Patellar Tendinitis, Jumper's Knee

with Rehab

Tendinitis is inflammation of a tendon. Tendonitis of the tendon below the kneecap (patella) is known as patellar tendonitis. Patellar tendonitis is a common cause of pain below the kneecap (infrapatella). Patellar tendonitis may involve a tear (strain) in the ligament. Strains are classified into three categories. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament, due to the ligament being stretched or partially ruptured. With grade 2 strains there is still function, although function may be decreased. Grade 3 strains involve a complete tear of the tendon or muscle, and function is usually impaired. Patellar tendon strains are usually grade 1 or 2.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness over the patellar tendon (just below the kneecap).

  • Pain and loss of strength (sometimes), with forcefully straightening the knee (especially when jumping or rising from a seated or squatting position), or bending the knee completely (squatting or kneeling).

  • Crackling sound (crepitation) when the tendon is moved or touched.

CAUSES

Patellar tendonitis is caused by injury to the patellar tendon. The inflammation is the body's healing response. Common causes of injury include:

  • Stress from a sudden increase in intensity, frequency, or duration of training.

  • Overuse of the quadriceps thigh muscles and patellar tendon.

  • Direct hit (trauma) to the knee or patellar tendon.

RISK INCREASES WITH:

  • Sports that require sudden, explosive thigh muscle (quadriceps) contraction, such as jumping, quick starts, or kicking.

  • Running sports, especially running down hills.

  • Poor strength and flexibility of the thigh and knee.

  • Flat feet.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Protect the knee joint with taping, protective strapping, bracing, or elastic compression bandage.

  • Wear arch supports (orthotics).

PROGNOSIS

If treated properly, patellar tendonitis usually heals within 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given enough time to heal.

  • Recurring symptoms, if activity is resumed too soon, with overuse, with a direct blow, or when using poor technique.

  • If untreated, tendon rupture requiring surgery.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. Serious cases of tendonitis may require restraining the knee for 10 to 14 days, to prevent stress on the tendon and to promote healing. Crutches may be used (uncommon) until you can walk without a limp. For cases in which non-surgical treatment is unsuccessful, surgery may be advised, to remove the inflamed tendon lining (sheath). Surgery is rare, and is only advised after at least 6 months of non-surgical treatment.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Patellar Tendinitis (Jumper's Knee)

These are some of the initial exercises with which you may start your rehabilitation program, until you see your caregiver again or until your symptoms are resolved. Remember:

  • Flexible tissue is more tolerant of the stresses placed on it during activities.

  • Each stretch should be held for 20 to 30 seconds.

  • A gentle stretching sensation should be felt.

STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall, and the opposite leg flat on the ground through the door. At first, position your bottom farther away from the wall.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door, and hold __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool.

  • Keep a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Adductors, Lunge

  • While standing, spread your legs, with your right / left leg behind you.

  • Lean away from your right / left leg by bending your opposite knee. You may rest your hands on your thigh for balance.

  • You should feel a stretch in your right / left inner thigh. Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Patellar Tendinitis (Jumper's Knee)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat, or bed on which you are lying.

  • Hold the muscle as tight as you can, without increasing your pain, for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your right / left knee, so that the knee bends slightly.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/ 0.5 kilogram increments.

STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to be sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Quadriceps, Squats

  • Stand in a door frame so that your feet and knees are in line with the frame.

  • Use your hands for balance, not support, on the frame.

  • Slowly lower your weight, bending at the hips and knees. Keep your lower legs upright so that they are parallel with the door frame. Squat only within the range that does not increase your knee pain. Never let your hips drop below your knees.

  • Slowly return upright, pushing with your legs, not pulling with your hands.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Quadriceps, Step-Downs

  • Stand on the edge of a step stool or stair. Be prepared to use a countertop or wall for balance, if needed.

  • Keeping your right / left knee directly over the middle of your foot, slowly touch your opposite heel to the floor or lower step. Do not go all the way to the floor if your knee pain increases, just go as far as you can without increased discomfort. Use your right / left leg muscles, not gravity to lower your body weight.

  • Slowly push your body weight back up to the starting position,

Repeat __________ times. Complete this exercise __________ times per day.