Patellar Tendinitis

Patellar tendinitis also known as Patellar tendinopathy and Jumper’s knee is the source of anterior knee pain in athletes. It results due to an injury to the tendon connecting kneecap (patella) to the shinbone (tibia). 

The patellar tendon works with the muscles at the front of a person’s thigh to extend the knee so that he can kick, run and jump. Patellar tendinitis is most common in athletes whose sports involve frequent jumping — such as basketball and volleyball. However, even people who don't participate in jumping sports can get patellar tendinitis. 

This condition usually starts with taut feeling in the patellar tendon under physical conditions like while running downhill or descending stairs. Like most tendon injuries, it may go away once a person gets warmed up, but as the injury worsens, it will remain painful for the duration of your workout.

Patellar tendinopathy is enfeebling, and can result in prolonged absence and potentially retirement from sports participation. For most people, treatment of patellar tendinitis begins with physical therapy to stretch and strengthen the muscles around the knee.

The main symptom of patellar tendinitis is the pain in the tendon between kneecap and shinbone (tibia) which is mostly noticeable when a person moves knee or try to kneel. Other signs and symptoms include:

Common symptoms of jumper's knee include:

• pain directly over the patellar tendon (or more specifically, below the kneecap)
• stiffness of the knee, particularly while jumping, kneeling, squatting, sitting, or climbing stairs
• pain when bending the knee
• pain in the quadriceps muscle
• leg or calf weakness

Less common symptoms include:

• balance problems
• warmth, tenderness, or swelling around the lower knee

Patellar tendinitis is a common overuse injury, caused by repeated stress on the patellar tendon. The stress results in tiny tears in the tendon, which the body attempts to repair. But as the tears in the tendon multiply, they cause pain from inflammation and weakening of the tendon. 

When this tendon damage persists for more than a few weeks, it's called tendinopathy.

The other conditions that lead to this particular problem includes:

• running,
• jumping,
• repetitive knee flexion into extension (e.g., rising from a deep exercise).

Both extrinsic factors (e.g., inappropriate footwear, training errors and surface or ground) and intrinsic factors (e.g., age, flexibility, and joint laxity) play key roles in tendinitis.

Making a diagnosis of patellar tendinitis is done during physical examination and by performing several tests.

If a person has knee pain during or after physical activity that doesn't improve with ice or rest, consulting a doctor is highly recommended. 

Doctor will do a physical examination of the injury during which he/she may apply pressure to parts of the patient’s knee to determine to locate the site of injury. Usually, pain from patellar tendinitis is on the front part of the knee, just below kneecap. The doctor may suggest one or more imaging tests.

1. X-rays: X-rays help to exclude other bone problems that can cause knee pain. 
2. Ultrasound:This test uses sound waves to create an image of your knee, revealing tears in your patellar tendon. 
3. Magnetic resonance imaging (MRI):MRI uses a magnetic field and radio waves to create detailed images that can reveal subtle changes in the patellar tendon.

The first and the fore most treatment for patellar tendinitis  is to reduce the inflammation in the knee, therefore, the doctors usually begins with less invasive (non-surgical treatment) before going for the invasive (surgical) methods. 

Medicines

Medicines such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may provide short-term relief from pain associated with patellar tendinitis. 

Physical therapy

Physical therapy techniques can help reduce the symptoms associated with patellar tendinitis, including: Stretching and strengthening exercises where regular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit.

Strengthening exercises help in reducing the weak thigh muscles that contribute to the strain on your patellar tendon. Exercises that involve lowering your leg very slowly after extending it are particularly helpful. 

Patellar tendon strap

Patellar tendon strap is another method involving a strap that applies pressure to your patellar tendon and can help to distribute force away from the tendon and direct it through the strap instead. This may help relieve pain. 

Iontophoresis therapy

Iontophoresis therapy involves spreading a corticosteroid medicine on your skin and then using a device that delivers a low electrical charge to push the medication through your skin.

If these noninvasive methods are not effective, then the doctors opt for techniques such as:

• Corticosteroid injection: An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon may help relieve pain but at the same time these drugs may carry certain disadvantages like they can weaken tendons and make them more likely to rupture. 
• Platelet-rich plasma injection: Platelet-rich plasma injection is another type of injection which has been applied to the people with chronic patellar tendon problems. 

In rare conditions, where above mentioned techniques fails the doctors goes for surgical methods to repair the patellar tendon. 

To prevent patellar tendinitis, follow these steps:

• Do not play through pain: As soon as you notice exercise-related knee pain, ice the area and rest. Until your knee is pain-free, avoid activities that put stress on your patellar tendon. 
• Strengthen your muscles: Strong thigh muscles are able to handle the stresses better that can cause patellar tendinitis. 
• Eccentric exercises, which involve lowering your leg very slowly after extending your knee, are particularly helpful. 
• Improve your technique: To be sure you're using your body correctly, consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.

A few alternative remedies exist for managing the symptoms patellar tendinitis.

If your knee hurts, ibuprofen and naproxen sodium can be considered good in reducing pain for short period of time.  One should avoid activity or sports that cause pain as working through pain can further damage your patellar tendon. 

Apply ice after activity that causes pain. Place ice in a plastic bag and wrap the bag in a towel around the knee or try an ice massage.

A combination of factors may contribute to the development of patellar tendinitis, including: 

• Physical activity: Involving in physical activities like running, jumping playing basketball, etc. increases the risk of patellar tendinitis.  
• Tight leg muscles: Tight thigh muscles (quadriceps) and hamstrings, which run up the back of your thighs, can increase strain on your patellar tendon. 
• Muscular imbalance: If some muscles in your legs are much stronger than others, the stronger muscles could pull harder on your patellar tendon. This uneven pull could cause tendinitis. 
• If you are trying to work through your pain and ignoring your body's warning signs, you are increasing the stress patellar tendon.