Patellar Tendinitis


Patellar Tendonitis (Jumper's Knee) Overview

Tendonitis of the Patella (also known as Jumper's Knee and Sinding-Larsen-Johansson disease) is a painful condition affecting the patellar tendon (also called the patellar ligament or anterior ligament) in the knee joint. Like all forms of tendinitis, patellar tendinitis is a condition that can flare up and subside over a period of time. Inflammation in the patellar tendon is often due to irritation and/or micro-tearing of the collagen fibers. When the fibers tear, they become weaker, inflamed and swollen causing pain and tenderness in the area.

Patellar tendinitis refers to pain and inflammation of the patellar tendon in the kneecap

Tendons, by nature, receive very little blood flow. This prevents certain areas of the tendons from getting adequate blood supply in order to repair and maintain themselves. This makes tendons prone to micro-tearing and inflammation if they are strained or overused.

There are 2 types of tendonitis, acute and chronic. Acute tendonitis refers to inflammation that comes on suddenly, usually from a tendon strain or overloading it during exercise. Chronic tendonitis occurs over time and generally results from long term repetitive use of the patella tendon. With both types of patellar tendinitis, scar tissue develops on the tendon as the tears begin to heal. This scar tissue mends the tears in an abnormal way leaving the collagen fibers weaker and less flexible and its presence can result in re-tearing the same small areas over and over.

The patellar tendon connects the shin bone (tibia) below the (patella) kneecap to the quadriceps femoris tendon above the kneecap. The fibres of the patellar tendon encase the patella itself, allowing it to glide up and down.

The patellar tendon is responsible for extending the knee with the help of the quadriceps femoris tendon which passes down both sides of the patella and the quadriceps femoris muscle in the upper leg - a process known as the quadriceps mechanism.

Other conditions which can be a cause of anterior knee pain are commonly confused with patellar tendonitis. These conditions include quadriceps tendonitis, chondromalacia, patello-femoral subluxation and hyper-pressure, fat pad impingement or Hoffa's Syndrome, and patello-femoral arthritis.


Patellar Tendonitis Causes

Patella Tendonitis is usually caused by repetitive use of the patellar tendon, but can also be caused by trauma such as a blow to the knee. This condition is most common in an aging athlete who is involved in "jumping" sports such as basketball, gymnastics, figure skating, and volleyball. Other risk factors include:

Patellar tendinitis, also called Jumper's Knee, is common among althetes of sports which involve a lot of jumping or repetitive use of the knee joint.

There are a variety of internal and external causal factors for patellar tendonitis. Some outside factors would include overuse of your knee, wearing shoes that don't give you proper support, or athletic activity / exercising too much, too fast or for too long. Some internal factors include your age, flexibility, and the natural alignment of your feet, calves, knees and thighs.

  • Activities that require sharp, sudden changes of direction such as soccer.
  • Activities that involve repetitive use of the knees, such as cycling.
  • Having diabetes, gout and/or para-hypothyroidism.
  • Landing or falling heavily on your knees.
  • Age - as we grow older, our tendons become more brittle and therefore prone to injury.
  • Mis-alignment of the foot, ankle, and leg including flat feet, leg length discrepancy, tracking abnormalities etc.


Symptoms of Patellar Tendonitis

Patellar tendon pain radiates under the knee cap

You might be suffering from Patellar Tendonitis if:

  • You have pain right under your knee cap that disappears after any form of activity, exercise or workout.
  • You find climbing stairs or getting up from a seated position difficult - these actions cause you pain under your knee cap.
  • You have swelling, redness, heat sensation and/or burning pain on the front of your knee around your knee cap.
  • Pain that's more noticeable when you move your knee or try to kneel.
  • Pain that starts as you begin physical activity or just after an intense workout.
  • If you're a runner or an active athlete, the pain may get worse while running or participating in sports.(particular difficulty when running down hills)
Dealing with chronic pain from tendonitis.

If any of those statements are true for you or you're suffering from on-going pain under your knee cap (patella) then you might have an injury called "Patellar Tendonitis". This type of tendonitis is usually an injury that athletes get, but it can happen to individuals who aren't athletes as well. Anyone - young or old - can suffer from this injury, and if you're active this condition will keep you from doing the things you love to do. It will even start interrupting your normal daily tasks and make living life harder than it really needs to be.



The Patellar Tendon

The knee joint is made-up of 4 bones: the femur (thigh bone), fibula & tibia (shin bone), and the knee cap. The knee cap is a sesamoid bone, which means that it is a bone that's embedded in a tendon. For the knee cap this means that above the knee cap is the quadriceps tendon and below the knee cap is the patellar tendon. The patellar tendon attaches the knee cap, quadriceps tendon and quadriceps muscle to the shinbone below the knee. All of these elements work together to function as the "quadriceps mechanism" to help you when straightening your knee / leg.

The patellar tendon plays an important role in the way you use your leg muscles. The patellar tendon helps your muscles extend your knee so that you can kick a ball, run uphill and jump up in the air. This is why patella (patellar or 'infrapatellar') tendonitis is often called 'Jumper's knee'.




Patellar Tendinopathy

Tendonitis is fraying of the tendon fibers from injury or over-use

Jumper's Knee and patellar tendinopathy is a general term used to describe any kind of injury that causes irritation, tearing, or inflammation in the patellar tendon. There are different kinds of patellar tendinopathy that can happen that will influence how long you suffer from this injury, what type of treatment is needed and how to prevent further injury to your patellar tendon.

Patellar Tendonitis

Short-term inflammation in the patellar tendon is considered 'patellar tendonitis'. This is where the tendon becomes frayed or torn from an incident (like playing sports / running), or over-use (repetitively participating in the same activities).

You may partially or completely tear your patellar tendon. If you completely tear your patellar tendon, your tendon will no longer be attached to your knee cap (patella). Without that attachment you won't be able to straighten your knee. Partial tearing usually happens to the middle of the patellar tendon, while complete tearing often happens where the patellar tendon connects to the knee cap (patella).

Patellar Tendinosis

Patellar tendinosis happens when the tendon gets worn out over a long period of time (from overuse or aging of the tissue) and becomes damaged. This type of injury causes the tendon to thicken and micro-tear. Usually with tendinosis there isn't a lot of swelling or inflammation, just chronic, long-lasting pain.

Patellar Tenosynovitis

If the protective lining of your tendon (called the 'tendon sheath') becomes irritated or damaged this is called 'tenosynovitis'. This condition happens to the inner lining of the sheath, and this irritation can happen from injury, overuse, or repetitive tasks.




Patellar Tendonitis Diagnosis

A visit to your doctor is the best way to know if you have patellar tendonitis. To properly diagnose your knee pain your doctor will ask about your medical history, your current condition and symptoms. They will ask your about the intensity of your present pain, how long you've had these symptoms and the limitations you're experiencing. Details about what you think may have caused the problem, when it started, and whether or not you have ever had treatments for this or a similar condition in the past, are very helpful in assessing your injury.

There are 2 tests your doctor may perform to decide if you have a patellar tendon injury:

  • 'Passive Extension / Flexion Sign' - While you lay down on the examination table doctor will bend your knee to a 90 degree angle and then will apply pressure to the patellar tendon.
  • 'Standing Active Quadriceps Sign' - While you stand normally your doctor will feel along the length of the patellar tendon. Then you'll be asked put all of your weight on your sore knee and bend your knee 30 degrees.

Both of these physical tests will help your doctor to determine a correct diagnosis of your knee pain. If for any reason the test(s) don't help to discover the source of your pain, then diagnostic testing (an X-ray and/or MRI) will be ordered. These tests are also often used to rule out other conditions.

X-rays will provide a 2-dimensional image of the overall structure of your knee. They're helpful in identifying knee instability, abnormal bone shapes (bone spurs or bone cysts, fractures, wear and tear on the joints).

MRIs (magnetic resonance imaging) will provide more detailed information and will help to evaluate the soft tissues in and around your knee (muscles, tendons, ligaments, menisci and other connective tissues). It can identify ligament or tendon damage, and can help to determine the extent of your injury, the displacement and degree of your tear or inflammation, as well as other associated knee conditions.

MRI to see the patellar tendon in the knee

Conservative Treatment Options for Jumpers Knee (Patellar Tendinitis)

The best way to treat patellar tendonitis is to rest the area, especially avoiding the particular activity that produced the condition. If the strain was minor, the body should be able to heal the tendon fibers normally. Unfortunately, this is not the usual result, due to the injured tendon being used instead of rested.

The body heals the injured patellar tendon fibers by binding them together with fibrotic adhesions, or scar tissue. This is a normal, protective response of the body, done in an attempt to prevent further damage to the injured area. Unfortunately, this leads to inflexibility in the knee and possibly chronic knee problems.

Although steroid injections may provide temporary relief from the pain of an achilles injury they should generally be undertaken with caution as they weaken the tendon and may lead to a complete rupture. If you do opt for an injection, doctors usually recommend that you do not participate in strenuous activities for several weeks to reduce the risk of a rupture.


Step 1 - Reduce Pain and Swelling with Cold Compression

The first step for conservative treatment of your kneecap tendonitis is to reduce the swelling to "open up" the area for more blood flow. Anyone in the health-care business knows that your blood supplies the oxygen and much needed nutrients required to heal foot tendonitis injuries. This is why for years, doctors, trainers, and other medical professionals have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.

This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood to your damaged tendon and tissue begins to break-down. Without cold compressiontissue damage and break-down continue as they cannot get the oxygen they need to survive By limiting the amount of damage done to your tendons, you also limit the amount of healing that needs to occur. This is a very important step to heal acute or chronic tendon injuries faster and with less pain!

The combination of rest, topical pain relief cream and minor amounts of cold is the gold standard in medicine for minimizing tissue damage and reducing inflammation after injury or activity. It serves as a critical bridge into the next phase of the healing process.


Step 2 - Enhance Circulation, Soften Scar Tissue & Reduce Risk of Re-Injury with a T•Shellz Wrap®

After the inflammation in your knee has been reduced, moving the tendon and applying a local circulatory stimulation device like the Knee T•Shellz Wrap® is really what is needed for completing the recovery cycle. This is critical because tendons are known to receive very little natural blood flow and blood flow is really how your body is able to heal itself. When the tendon tissue is damaged, the already-reduced blood flow is decreased down to a trickle which is why movement is encouraged - it helps get blood flow to where it is needed.

Blood flow (healthy circulation) is an important part of natural tissue healing. Injured tendons take the nutrients available in local blood flow to get rid of any damaged tissue and start growing healthy tissue.

Knee TShellz Wrap Jumper's Knee patella tendonitis

Increased Blood Circulation = Increased Healing Capability


T•Shellz Wraps® contain a unique Carbon Fiber Energy Pad which is flexible and will shape to conform to your body. This Energy Pad emits a uniform wave of perfectly safe energy over its entire surface. This energy is absorbed by soft tissue in the treatment area, opening blood vessels, resulting in an increase in blood flow. Increased blood circulation is what your body needs to maximize its cabability of healing soft tissue and this is why we recommend the T•Shellz Wrap®.

The Knee T•Shellz Wrap® is an FDA Registered Medical Device and is suitable for use in therapeutic clinics and FROM HOME. It is completely safe for people and patients to use for themselves.

The technology found in a T•Shellz Wrap® has been used for decades in the worlds of professional and amateur sports - a contributing factor as to why athletes seem to recover from injuries so quickly.

Have you ever wondered by an athlete can return to activity after 4 or 5 weeks following a knee injury - while your average person takes much longer to return back to normal? The secret isn't really that much of a secret - it involves consistent treatments (meaning multiple times a day) using a treatment like the T•Shellz Wrap® to stimulate blood flow to the injured tissues. Most athletes have the luxury of using in-house facilities many times per day.

How many us can afford the time and money to visit a clinic multiple times a day? Very few indeed. This is how you can gain some of the advantages that athletes enjoy in their injury recovery - by using a device like the Knee T•Shellz Wrap® two or three times a day on a consistent basis.


T•Shellz Wrap side of knee coverage

Consistent Treatments = Consistent And Long Term Improvement


What Else Makes the Knee T•Shellz Wrap® So Special?

We believe the T•Shellz Wrap® to be one of the most effective home treatments to increase localized blood flow in and around the treatment area.

We can promise that you will receive a product that is designed to be safe and does what it is supposed to do... reduce pain (as stated in "Therapeutic Heat and Cold", 4th edition. - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin) temporarily increase length & flexibility of soft tissue (as stated in "Therapeutic Heat and Cold", 4th edition. - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin) and aid your body in recovering from tendon, muscle and other soft tissue injuries via enhanced blood flow.

The unit plugs into a standard wall outlet to get its power. The nice thing about the power supply is that the same unit can be used in North America and overseas as well. It has the capability to operate between 110v and 230v.

The T•Shellz Wrap® has a special signal controller that can be set for 3 different power levels of application (3=High, 2=Medium, 1=Low). The cord is long enough that you can sit or lie comfortably and watch TV, read or surf the net while you're using it.

We recommend 5 to 10 minute treatments to start; the safety shutoff controller is set to max 30 minutes in duration. The device can be worn over clothing and allows you to use the device at work, at home, or really anywhere you have access to an electrical outlet.

common areas for knee bursitis

Conservative Treatment Step 3: Recognize That Healing is a Process

With dedication, the right tools, and the right information - you will achieve your goal of a sustainable recovery. A combination approach of cold, heat treatments, and functional movements will make it happen much more quickly. Healing takes a comprehensive approach and will differ from person to person.

Have you seen what happens when you add water to a flower wilted from drought? In essence, your injured knee is much like a "wilted" flower; your body wants to heal its injury, but needs lots of nutrients to do it. Blood brings life to your tissue by delivering healing nutrients and oxygen that are vital for their growth and survival. In addition, the blood carries away toxins and waste cleaning the area and healing it faster. Without a good supply of blood, your knee simply won't heal as quickly, opening it up to greater risk of re-injury and/or tendonosis.

Pain and Anti-inflammatory (NSAIDs - Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties and increase the risk of cardiovascular disease. The use of cold packs and Circulatory Boost in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal quicker.


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Use a Knee T•Shellz Wrap®:

  • After swelling and inflammation have been reduced with cold compression.
  • BEFORE getting out of bed in the morning. BEFORE going to bed at night.
  • BEFORE exercise, workouts or activity of any kind to increase elasticity of knee tendons, ligaments and muscles and decrease the chance of re-injury.
  • Anytime you feel the tissue in your knee has stiffened up, is tight and your mobility is reduced causing you more pain.
  • Anytime you have sore or aching tissue around your knee.
  • AFTER surgery (once the skin wound has healed over and swelling has reduced - basically at least 6 weeks after the surgery) to boost blood circulation, helping surgically repaired tissues recover for long-term health and minimize scar tissue growth at the surgery location.
  • Any other situation where you need to increase blood flow to your knee to relax your soft tissue, relieve pain, prevent re-injury and enhance flexibility of your tissue.

Use a Cold Compress or Ice Pack:

  • 24 to 72 hours after your initial injury or when you first notice pain and swelling in your knee to stop tissue damage, relieve pain, and decrease swelling.
  • After exercise, workouts or activity of any kind to prevent re-injury of your knee.
  • Before and after surgery during rehabilitation to control pre and post-surgery pain and swelling.
  • Anytime you feel your knee is painful or you're having a flare-up of an old patellar tendon injury.
  • Anytime you have swelling, sharp throbbing pain or inflammation in your knee.
  • Any other situation where you need to draw the pain and inflammation out of your knee.

The more diligent you are with your treatment and rehabilitation, the faster you will see successful results.


Learn More About Achilles Injuries & Treatments

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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition.


 
 

Please be aware that this information is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider before using any of our outstanding products to make sure they're right for you and your condition or if you have any questions regarding a medical condition. Always see your doctor for a proper diagnosis as there are often many injuries and conditions (some very serious) that could be the cause of your pain.


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