Knee Pain (Patellar Tendinitis) Facts

What is Patellar Tendinitis (PT)

A common complaint of athletes is pain in the front part of the knee. The medical term for this pain is patello-femoral pain syndrome, runners knee, anterior knee pain, extensor mechanism disorder, or patellar tendonitis (PT).

People with PT frequently complain of dull pain, which is worse running, squatting, jumping, or walking up or down stairs. Pain may feel worse after bending your knee when sitting. Sometimes the knee clicks or locks. Sometimes it feels like it is buckling under you when you walk. Sometimes it is swollen. This pain is usually chronic in nature.

Occasionally, direct trauma to the knee can cause PT, but usually it is caused by repetitive strain from overuse during activities. Knee pain is typically secondary to foot or hip dysfunction. Flat feet alter normal muscle relationships, and can force the knee into the wrong position while you are walking, running, or jumping. Even wearing the wrong shoes may cause stresses on the muscles around the knee. Repetitive movements in sports or work activities may exaggerate these imbalances and lead to PT.

When should you see a doctor?

Even though PT may be caused by a wide variety of conditions, usually it can be treated without surgical intervention. If your pain is so severe that you have difficulty with your normal activities, you should see a doctor. The healthcare provider you select will help you with ways to better control your pain and to improve your ability to perform desired activities.

What can you do for yourself?

Even though you are in pain, it is important for you to stay active. Being active can help prevent long-term problems.

If your pain is acute, ice or anti-inflammatory medication may help. Use the R.I.C.E. formula:

• Rest: Avoid putting weight on the painful knee. Some athletes temporarily switch to a non-weight bearing activity, such as swimming.
• Ice: Apply cold packs or ice wrapped in a towel for short periods of time, several times a day.
• Compression: Use an elastic bandage such as a simple knee sleeve with or without the kneecap cut out that fits snugly without causing pain.
• Elevation: Keep the knee raised up higher than your heart.

Ways to Increase your activity.

Evaluate what you can do, how long you can do it without increasing your pain, and what is too painful to do. Record how long you can participate in the activity without increasing the pain in your sore leg. Continue those activities you can do without pain. Temporarily avoid those activities, which are too painful to do at all. For those activities which cause “flare-ups” after some use, try the following guidelines:

• Look at how long you can comfortably perform the activity, and reduce the time you do it by 20%. (In this way you should avoid the “flare-up”.)
• Over several sessions, gradually increase the time spent doing the activity.

If another “flare-up” occurs, don’t panic! You may have tried to do too much too soon. Once again reduce your activity level by 20 %, and keep active.

Ways to modify your activity.

In sports

• Check your athletic shoes. How long have your worn them. As a rule of thumb, frequent runners should change their running shoes about every 6 months.
• During the beginning of your healing process, it may help to use a knee brace or patellar strap while exercising.
• Check your posture and the rhythm of your movements. Are you moving in a coordinated and balanced way?

At work and home

• Try to change your activities frequently.
• When gardening, sit in a low chair to avoid repetitive squatting.
• Minimize trips up and down stairs.
• Take frequent breaks.

Rehabilitation

A rehabilitation specialist will perform a functional examination to rule out serious conditions, discover functional weaknesses, and help you identify specific goals of treatment. This is important. There may be restrictions in your foot, hip or low back, which cause you to put unnecessary stresses on the knee. These stresses make it difficult to successfully complete your desired tasks. Your rehab exam will uncover these hidden causes to your problem.

Once your pain is under control, and your doctor has ruled out serious conditions, there are simple exercises, which may help you balance the muscles, correct your posture, and free the entrapped nerves. By increasing your function, these exercises become the key to your healing.

One of the most basic knee exercises to improve the “tracking” of the knee cap (patella) is called the pillow push. Simply push the back of your knee into the pillow and hold it there for 5-6 seconds. Then release. Repeat 8-10 times. Perform twice a day.

Pillow Push – start position		Pillow Push – final position

If the exercises you are doing, increase your symptoms, do not continue them. Consult your rehabilitation specialist.

Along with rehabilitation exercises, your rehab specialist may perform gentle mobilizations to the restricted joints and muscles, myofascial release, as well as recommend simple changes to your work or play activities. The goal of treatment is to relieve your pain and increase your function. Remember try not to focus on pain. Throughout the treatments, try to focus on your functional improvements. It is the improvements in what you can do and how long you can do it, which allow you to increase your activity level, and return you to your normal activities.