Sports rehab patellar tendonitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Patellar tendonitis is also known as jumper's knee.

It is due to inflammation in the patellar tendon which connects the kneecap (patella) to the shinbone (tibia).

Patellar tendonitis is caused by excessive jumping. Other repetitive activities such as running, walking, or cycling may also lead to patellar tendonitis. These activities put stress on the patellar tendon. This causes the tendon to become inflamed.

Patellar tendonitis can also occur in people who have alignment problems in their legs. This alignment problem can result from having wide hips, being knock-kneed, or having feet that over-pronate.

The patellar tendon may sometimes tear during strenuous activity.

Symptoms are:

• pain and tenderness involving the patellar tendon
• swelling where the patellar tendon attaches to the tibia
• pain with jumping, running, or walking, especially when going downhill or downstairs
• pain with flexing or extending (bending or straightening) the leg

If the tendon ruptures, there is sudden severe pain with inability to straighten the leg.

The diagnosis is suspected when there is tenderness at the patellar tendon. The pain is increased with running, jumping, or squatting. The feet should be checked for over-pronation. MRI of the knee confirms the diagnosis.

Initial treatment is rest.

Other treatment consists of:
• applying ice to the knee for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or perhaps a bit longer
• anti-inflammatory medication
• wearing a band across the patellar tendon. This is called an infrapatellar strap. It helps support the patellar tendon and helps with pain
• wearing custom-made orthotics. These arch supports help with over-pronation.

Platelet-rich plasma (PRP) administered using ultrasound guidance can speed healing. (For more information on PRP go to Tendonitis

If the patellar tendon ruptures, surgery is indicated.

Rehabilitation exercises need to be started.

Return to activity will be determined by how soon the knee recovers The longer the symptoms before treatment is started, the longer it takes to recover.

Signs that recovery has occurred for the athlete are in progressive order:
• The knee can be fully straightened and bent without pain.
• The knee and leg have regained normal strength
• The knee is not swollen.
• The patient is able to jog straight ahead without limping.
• The patient can sprint straight ahead without limping.

Patellar tendonitis can best be prevented by having strong quadriceps (thigh muscles).

Avoid activities which may aggravate the patellofemoral joint such as:
• Squatting
• Deep knee bends
• Excessive bending
• Sitting back on the heels
• Kneeling directly on knee
• Excessive stair or hill climbing
• Wearing high-heel shoes
• Riding a bike with a low seat

The following may also help prevent injury:
• Wearing shoes that fit properly and are right for the activity.
• Gently stretching before and after exercising.

Adapted from the article written by Pierre Rouzier, M.D., for McKesson Clinical Reference Systems. Published by McKesson Clinical Reference Systems.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Sports Medicine Advisor 2002.1 Index
Sports Medicine Advisor 2002.1 Credits
Copyright © 1997-2002 McKesson Health Solutions LLC. All rights reserved.

Patellar Tendonitis (Jumper's Knee) Rehabilitation Exercises

You can start doing the patellar mobility exercise as soon as the pain in the kneecap lessens to the point that you can move it without excessive discomfort. You can do the hamstring stretch immediately.

When the pain in the knee has decreased, you can do the quadriceps stretch and start strengthening the quadriceps (thigh muscles) using the rest of the exercises.

• Patellar mobility: Sit with the injured leg outstretched in front of you and the muscles on the top of your thigh relaxed. Take the index finger and thumb and gently press the kneecap down toward the foot. Hold the position for 10 seconds. Return to the starting position. Next, pull the kneecap up toward the waist and hold it for 10 seconds. Return to the starting position. Then, try to gently push the kneecap inward toward the other leg and hold for 10 seconds. Repeat these for approximately 5 minutes.

• Standing hamstring stretch: Place the heel of the leg on a stool about 15 inches high. Keep the knee straight. Lean forward, bending at the hips until a mild stretch is felt in the back of the thigh. Make sure not to roll the shoulders and bend at the waist when doing this. Otherwise, the lower back will be stretched instead. Hold the stretch for 15 to 30 seconds. Repeat 3 times.

• Quadriceps stretch: Stand an arm's length away from the wall, facing straight ahead. Brace by keeping the hand on the uninjured side against the wall. With the other hand, grasp the ankle of the injured leg and pull the heel toward the buttocks. Don't arch or twist the back and keep the knees together. Hold this stretch for 15 to 30 seconds. Repeat 3 times.

• Quadriceps isometrics: Sitting on the floor with the injured leg straight and the other leg bent, press the back of the knee into the floor by tightening the muscles on the top of the thigh. Hold this position 10 seconds. Relax. Do 3 sets of 10.

• Straight leg raise: Lie on the back with legs straight out in front. Tighten up the top of the thigh muscle on the injured leg and lift that leg about 8 inches off the floor, keeping the thigh muscle tight throughout. Slowly lower the leg back down to the floor. Do 3 sets of 10.

• Step-up: Stand with the foot of the injured leg on a support (like a block of wood) 3 to 5 inches high. Keep the other foot flat on the floor. Shift the weight onto the injured leg and straighten the knee as the uninjured leg comes off the floor. Lower the uninjured leg to the floor slowly. Do 3 sets of 10.

• Wall squat with a ball: Stand with back, shoulders, and head against a wall and look straight ahead. Keep the shoulders relaxed and the feet 1 foot away from the wall and a shoulder's width apart. Place a rolled up pillow or a soccer-sized ball between the thighs. Keeping the head against the wall, slowly squat while squeezing the pillow or ball at the same time. Squat down until almost in a sitting position. The thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the wall. Make sure to keep squeezing the pillow or ball throughout this exercise. Repeat 10 times. Build up to 3 sets of 10.

• Knee stabilization: Wrap a piece of elastic tubing around the ankle of the uninjured leg. Tie the tubing to a table or other fixed object.
A. Stand on the injured leg facing the table and bend the knee slightly, keeping the thigh muscles tight. While maintaining this position, move the uninjured leg straight back behind. Do 3 sets of 10.
B. Turn 90° so the injured leg is closest to the table. Move the uninjured leg away from the body. Do 3 sets of 10.
C. Turn 90° again so the back is to the table. Move the uninjured leg straight out in front. Do 3 sets of 10.
D. Turn the body 90° again so the uninjured leg is closest to the table. Move the uninjured leg across the body. Do 3 sets of 10.

Hold onto a chair if balance is needed. This exercise can be made even more challenging by standing on a pillow while moving the uninjured leg.

• Resisted knee extension: Make a loop from a piece of elastic tubing by tying it around the leg of a table or other fixed object. Step into the loop so the tubing is around the back of the injured leg. Lift the uninjured foot off the ground. Hold onto a chair for balance, if needed.
A. Bend the knee about 45 degrees.
B. Slowly straighten the leg, keeping the thigh muscles tight as this is done.

Do this 10 times. Do 3 sets. An easier way to do this is to perform this exercise while standing on both legs.

Adapted from the article written by Tammy White, M.S., P.T., for McKesson Health Solutions LLC.
Published by McKesson Health Solutions LLC.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Sports Medicine Advisor 2003.2 Index
Sports Medicine Advisor 2003.2 Credits
Copyright © 2003 McKesson Health Solutions LLC. All rights reserved.

In patients who do not respond to conservative measures, a newer treatment for tendonitis may be effective and prevent the need for surgery. Percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the fascia. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality fascial tissue is stimulated to grow with natural healing.

For more information about this procedure, visit our sister site:
Tendonitis provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

Get more information about sports rehab patellar tendonitis and related topics as well as...

• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

• Devastating ammunition against low back pain... discover 9 secrets!

• Ignored remedies that eliminate fibromyalgia symptoms quickly!

• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!

• The stiff penalties you face if you ignore this type of hip pain...

• 7 easy-to-implement neck pain remedies that work like a charm!

• And much more...

Click here Second Opinion Arthritis Treatment Kit

Return to arthritis home page.

Copyright (c) 2004 All Rights Reserved

How to Beat Arthritis! Get our FREE monthly Ezine and get your life back!

Enter your E-mail Address
Enter your First Name (optional)

Don't worry — your e-mail address is totally secure.
I promise to use it only to send you Insider Arthritis Tips.