself by keeping the hand on the uninjured side against the wall. With your other hand, grasp the
ankle of the injured leg and pull your heel toward your buttocks. Don't arch or twist your back and
keep your knees together. Hold this stretch for 15 to 30 seconds. Repeat 3 times.
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Side-lying leg lift: Lying on your uninjured side, tighten the front thigh muscles on your injured leg
and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.
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