Anatomy & Background
The knee is the largest joint in the body. It is built for bearing weight, stability and mobility. The knee is composed of four bones and three bone-to-bone joints. The most common injury or condition of the knee is tendinitis. There are several groups of tendons that attach near and control the knee. A tendon is a cord-like part of the muscle that attaches the muscle to the bone. Knee tendinitis is the irritation, inflammation and swelling of tendons around the knee. The most common tendons affected are the patella tendon, hamstring tendons and the illiotibial band.
The patella tendon is the large tendon in the front of the knee that runs from the patella to the tibia. The patella is located within the quadriceps tendon, which is formed by the intersecting of the four quadriceps muscles on the front of the thigh. It is responsible for straightening the knee and plays a vital role in walking, stair climbing, running and jumping activities. Patella tendinitis is often referred to as “jumper’s knee.”
Common causes of patella tendinitis include:
- Overuse, common when participating in activities like basketball, running, volleyball, and soccer.
- An injury or direct impact to the tendon.
- Daily activities that involve repeated kneeling and/or squatting.
- Weakness of the quadriceps muscle.
- An increase in the frequency or intensity of training.
- Poor training technique or training on a hard surface.
The hamstring tendons purpose is to attach the hamstrings to the inside and outside of the knee. The medial hamstrings, semitendonosis and semimembranosis, insert at the inside of the knee. This is also referred to as the pes-enserines. The lateral hamstring attaches to the outside of the knee at the tibia and fibula. The hamstring’s primary role is to bend the knee and straighten the hip, making them an essential component to walking, running and jumping.
Common causes of hamstring tendinitis:
- Repetitive activities such as running, jumping or kicking.
- Sudden and frequent deceleration, acceleration or stopping.
- A rapid increase in frequency or intensity of exercise or training.
- Improper running technique or training on hard surfaces.
- Weakness in the hamstring muscle causing the tendons to endure more strain.
- Poor pelvic alignment.
- Obesity increases the stress on an individuals hamstring tendons.
Iliotibial Band Tendon
The iliotibial band runs from the lateral pelvis to the outside of the knee, attaching to the tibia. The iliotibial band stabilizes the knee and hip during walking, standing and running. Iliotibial band tendinitis is also known as Iliotibial Band Friction Syndrome. This condition is caused when a bursa below the iliotibial band that helps the band glide over the lateral femoral condyle of the femur becomes irritated. When this bursa is inflamed or swollen the iliotibial band does not glide smoothly and develops into Iliotibial band tendinitis.
Causes: Common causes of Iliotibial band tendinitis or friction syndrome:
- This is a common overuse injury found in people who suddenly increase their level of activity. It is especially prevalent in runners, cyclists or rowers who suddenly increase their mileage/distance when training.
- Individuals who have poor alignment in their legs and feet, such as pronation, flat feet, or are bowlegged may be more susceptible to iliotibial band tendinitis.
- One leg that is longer than the other.
- Tightness of the iliotibial band.
- Excessive downhill running.
Treating Knee Tendinitis
Treatment for knee tendinitis will depend on the severity of the condition. Acute knee tendinitis should be treated using the principles of RICE (rest, ice, compression and elevation).
- Rest: avoid the activities that produce the pain (jumping, running, stairs, kneeling, squatting, etc).
- Ice: apply ice to the tendon or area of inflammation. Apply ice right away (not directly to the skin) and at intervals for around 20 minutes at a time.
- Compression: when using ice, apply light compression.
- Elevation: elevate the area to help reduce inflammation.
In mild cases many patients found that rest, ice and medication were enough to stop (or at least reduce) the pain. Your return to activity should be gradual to prevent a flare up of symptoms, and if symptoms continue it is advised to see a pain management specialist for a more specific diagnosis.
Moderate to Severe Cases
If the pain and inflammation persists, you should consult with your health care provider. Your pain management specialist should then perform a thorough evaluation to determine what tendon(s) are involved, the severity of the knee tendinitis, and finally the best course of treatment.
Your first course of treatment should be avoiding the activities that produce and cause pain.
- RICE: Rest, Ice, Compression Elevation should be used to alleviate the stress on the bursa.
- NSAIDS (Non-steroidal anti-inflammatory drugs) to minimize pain and swelling.
- Injection of steroids may be prescribed to minimize inflammation of the tendon.
- Immobilization or the use of a brace may benefit the tendon and promote healing.
- In extreme conditions, surgery may be necessary in order to repair the tendon.
Normally, patients respond well to conservative treatment of knee tendinitis. PLEASE NOTE: that once the pain and swelling is reduced and the individuals motion and strength are restored, the patient should gradually return to full mobility and function. In general, full return to all activity will take anywhere from two to six weeks depending on the severity of the injury. As a preventive measure individuals should:
- Warm Up: warming up prior to physical activity is necessary in preparing muscles and tendons for any work required of them. A five to ten minute warm up raises the body temperature and increases the circulation to the muscles and tendons and raises your heart rate. Elevating your body temperature and increasing the circulation will also help allow the muscles and tendons to be pliable and stretch with ease.
- Stretching: stretching before and after any activities will reduce the probability of developing tendinitis. Stretching will improve and maintain the elasticity of the muscles and tendons. Hold each stretch for 20 seconds and do NOT bounce while stretching. Remember, as tendons age, they lose their flexibility. This is simply part of the natural aging process.
- Strength: participating in a strength program will help muscles maintain enough strength to absorb the stress placed on them. Just running or participating in a sport will not prepare the muscles for the impact involved in many strenuous activities. As people age they naturally become weaker, and a great way to combat this weakness is through a strength program.
- Training: avoid sudden increases in your training regimen. Training progress should be gradually increased to avoid injury, especially if diagnosed with tendinitis previously.
- Foot Wear: When weight bearing or taking part in impact activities, proper footwear is imperative to minimize impacts and distribute forces properly.