Patellar Tendinopathy

Patellar tendinopathy is pain typically at the inferior pole of the patellar tendon and is common in those who participate in running and jumping sports or other activities that create increased demand on the knee extensor musculature. Pain is typically palpable on the tendon and is caused by sports activities but also sitting, squatting, stairs, and walking downhill in more irritable cases. The clinician should rule out patellofemoral pain, or pain under the kneecap, as the rehab approach is slightly different.

As we discussed with the Achilles, the best treatment approach for tendinopathy is a tendon loading program. This helps to strengthen the quad musculature but also stimulates reorganization of collagen in the tendon to make it stronger and begin to return to a more normal structure. This will be done through open-chain exercises such as a knee extension with a machine, ankle weights or a resistance band as well as with closed-chain exercises such as squats, lunges, and step exercises. To increase the load on the tendon, perform squats with the heels elevated, knees over toes is okay and actually beneficial in this condition!

Exercises progress from double to single limb, with higher resistance and with faster speeds with plyometrics and agilities which will challenge the tendon to quickly store and release energy.

Stretching the quad and IT band as well as STM, foam rolling and use of a massage gun may help to decrease tension on the area and may supplement the loading program. Shockwave therapy may be considered in chronic cases that do not respond to conservative care.