Question 1

Overview of the patellar tendon

Accepted Answer

Your patellar tendon lies below your kneecap (the patella). It runs from the lower border of your kneecap to the front top part of your shinbone (tibia), where it attaches.

Your front thigh muscles (quadricep muscles or quads) end in one thick tendon called the quadriceps tendon. Your quadriceps tendon attaches to the top part of your kneecap, but some fibers continue over the kneecap. These fibers help to form your patellar tendon.

Patellar tendinopathy (or tendonitis), is an overuse injury. It is usually caused by a sudden increase in activities that work the quadricep muscles intensely, such as jumping or running. It can also develop from not allowing enough recovery time between training sessions.

Question 2

Symptoms of patellar tendinopathy

Accepted Answer

Diagnosing patellar tendinopathy can be tricky because it can feel similar to other knee conditions, like patellofemoral pain syndrome or fat pad impingement.

You will feel pain and stiffness in the patellar tendon. Most commonly, you feel it in the part of the tendon that attaches to the lower edge of your kneecap. But, you may also feel it in the middle or lower parts of the tendon. If your pain is more diffuse (spread out) and difficult to pinpoint, it's unlikely to be patellar tendinopathy.
Symptoms start slowly and gradually increase as you continue to train and aggravate it.
Activities that load the quadricep muscles usually cause pain, e.g., running, walking up or down stairs, squats, or jumping.
You may find that exercise improves your pain initially, only for it to flare up and hurt more several hours later, typically the next day.
Initially, it may only hurt when you do high-load activities such as fast running or jumping. If you continue irritating it, it may eventually be too painful to run.
Low-load activities like swimming, cycling, and walking don't usually cause pain.
It usually doesn't hurt at rest, but sitting with your knee bent to 90 degrees or more for extended periods may cause pain.
Patellar tendinopathy does not cause swelling or bruising.

Question 3

When to see a doctor

Accepted Answer

You should consult your doctor or physical therapist before using the app to ensure you have the correct diagnosis and are ready to start rehab exercises. If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

You feel a sudden sharp pain in your knee or patellar tendon during an activity - this may mean you've strained or torn the tendon, and the app's program is not appropriate for tendon tear rehab
You notice bruising or swelling - patellar tendinopathy does not cause bruising or swelling
Any part of your leg (thigh, calf, or foot) is swollen, red, hot to touch, or throbs with pain - these signs can indicate a blood clot, and you should have it investigated as soon as possible
You have pain at night that keeps you awake or interrupts your sleep
You feel pins and needles or tingling in your leg - this can indicate an injured nerve, and our rehab plan may not suit you
Your symptoms are getting worse
Your injury is not recovering as expected (see expected recovery times below)

Question 4

Causes of Patellar tendinopathy

Accepted Answer

Patellar tendinopathy is an overuse injury. The overuse can happen suddenly, during a single hard training session, or develop slowly over a more extended period.Sudden overuse usually occurs during a training session that incorporates activities that work the quadricep muscles intensely. Examples include plyometrics (jumping or hopping), heavy and/or deep squats, downhill running, and fast running.Gradual overload usually happens because you're:

Not allowing enough recovery time between training sessions, or
Doing too many high-intensity training sessions in short succession.

Evidence suggests that the risk of patellar tendinopathy can increase when there is:

Weakness in your other muscle groups (glutes and calves), and
Reduced mobility and range of motion in your ankle joints, hamstrings, and quadriceps.

Other causes include:

A direct hit to the patellar tendon
Fluoroquinolone antibiotics - these medications can cause tendon injuries, including tendinopathy and tears
Inflammatory conditions - conditions like gout, rheumatoid arthritis, and psoriasis also cause tendon pain and can easily be mistaken for tendinopathy

Question 5

Treatment, recovery times & prevention

Accepted Answer

Treatment

Research suggests the most effective intervention is the right combination of rest and exercise tailored to the individual. A well-rounded rehab plan for patellar tendinopathy should include:

Relative rest: Cut out aggravating activities and reduce your training program to allow your tendon pain to settle
A slow, progressive strength training plan: Gradually restore the load tolerance of the tendon by targeting the quadricep muscles and patellar tendon
General strength and control exercises: Condition your core and other supporting muscles (glutes, hamstrings, and calf muscles) to help share the load when you run and jump
Mobility and range of movement exercises: Gain and maintain good mobility in all your lower body joints and muscles to reduce the strain on your patellar tendon
Movement retraining: Learn how to use your whole kinetic chain (all the interconnected parts of your body) optimally while running, specifically during the landing phase

The rehab plan in the app includes all of these components. It starts with low-load exercises that help settle your pain, then slowly increases the exercise intensity as your tendon strengthens and heals.

Other treatments you may encounter

Complete rest: It may calm your pain initially, but resting for prolonged periods is not advised as it can cause your tendon to lose more strength
Patellar straps or taping: May help reduce your pain during rehab exercises and sports
Massage: May help reduce pain, but it does not strengthen your tendon, and vigorous tendon massage can also irritate the tendon and increase your pain
Electrotherapy (like ultrasound): Not recommended by the current research
Shockwave therapy: May be helpful in some cases, but research shows contradictory results

Recovery time

Most researchers agree that the minimum time it takes to complete rehab and return to full sports participation is 6 months. However, taking 12 months or longer to fully recover from patellar tendinopathy is not uncommon.Staying patient and motivated during this time can be difficult, but rushing your rehab and increasing exercise intensities too quickly can cause setbacks. We’ve included information that will help you monitor your progress and know when to train harder, rest, or ask for help - giving you greater control over your recovery.

Prevention

You can reduce your risk of developing patellar tendinopathy if you:

Avoid sudden increases in training intensity or volume
Allow enough recovery time after intense training sessions
Vary your training, i.e., don't go to your limit in every session
Do regular strength training for your calves, core, and legs
Maintain good mobility and flexibility in your lower body joints and muscles

Once you've completed your rehab, switch to the injury prevention plan in the app - it’s been designed with all of these elements in mind.

Question 6

Research References

Accepted Answer

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Strong Knees: Patellar Tendon