What is patella tendonitis?
Patella tendonitis often known as jumpers knee is an injury to the patella tendon, a thick tendon which attaches the patella (the knee cap) to the tibia (shin bone). This means it plays a crucial role in extending at the knee joint, which is a motion we use thousands of times a day.
Pain is usually felt below the knee cap and most commonly when we are braking or decelerating such as walking down stairs, landing from a jump or rapidly slowing from sprinting. This is when the tendon in under the most amount of stress, we need strong but supple muscles in the legs and hips to absorbs these compressive forces and to relieve the tendon from being under constant tension due to very tight muscles.
Your body will try to repair your tendon by laying down more collagen fibers as the more fibers there are the stronger the tendon will be. Problems arise when you don’t allow time to heal and continue to train intensely with this issue, this makes the new fibers become messy and frayed like rope, this prolongs the injury.
How is it caused?
There are many reasons why patella tendonitis can be caused and we are going to go through several of them as they often overlap.
Repetitive Stress – The main reason is repetitive use along with one or more of the following
Bad Technique – This is very common and often something that can be rectified swiftly providing regular practice is followed in order to consolidate new movement patterns.
Let’s use the squat for example we’ve all seen that person in the gym who squats with too much weight and half reps, but also often their heels are coming off the floor telling us they lack ankle mobility & flexibility, their knees are shooting way way past their toes and the back is taking a lots of the load. This position here especially with heavy loads and when repeated puts a lot of pressure on the patella tendon in a shearing type motion. I don’t really have an issue with knees coming past the toes especially when you have long femurs but if your knees are tracking forward due to bad technique or mobility then it’s not going to end well.
You may also find that the knees internally rotate towards each other on the upward phase of a squat, this is usually due to weak glutes (butt muscles) or dropped arches and in-proper footware. The above poor technique can be down to may factors such as, poor flexibility, ego, lack of knowledge in technique, unfavourable bio mechanics, weak muscles, misfiring muscles and poor recruitment patterns.
So you can see we really have to assess the inpidual to gain knowledge on their specific causes, this is quite easy to do as there are tell tale signs. Simply watching how they stand and sit alone will give you insight, for example if they stand with one foot turned out you can do some simple tests to see if they have weak or tight glutes.
When they squat, lunge or walk up stairs do their knees internally rotate (knock together) then you can be pretty sure they have weak glute medius and external rotators which is super common.
When they squat or sit down slowly do they load their bodyweight into the glutes (butt) by pushing the hips back and are the glutes strong enough to hold them. This very common especially in squats where people push their knees forward, when really they need to rely more on the BIG powerful glutes muscles to hold them and ultimately aid in pushing them upright back into extension at the hips. Weak glutes in the most common weakness we find in clients by far.
Unfavourable bio mechanics – We are all built differently skeletal wise and this does make some of us more suitable to certain exercises than others, for example if you squat and have long femurs (thigh bones) you simply cannot sit your hips back like you can with shorter femurs. This is simply because you will fall over as your longer thigh bones push your torso away from you centre point of balance and causes you to lean your chest very far forward loading the lower back more. To get around this you can use lifting shoes, take a wider stance, turn your feet and knees out more, use a lower bar position.
How do we fix it?
Rest is crucial as each time we cause pain in the knee we damage the tendon and prolong the injury, but rest alone will not strengthen an injury often caused by weak associating muscles. So we can strengthen the associated muscles, learn proper technique and engrain proper movement patterns via repetition while slowly increasing our volume and intensity of exercises on the knee. Isometric wall squats are one of the first exercises I would use in getting some work through the knee. With these you can position yourself so that the knee is directly over the ankle reducing the tension through the patella. Then i’d move onto controlled eccentric and stabilising work, often raising the heel on a plate or wedge will make squatting easier due to ankle flexibility.
Before we go into some exercises for rehab let’s first look at stretching and mobility work as this is
just as important in relieving patella tendonitis symptoms and is your first point of call along with rest.
Mobility and flexibility
Stretch & foam rolling is going to be your best friend so get used to it, we want to open up the hips allowing for full range of movement and take any extra stress off the patella. Here are the main muscle and fascia we want stretch and release.
Hamstring and calves (gastrocnemius) work in flexion so if they are tight it’s puts more tension through the patella when extending.
Hips being tight along with the tight/weak glutes will cause issues that travel down to the knees and make for unfavourable movement which when repeated will cause damage to the tendon.
Quads and hip flexors need a lot of work as these are normally super tight especially from being in a seated position a lot. Again these muscles will affect your ROM and movement through out squatting and similar movements.
TFL, The tensor fasciae latae works in synergy with the gluteus medius and gluteus minimus muscles to abduct and medially rotate the femur. The TFL is a hip abductor muscle and a pain to get at, for me it requires laying on a cricket ball but it also gave me the most results in increasing hip mobility.
Tibialis anterior on the outside of your shin along with calves will aid in ankle flexibility and the Tibialis specifically really helped my knee pain. Anecdotally I put it down to the fact that it attaches near the patella tendon.
Here’s a video we did on foam rolling, it’s also worth reading our blog on foam rolling the ITB as our opinion has changed.
Another common problem and one I suffer from is ankle rolling and this is often controlled by how the foot meets the floor. By now you may have noticed than issues from either the hips or the feet can travel up and down the leg until they show their weakness at the knee as it’s the next mobile structure in the leg. Here is a great article to get you up to speed. http://www.footbalance.com/why-footbalance
Exercises that especially work on hip extension for the glutes, isometrics and slow eccentric deceleration work great as when we are in the eccentric portion (lowering phase) of an exercise this where the tendons and ligaments are under the most amount of tension thus allowing them to grow stronger. It’s a balancing act as you want to make them work but without feeling pain and causing damage.
None of these videos are mine and they are here as a visual guide to the exercise and may not be how I would execute the exercise.
Isometric squat https://www.youtube.com/watch?v=BafMfLMHIDM&nohtml5=False
Single leg eccentric box squat https://www.youtube.com/watch?v=DuE_ScvXwtg
Knee Banded squats https://www.youtube.com/watch?v=8Hkf-t7DVOg&nohtml5=False
Step up’s Eccentric loading https://www.youtube.com/watch?v=_Ktua957nDI&nohtml5=False
Glute hip thrusts – https://www.youtube.com/watch?v=cBrHdatPj9g&nohtml5=False
Tibialis and calves.
The bottom line is patella tendonitis is a persistent pain for many of us, I suggest you do your best and have yourself assessed by a professional to get on top of this awkward injury as soon as possible.
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