Knee Pain and Patellar Tendinopathy

This article is by Jo Knock the physiotherapist in London at Islington’s Angel Sports Injury and Physiotherapy Clinic. Our physiotherapist in London looks at knee pain and why there has been a change in name from patellar tendonitis to patellar tendinopathy. Our physiotherapist looks at how this cause of knee pain is diagnosed and how it is treated.

It is tennis time again with the French Open on the go in Paris and with Wimbledon starting on the 25th June. There has already been some drama at the French Open with Andy Murray suffering low back pain and back spasms in his second round match and needing urgent courtside physiotherapy. Hopefully he will be fully recovered by Wimbledon and he wont be requiring the physiotherapist in London for the event.

Rafael Nadal has already been severely hampered by his ongoing knee injury this year. In 2012 he pulled out of the Sony Ericsson Open and he also retired early from 2010 Australian Open.

He also frequently appears on court with strapping below both knees to help decrease his knee pain. It is safe to assume that he has a travelling physiotherapist with him and I am sure he too will have his physio with him in London for Wimbledon.

This is a man who is only 26 (a happy birthday to you Rafa for the 3rd of June!) yet has been playing tennis for 23 years – beginning at age 3!! Now it is really no wonder his body is falling apart and that he needs a physio for his knee pain. He has incredible foot-work and is lightening fast on the court, however this has taken a heavy toll on his knees.

Rafa Nadal and Knee Pain

Rafa suffers with Patella tendinopathy, also known as jumpers knee and formerly known as patellar tendonitis which is a condition that isn’t unusual for me to see as a physio in London dealing with runners and joggers.

“Formerly known as patellar tendonitis as health professionals thought it was an inflammatory problem, it is now referred to as patellar tendinopathy, and is due to a failed adaptation to load.” Jo Knock, Physiotherapist in London.

This injury is seen commonly in:
• Running
• Basketball / netball
• Field events in athletics e.g. high jump, long jump and triple jump
• And of course tennis

What is patellar tendinopathy?

In its very early stages, it can be an acute inflammatory problem, and if you catch it early rest, ice and anti-inflammatories will help. But the majority of patellar tendinopathy’s are as a result of overuse and overload, hence being now known as a failed adaptation to load. It is a degenerative condition occurring at the base of patellar (or knee cap).

There are in fact THREE types of common patellar tendinopathy’s:
1) Mid substance patellar tendinopathy
2) Infra-patellar pole tendinopathy
3) Insertional tendinopathy

It is very important to have your knee accurately assessed by a physiotherapist to determine which type of tendinopathy you are suffering with as the treatment varies for each.

If you are concerned about a painful knee and think it may be a tendinopathy, come in for an assessment with our physiotherapist. This knee injury is similar to shin splints (see my article on Shin Splints) in that it is rarely an acute injury. That is, it is not an immediate obvious injury and does not happen all of a sudden like a torn hamstring in sprinters or an Anterior Cruciate Ligament rupture in kicking sports, but rather it is a build up over time.

The knee pain from patellar tendinopathy is due to any number of factors occurring independently or together such as:
• Constant, repetitive high loading and impact to the tendon
• Change in foot wear
• Change in technique
• Sudden increase in activity without sufficient pre-season training

Diagnosis, Signs and Symptoms of patellar tendinopathy

The diagnosis of patellar tendinopathy is primarily based on a physiotherapist’s assessment in the clinic. As a physiotherapist in London I have access to the latest imaging techniques such as ultrasound and MRI and these can provide additional diagnostic value where a thickening and swelling of the tendon is often seen.

Patellar Tendinopathy is characterised by a very agitated tendon. There will be pain at bottom of patellar where the tendon feeds into the bone or in the tendon itself (depending on the type of tendinopathy), tenderness when palpated, a pain / ache during and after exercise and it can range from mildly to horrendously debilitating. There will often be a visible area of swelling, and it can feel thick and boggy to the trained touch as well as crunchy or creaky (what we call crepitus).

Treatment for patellar tendinopathy

Treatment will vary depending on which type of tendinopathy you have, hence the importance of an accurate assessment by your physiotherapist, in London you can arrange an appointment with me at the Islington clinic.

• In the most basic form, initial treatment will consist of rest from aggravating activity, ice to help pain & strapping or the use of a counter force brace (see STRAPPING AND BRACE SUPPORT FOR PATELLAR TENDINOPATHYS) to offload the tendon
• Manual physiotherapy
• Sports massage is very effective at helping to realign the new collagen fibres which the body sends to the injury sight for healing. Without massage to this soft tissue, you are at risk of the new collagen fibres forming scar tissue.
• Exercise Rehabilitation then forms the most important part of your treatment for patellar tendinopathy and follows this path

Exercise rehabilitation for patellar tendinopathy

o initial isometric load of the tendon at inner range
o moving into eccentric load of the tendon to strengthen the tendon and muscles
o then performing sport specific and functional activities to load the tendon as it would be in your chosen sport with gradual return to full fitness
o stretching of lower limb muscles

Prevention of patellar tendinopathy

As I physiotherapist in London with a number of weekend worriors as patients I know that prevention is better than having to treat an aggrevated tendon. The first thing to do is to identify any biomechanical problems that may increase the risk e.g. pronated feet, poor lower limb mechanics, tight ITB(ilio tibial band) / TFL(tensor fascia lata).

If you are not sure, seek professional help and advice from your physio. Effective stretching and good flexibility of all lower limb muscles especially the quads is essential – if you are a woeful stretcher a regular massage can help keep you in check.

If you are a "weekend warrior" and feel that you would rather avoid developing this condition or you have knee pain and want it diagnosed and treated properly then click below to make an appointment with the physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic in Islington.

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