Causes, Prevention and TreatmentAnatomy of the Knee
Before we discuss what patellar tendonitis is, it is important to have a general understanding of the structures that make up the knee joint.
The picture to the right is a front-on view of the bones, tendons and ligaments that make up the knee joint. In the very center of the picture is the patella, or kneecap. The blue structure that runs downward from the patella to the tibia (shinbone) is the patella ligament.
On occasion you may hear of this structure being referred to as the patellar tendon, but for the purposes of anatomy and physiology this structure is a ligament, as it attaches the patella (knee cap) to the tibia (shin bone). Ligaments attach bone to bone, while tendons attach muscle to bone.
What is Patellar Tendonitis?
As with all cases of tendonitis, patella tendonitis is simply the inflammation, degeneration or rupture of the patellar ligament and the tissue that surround it, leading to pain and discomfort in the area just below the knee cap.
What causes Patellar Tendonitis?
Overuse is the major cause of patellar tendonitis. Activities that involve a lot of jumping or rapid change of direction are particularly stressful to the patellar ligament. Participants of basketball, volleyball, soccer, and other running related sports are particularly vulnerable to patellar tendonitis.
Patellar tendonitis can also be caused by a sudden, unexpected injury like a fall. Landing heavily on your knees can damage the patellar ligament, which can lead to patellar tendonitis.
What are the Signs & Symptoms of Patellar Tendonitis?
The major symptom of patellar tendonitis is pain in the area just below the kneecap. Activities like walking, running and especially squatting, kneeling or jumping will cause increased pain and discomfort. Swelling is also commonly associated with patellar tendonitis.
Patellar Tendonitis Treatment
Patellar tendonitis is just like any other soft tissue injury and should be treated accordingly. This involves the application of R.I.C.E.R. (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment. The following two points are of most importance.
1. Rest & Immobilization
Once patellar tendonitis is diagnosed it is important that the affected area be rested immediately. Any further movement or stress will only aggravate the condition and prolong recovery. It is also important to keep the injured area as still as possible.
2. Ice
By far the most important part. The application of ice will have the greatest effect on reducing bleeding, swelling and pain. Apply ice as soon as possible after the injury has occurred or been diagnosed.
How do you apply ice? Crushed ice in a plastic bag is usually best. However, blocks of ice, commercial cold packs and bags of frozen peas will all do fine. Even cold water from a tap is better than nothing at all.
When using ice, be careful not to apply it directly to the skin. This can cause "ice burns" and further skin damage. Wrapping the ice in a damp towel generally provides the best protection for the skin.
How long, how often? This is the point where few people agree. Let me give you some figures to use, as a rough guide, and then I will give you some advice from personal experience. The most common recommendation is to apply ice for 20 minutes every 2 hours for the first 48 to 72 hours.
These figures are a good starting point, but remember they are only a guide. You must take into account that some people are more sensitive to cold than others are. Also, be aware that children and elderly people have a lower tolerance to ice and cold. Finally, people with circulatory problems are also more sensitive to ice. Remember to keep these things in mind when treating yourself or someone else with ice.
Personally, I recommend that people use their own judgement when applying ice to them self. For some people, 20 minutes is too much. For others, especially well conditioned athletes, they can leave ice on for up to an hour at a time. The individual should make the decision as to how long the ice should stay on.
My personal recommendation is that people should apply ice for as long as it is comfortable. Obviously, there will be a slight discomfort from the cold, but as soon as pain or excessive discomfort is experienced, it is time to remove the ice. It is much better to apply ice for 3 to 5 minutes a couple of time an hour, than not at all.
During the first 24 to 72 hours after an injury, be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spas, Jacuzzi's and saunas. Avoid all movement and massage of the injured area. Also, avoid excessive alcohol. All these things will increase the bleeding, swelling and pain of your injury. Avoid them at all costs.
Patellar Tendonitis Prevention
Although it is important to be able to treat patellar tendonitis, prevention should be your first priority. So what are some of the things you can do to help prevent patellar tendonitis?
1. Warm Up properly
A good warm up is essential in getting the body ready for any activity. A well-structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. If you would like to know more about the warm up, visit http://www.thestretchinghandbook.com/archives/warm-up.html.
2. Avoid activities that cause pain
This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
3. Rest and Recovery
Rest is very important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
4. Balancing Exercises
Any activity that challenges your ability to balance, and keep your balance, will help what is called, proprioception: - your body's ability to know where its limbs are at any given time.
5. Stretch and Strengthen
To prevent patellar tendonitis, it is important that the muscles around the knee be in top condition. Be sure to work on the strength and flexibility of all the muscle groups in the leg.
6. Footwear
Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees stable, provide adequate cushioning, and support your knees and lower leg during the running or walking motion.
7. Strapping
Strapping, or taping can provide an added level of support and stability to weak or injured knees.
