Anatomy & Background
The knee is the largest joint in the body. It was designed for bearing weight, stability and mobility. The knee is composed of four bones and three bone-to-bone joints. The most common injury of the knee is tendinitis. A tendon is the cord-like part of the muscle that attaches muscle to bone. There are several tendons that attach near and control the knee. Knee tendinitis refers to the irritation, and inflammation of the tendons around the knee. The common tendons injured 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, and running and jumping activities. Patella tendinitis is often referred to as “jumper’s knee.”
Common causes of patella tendinitis include:
- Overuse, common to 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.
Symptoms of Patella Tendinitis
- Pain and tenderness of the patella tendon on palpation.
- Swelling over the patella tendon.
- Difficulty and pain with jumping, running, stairs, squatting or kneeling activities.
- Achiness or stiffness in the front of the knee below the patella after exertion or exercise.
- Pain and weakness with resistance of the quadriceps muscle.
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).
- Ice: apply ice to the tendon or area of inflammation. Apply ice right away (do not apply directly to 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 patients found that rest, ice and medication were enough to stop the pain. 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.
Avoiding the activities that produce the pain or stress the involved tendon is the first line of treatment.
- 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 bracing 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 forces 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.