Optimising Cycling Performance. North Yorkshire

Patella Tendinopathy

Patella Tendinopathy

 MRI showing thickening of the patella tendon, below the knee cap indicative of patella tendinopathy.

MRI showing thickening of the patella tendon, below the knee cap indicative of patella tendinopathy.


What is Patella Tendinopathy?


Patella tendinopathy is exactly what it sounds like it should be – a pathology of the patella tendon. Your patella tendon is the exceptionally important bit of tissue that joins your knee cap (patella) to your shin bone. It takes all the force from your quadriceps muscle and uses it to straighten your knee, hold your knee in a position against a load or gradually control leg bending when a load is trying to bend it quicker.

The pathology (the reason for the pain) that is present at the patella tendon is open for much debate at present. Certainly this used to be talked about as tendonitis – that is inflammation of the tendon. It is clear that in the vast majority of cases this isn’t true. There is no inflammation; not in the commonly understood sense anyway. Tendon pain also doesn’t follow a usual inflammatory presentation and treating it like a normal inflammatory issue does not help.

Modern thinking on this subject suggests that it is due to a disturbance in the healthy balance that the tendon tries to maintain. All our body’s tissues are constantly going through a process of replenishment; old tissue is broken down and replaced with new tissue. Tendon is no different. It is generally thought that. When there is a mismatch in this process, when the balance is lost your body tries to deal with this by releasing chemicals. It is thought that amongst other things these chemicals lead to tendon pain.  

It is commonly seen that two distinct sets of issues lead to the development of tendinopathy. However for many years it has really only been the former that has been treated by most practitioners.

1. Problems with tendon loading

  • Sudden changes in tendon loading. Such as starting to train at the beginning of a sports season or increasing your running past the dreaded 20 miles per week mark!
  • Sustained loading of the tendon. The archetypal overuse injury.
  • (Bio) Mechanical reasons why the tendon is loaded more

2. Problems with the health of the tendon – how able is the tendon to maintain an equilibrium despite fluctuations in load. The features below influence this:

  • Age
  • Genetics
  • Smoking status
  • General health and lifestyle factors.


What are the symptoms of Patella Tendinopathy?


Pain is the most common symptom of patella tendinopathy. This is usually seen localized very much to the tendon its self. Felt just below the kneecap at the front.

Pain is often worse on starting movement, such as getting up from a chair after sitting for a while. It can often feel better with activity, but will commonly eventually stop that activity due to pain.

If left unmanaged the pain can stop sporting activity all together.

The patella tendon is often very tender to touch. It can also become swollen. However it does not usually lead to swelling of the knee joint as a whole, just local to the tendon. If your whole knee is swollen you may have another issue. If you are unsure we would be very willing to help. An appointment with a knee specialist can be made here.


What can I do for myself?


If you have read and understood the ‘What is patella tendinopathy?’ section you may be already thinking about what you can do.

Think about the reasons you may have developed the issue in the first place. Of course we do not advocate stopping aging, but a truthful reflection on what you have been doing from an exercise point of view may well lead to where things have gone wrong.

Correct the issues with your tendon loading. If these are not obvious to you then we can help. 

Also it is very important to think about your health and lifestyle choices and the impact these have on your tendon health. 

Once you have realized why things might have gone wrong and corrected the issues (this will often lead to an initial period of reduced activity) it is then important to start to re-load the tendon. Specific patella tendon loading exercises like in the video below are a great way to target the issue.

Once you have noticed your knee starting to feel somewhat easier with the early management it is a good idea to start to think about recovery:

  • Continue to progress the loading of your patella tendon
  • Regaining full flexibility
  • Regaining full strength
  • Returning to previous levels of activity

Once you start this journey how far you continue depends on what you wish to get back to doing. If you have a specific sport or hobby that you wish to return to then gaining the help of a rehabilitation specialist would be advised. This is something we would be able to help you with.


What other treatments are available?


Good physical and lifestyle management is the mainstay of the treatment of patella tendinopathy. As experienced knee specialists it is very uncommon that anything further than a well planned and implemented physical treatment regime is required.

If you are struggling then I would recommend that you see a specialist in this area to help you return to function. This is a service that our knee specialists at Cycloform Physiotherapy have been undertaking for many years.

In some instances a well-planned physical and lifestyle management program can be augmented by Extracorporeal Shockwave Therapy.

In incredibly rare situations the patella tendon its self can become thickened and scar tissue can form. This scar tissue can lead to continued irritation of the tendon and can stop the tendinopthay from settling. In this instance a surgical procedure can be undertaken to debride some of the scarring.

There are specialist knee surgeons that can undertake this procedure. It is not recommended unless you have failed a complete package of non-surgical management. The decision-making around this subject is complex and an extensive knowledge of the non-surgical treatment options is required. This is something that our knee specialists would be more than happy to help you with.