Does your knee ache after activity? Does the front of your kneecap feel like it's burning or sore? Are you having trouble doing routine things like going up and down stairs, squatting to get something off the floor or exercising? If so, you may have a case of patellar tendonitis.
Patellar tendonitis is one of the more common forms of tendonitis. It occurs in patients of all ages, but most frequently in those younger than 60.
To find your patellar tendon, put your fingers slightly below the bottom tip of your kneecap. Now, extend your knee so your leg is straight. What you feel popping into your fingers is your patellar tendon. Poke all around it — if the pressure is uncomfortable, you may have just ruled in patellar tendonitis.
Hallmarks of patellar tendonitis are clear and distinguishable from other forms of knee pain like meniscal tears, anterior cruciate ligament (ACL) injuries and even arthritis. The most commonly reported symptom is a feeling of burning around the kneecap. The knee in general can be sore and even the skin on the surface of the knee can be sensitive to the touch. In more severe cases, the pain may be felt as sharp or shooting, and some patients say they feel as if the "tendon is ripping."
With an acute tendonitis, the most important initial step is to rest the tendon and allow the healing process to start. It is recommended to rest it for at least a week in minor cases, and two weeks of rest (or more) is indicated in severe cases. This gives the body a chance to filter blood and other inflammatory substances away from the tendon, creating a better environment for repair. Skipping this stage could result in a prolonged bout of tendonitis, and in some instances, chronic tendon problems.
Outside of rest, there are a number of treatment options patients can try short of a formal rehab program. The most commonly used modality is ice. Ice prevents further inflammation from infiltrating the tendon and has a strong pain-numbing effect. Conversely to ice, heat will increase inflammation and often results in extended recovery times and increased soreness and should not be used in cases of acute tendonitis.
Maintaining flexibility of the knee is a critically important feature to help achieve recovery. Quadriceps and hamstring muscle stretches are interventions that can be used to reduce force on the tendon itself and promote better balance between the muscles of the thigh and hamstrings. Better balance between the two muscle groups prevents sheer forces from going through the knee, often compounding cases of tendonitis.
Most patients prefer non-medication solutions when they are available, but this isn't always an option. As a last line defense of self-management, anti-inflammatory drugs such as ibuprofen, Motrin and Naproxen can be helpful in alleviating some of the inflammation. Drugs such as Tylenol and aspirin are not effective for tendonitis because they do not act directly on the mechanisms that cause inflammation.
Most patients are able to fix themselves using these simple strategies, but some will move on to a formalized therapeutic program. In physical therapy, your therapist will screen your entire lower body for abnormalities in strength and range of motion. Often, problems at the hip and ankle lead to problems at the knee. By working on and fixing adjacent body parts, you may help accelerate the course of recovery.
Sometimes, therapists use more advanced techniques like joint manipulation, mobilization and extensive soft tissue work - but these cases are rare and almost all patients have an excellent outcome inside of a month.
For patients that aren't managing well with conservative care, there are other options like cortisone injections and topical steroid agents that help to reduce inflammation - some of which can be administered in physical therapy.
If you think you have a case of tendonitis and it's not going away with rest and stretching, see your doctor about starting a course of physical reaction.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly. Questions may be submitted to Joe by e-mail: joedivincenzo@comcast.net.
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