What is patellar tendonitis?
Patellar tendonitis, otherwise known as jumper’s knee, is an inflammation of the tendon that connects your kneecap (otherwise known as the patella) to your shin bone. This inflammation is usually brought on by overuse of your knee from activities like jumping or running. Patellar tendonitis is usually associated with pain with jumping or running, pain around your kneecap, or behind the lower part of your kneecap. You may also have swelling around the knee and pain with bending/straightening of your knee. Other symptoms can be present, as everyone is different. There are different grades of patellar tendonitis ranking the severity, with Grade 1 being the lowest and Grade 4 being the most severe. Grade 1 is mild patellar tendonitis, with pain present only during certain activities like running or jumping, and Grade 4 is severe patellar tendonitis, with pain being constant and severe. Only a healthcare provider can make an official diagnosis.
Running with Patellar Tendonitis
Running is not recommended when you first injure your patellar tendon. However, once pain has become mild or completely reduced, it is appropriate to begin a modified running regimen. If pain is noticeable when you run in shoes with a bigger ‘drop’, which is the height difference between the heel of the shoe and the forefoot, you can switch to a more minimal type shoe to help offload the knee. The minimal and barefoot style shoes remove the load from the knee and place more of the load to the foot and ankle. You can also slightly increase your running cadence, or steps you take in a minute, which can help reduce load from the knee. Also, improving your running form by running tall to prevent over striding and utilizing the piston cue technique can also be beneficial to preventing additional stress to the knee. It is best to keep in mind that if your pain level goes above 4 out of 10 and does not settle within 24 hours of exercise, it is best to stop running with patellar tendonitis.
Ok, I have it. Now what?
Typically, conservative treatments are effective at fixing patellar tendonitis. This includes applying ice for 10-15 minutes several times a day to reduce swelling, resting your injured knee and temporarily stopping activities that cause pain, taking nonsteroidal anti-inflammatories (NSAIDs) as needed for pain, and incorporating stretching and strengthening exercises. You can also wear a brace to help support the knee while running with patellar tendonitis. If the pain continues, you can seek additional help from a physical therapist. They will be able to show you different stretches and strengthening exercises that will help strengthen the muscles around the kneecap, reducing the strain and improving pain. Once the pain has stopped, you can gradually begin running again but keep in mind to ease back into your exercise routine slowly as to not reinjure your tendon. If conservative treatments have failed and you continue to have pain, surgery or non-invasive High-energy Extracorporeal Shockwave Therapy may be required. With surgery, your knee is put in an immobilizer for 6 to 8 weeks and recovery time can take 6 to 12 months. With High-energy Extracorporeal Shockwave Therapy, there is no downtime after the procedure buy you must avoid high-impact activities for at least 30 days before easing back into those activities.
Stretch, stretch, stretch
There are several exercises that can help stretch and strengthen the muscles and tendons around the patellar tendon. The four common stretches are the standing hamstring stretch, quadriceps stretch, side-lying leg lift and the rectus femoris stretch.
• The standing hamstring stretch helps the hamstring muscles become less tight, which can reduce the pulling of the knee. Tight hamstrings also contribute to low back pain. To do this exercise, put the heel of the leg on the injured side on a solid, stable surface that is about 15 inches high. This can be a stool, a box or a chair. Keep your leg straight and lean forward, bending at the hips, until you feel a slight stretch in the back of your leg. Hold this position for 15 to 30 seconds and repeat several times.
- The quadriceps stretch helps loosen the quadriceps. When the quadriceps muscles become too tight, they can pull on the patella, causing pain. This is a standing stretch, so be sure to have a wall or stable surface to hold for support. Stand on your uninjured leg, with the same hand holding the wall or stable surface for support. Grab your leg on the injured side, near the ankle if possible, and pull the leg towards your buttocks. You should feel a slight stretch in your quadricep muscles. Hold this position for 15 to 30 seconds and repeat several times.
- The side-lying leg lift is a body weight exercise that helps strengthen the hip adductors and glutes. Hip instability can increase risk of injury for runners. Lie on your uninjured side and tighten the front thigh muscles on your injured leg and lift 8-10 inches away from the other leg. Be sure to keep the leg straight and to have slow, controlled movement. Do 2 sets of 15.
- The rectus femoris stretch stretches the rectus femoris muscle which is a part of the quadriceps muscle. This muscle is responsible for knee extension and when it becomes overly tight, can lead to knee pain. For this stretch, kneel on your injured knee on a padded surface, and place your other leg in front of you with your foot flat on the floor. Keep your head and chest forward and upright and grab the ankle behind you. Slowly pull your ankle back towards your buttocks until you fee a stretch in front of your thigh. Hold for 15 to 30 seconds and repeat several times.
Before running with patellar tendonitis, it is recommended that you see your primary care physician if pain continues despite rest and self-care treatments. They can appropriately diagnose and provided alternate treatments and medications for your patellar tendonitis that would not be available to you otherwise. It is best to treat patellar tendonitis before it escalates and becomes too severe for conservative treatments.
Sarah Houghton, CNA
Sarah Houghton is a licensed CNA and a Medical Operations Officer in the United States Army Reserves. She earned her BS in Biomedical Science from Tarleton State University and has won numerous awards for her work. Sarah is an avid powerlifter and is dedicated to sharing her knowledge to help others be healthy and fit.