With our beautiful weather (and limited access to gyms), many of us are drawn back to our running shoes. While the freedom of the open road is invigorating, it can sometimes be dampened by new unwelcome aches and pains. One of the most common complaints we hear with running is knee pain. Typically, running does NOT lead to severe acute injuries like ACL tears. However, due to its repetitive nature, it can cause chronic overuse injuries like patellar tendinopathy.
What is it?
The patellar tendon is the connective tissue that runs from the bottom of the patella (knee cap) to the tibia (shin bone). It is actually a continuation of the quadricep muscle, which becomes the quadricep tendon and envelopes the knee cap, before transitioning into the patellar tendon and attaching to the tibial tuberosity. The patellar tendon is under load any time the quadriceps are engaged or placed under tension.
Patellar tendinopathy refers to the irritation or overuse of this tendon and presents as anterior knee pain, below the knee cap. Initially, it may present as an acute tendonitis with local inflammation, tenderness, and pain with activity. Untreated, it may progress to more chronic tendinosis, which includes degenerative changes in the tissue itself and may actually weaken the tendon. At this point, pain may be more persistent and limit lower intensity tasks like standing from a chair and climbing stairs.
How does this injury occur?
Patellar tendinopathy is most often associated with repetitive movement patterns or overuse. In fact, it is also called “jumper’s knee” due to the nature of common aggravating movements. The patellar tendon works with the quadriceps to extend the knee, so it is a critical component of running, kicking, jumping, squatting, and climbing stairs. Typically, injury occurs when the tendon cannot tolerate the amount of load placed on it – with global overuse or changing activity level too quickly.
Who does it impact?
We tend to see patellar tendon injuries in more active individuals with higher volumes of running and jumping including basketball and volleyball players. Individuals with increased tightness through the leg musculature, especially quads and hamstrings, may be at a slightly greater risk. We also associate patellar tendinopathy with impaired shock absorption and force production. These impaired mechanics are often related to dysfunction at the hip and ankle in addition to the knee itself. A history of other knee dysfunction including patellofemoral syndrome or osgood schlatters may increase likelihood of tendon based knee pain as well.
How do you treat it?
As with any injury, treatment should be catered to the individual. We will discuss your past injury history, assess mobility and strength as well as movement patterns, and review your big picture goals including return to activity. We try to keep you active and running through the process as much as possible.
Acute treatment will likely include offloading the tendon – through activity or volume modification (if needed) as well as strengthening surrounding structures. We may recommend the use of a brace or strap if appropriate. Long term treatment will include addressing more global impairments like strength, muscular flexibility, running and jumping mechanics, and long term volume management.
What should I expect at Physical Therapy?
A thorough subjective examination or discussion of your symptoms including:
- Description of symptoms including severity, chronicity, and triggers
- Running history – including training volume, terrain, intensity, and any pending races or events
- History of prior injury especially of the lower extremity
A physical examination to help identify what structures or movement patterns are contributing to your pain including:
- Examination of local knee structures including patellar mobility and any signs of acute inflammation
- Assessment of knee and hip strength especially quads, hamstrings, and glutes
- Assessment of foot, ankle, knee, and hip mobility
- Gait and running assessments, including high-speed video analysis
- Jumping and landing mechanics, with emphasis on shock absorption patterns
Appropriate treatment and patient education which may include:
- Behavior modifications for symptom management, which may include short-term offloading of patellar tendon through activity modification, change in running or jumping volume, or use of taping or braces/straps
- Manual therapy including mobilization of muscles and joints for improved range of motion, decreased pain, and improved mechanics
- Exercises specific to your impairments – targeting flexibility, strength, stability, or motor control/coordination per your evaluation
- Modifications to jumping and landing mechanics for both double leg and single leg tasks – running is repeated single leg landings!
- Long term management with home program to further progress strength and mobility, and help mitigate future injury
For a thorough evaluation and individualized treatment, contact us at Evolve Physical Therapy today!
Melisa Abesa is a California transplant who has come to love the Pacific Northwest. Since graduating with her Doctorate of Physical Therapy from the University of Southern California in 2014, she has practiced in the Portland/Salem area. She is a huge advocate for patient empowerment, individualized care, and a holistic approach to health and wellness.
As a board-certified clinical specialist in orthopedic physical therapy, she enjoys working with a large variety of orthopedic and sports related conditions, with special interests including runners, headache treatments, post-operative care, and adolescent athletes.