Rehabilitation for Patellar Tendinitis (jumpers knee) and Patellofemoral Syndrome (chondromalacia patella)
The most common tendinitis about the knee is irritation of the patellar tendon. Commonly called “jumper’s knee”, patellar tendinitis is an inflammation of the tendon that attaches the patella (kneecap) to the tibia (shin bone). This condition is commonly seen in people who play basketball, volleyball, distance running, long-jumping, mountain climbing, figure skating, tennis or high impact aerobics. In many cases, you will notice a sudden onset of aching and pain in the area just below the kneecap after sports or recreational activities. You may notice pain then landing from a jump or when going up and down stairs. There is sometimes pain at rest, particularly after sitting with the knees bent for a period of time. Swelling in the area just below the kneecap is common, as well as a feeling of weakness at the knee when pain is felt.
The patellar tendon becomes inflamed and tender due to overuse.
Overuse injuries of the patellar tendon occur when you repeat a particular activity (usually running, jumping or high-impact) until there is micro-failure of the tissue that makes up the substance of the tendon. Swelling, inflammation and pain follows. In the early (acute) stage of patellar tendinitis, the pain and inflammation subside with rest. There may be pain at the beginning of activity, but this pain often disappears after a period of warm-up and then re-appears after the completion of the activity. If you ontinue with your activity in the presence of pain, you initially can continue to exercise or perform at a normal level. However, if you continue to exercise and don’t rest, the pain will become more persistent and will be present before, during and after activity. At this stage, you can do permanent damage to the tendon if you continue your activity and it will take a long time to heal.
When the knee moves, the kneecap (patella) slides to remain in contact with the lower end of the thigh bone (trochlear groove of the femur). Normally, this motion has almost no friction: the friction between these two joint surfaces is approximately 20% the friction of ice sliding against ice. If the patella and /or femur joint surface (articular cartilage) becomes softened or irregular, the friction increases. Grinding or crepitus that can be heard or felt when the knee moves is the result. This condition in which there is patellofemoral crepitus is called chondromalacia patella or patellofemoral syndrome.
The force, or pressure, with which the patella pushes against the femur is 1.8 times body weight with each step when walking on a level surface. When climbing up stairs, the force is 3.5 times body weight and when going down stairs it is 5 times body weight. When running or landing from a jump the patellofemoral force can exceed 10 or 12 times body weight.
The symptoms of chondromalacia patella are usually pain in the front of the knee that is aggravated by going up and down stairs, sitting for long periods of time with the knees bent (such as in a movie) and when doing deep knee bends.
Pressure between the patella and femur is minimized when the knee is straight or only slightly bent. Exercises and activities that require deep knee bending, jumping and landing , pushing or pulling heavy loads and stopping and starting will place very high stresses on the patellofemoral joint and the patellar tendon.
Treatment has two objectives: to reduce the inflammation and to allow the tendon to heal. When the knee is painful and swollen, you must rest it. Avoid stair climbing and jumping sports. Keep your knee straight while sitting, and avoid squatting. Let pain be your guide. You are aggravating the condition if you continue activities while experiencing pain.
Mild discomfort or ache is not a problem but definite pain is a cause for concern.
Ice your knee for 20 minutes, two or three times a day and after any sporting activities—apply a bag of crushed ice over a towel. This reduces swelling, inflammation and pain.
Aspirin, Aleve or Advil sometimes helps to relieve pain and reduce inflammation.
A physical therapist or Dr. Gill can recommend exercises to strengthen the muscles. Exercises can also be used to stretch and balance the thigh muscles.
In some cases surgery may be indicated.
The best treatment for patellofemoral syndrome is to avoid activities that compress the patella against the femur with force. This means avoiding going up and down stairs and hills, deep knee bends, kneeling, step-aerobics and high impact aerobics. Do not wear high heeled shoes. Do not do exercises sitting on the edge of a table lifting leg weights (knee extension). An elastic knee support that has a central opening cut out for the kneecap sometimes helps. Applying ice packs for 20 minutes after exercising helps. Aspirin, Aleve or Advil sometimes helps.
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