Patellar Tendinopathy
Introduction
Patellar tendinopathy, also called Jumper’s knee, is a clinical condition of gradually progressive activity-related pain at the insertion of the patellar tendon at the apex patellae. [1] It is a musculoskeletal disorder affecting both recreational and elite athletes who run and jump as p.e. in volleyball and basketball. Patellar tendinopathy occurs more frequently in those mature adolescents or adults, ranging from ages 16-40 years. [1] [1]
Physiological background
Acute tendinitis involves an active inflammatory process, often occurring following an injury, which if treated, properly heals in 3-6 weeks.
Chronic patellar manifest itself after 6 weeks – 3months. These changes include absence of inflammatory cells in the tendon, a tendency toward poor healing, and decreased quality and disorganization of collagen fibers, both of which may lead to decreased tensile strength. Additonally, neovascularization, the growth of new vasculature in areas of poor blood supply, is common in chronic tendinopathy and may contribute to pain perception. The relationship between pain perception and neovasularization is not clearly understood, it is believed that increased levels of the neurotransmitter glutamate may play a role. [1] [1] [1]
Causes
There is a higher prevalence noted in sports with high impact ballistic loading to the knee extensors. Microtrauma can occur when the patellar tendon is subjected to extreme forces such as rapid acceleration – decelaration, jumping, and landing. [1] Drastic changes in frequency and or intensity of training may also lead to overuse training errors.
Intrinsic factors such as strength or flexibility may play a role. However the primary causes appear to relate to the extrinsic factors of overuse, improper training surfaces, insufficient foot-wear or inappropriate equipment. [1]
Symptoms
The purpose of the evaluation is to differently diagnose between condition affecting the patella. We can use the Kennedy Scale to evaluate a chronic patellar tendinopathy [1]:
• Phase 1: pain after activity
• Phase 2: pain at the beginning and after activity
• Phase 3: pain at the beginning, during and after activity, but the performance is not affected
• Phase 4: Pain at the beginning, during and after activity, and the performance is affected
Thickness of the tendon may be noted also in all stages. Pain in the patellar tendon may be reproduces with resisted knee extension.
The symptomatic evaluation should include history, age and any recent growth spurts, location of pain, and special tests.[1]
Rehabilitation
Rehabilitation incorporates three stages ranging from limited partial weight bearing loaded exercise to a sports specific return to play protocol.Most patients with patellar tendinopathy are treated non-operatively. Eccentric exercise has been promoted as an important conservative treatment choice for patellar tendinopathy.
The first stage of rehabilitation includes the initial rehabilitation with controlled rest. The rest is critical in the recovery. The patient should be refrained from a lot of physical activities or he should be abstained from the overuse abuse, and practice controlled exercise without load.
Initial treatment includes absence from jumping, relative rest, stretching of lower extremity musculature, deep transverse friction massage of the patellar tendon, eccentric quadriceps exercises, strengthening of hip and knee musculature, utilization of a patellar orthotic (if needed), and cryotherapy.[1] Prior the initiate the exercise , a warm-up and stretching period is recommended. Soft tissue mobilization is used to reduce pain and fibrotic limitations in tissue found in patellar tendinopathies. Deep transverse friction massage for 5-10 minutes twice daily is recommended to help promote normalized collagen alignment.
In the progression stage, after pain symptoms decrease, the eccentric exercise program should be progressed from partial-weight bearing to full weight bearing, then to weighted resistance using a back pack or weighted vest.[1]
Conclusion
A variety of rehabilitation techniques are necessary to assist an individual in returning the recreational en daily living activities. A combination of active rest, education eccentric exercise, progressing the training regime by 10% weekly, and modifying activity have all been found to be effective in tendinopathy treatment. [1] [1]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Johannes Zwerver, Evert Verhagen, Fred Hartgens, Inge van den Akker-Scheek and Ron Diercks – The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athlets with patellar tendionpaty: RCT (level of evidence: A1) – © Biomed Central 2010 Cite error: Invalid
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