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Patellar Tendonitis

Originally posted on June 24, 2010

What Is It?
Patellar tendonitis is an injury to the tendon that connects your quadriceps muscle to your lower leg below the knee cap.  It almost always hurts with direct pressure to the tendon and is often swollen when compared to the other knee.  Tendonitis results when repetitive micro-tearing occurs in the tendon from overuse.  Pain may alleviate during a run as the tissue warms up.  However, runners may see pain and swelling return after runs, sometimes delayed until the next day.  The pain and swelling can be made worse by kneeling and deep squatting.  Stairs, hilly running, and jumping sports can also aggravate the pain.

What Causes It?
Micro-tearing of the tendon results when it is repetitively overloaded over the course of time.  These tears can build up over the course of a season or may happen quickly if training loads increase too fast.  Micro-tears are a normal part of training and, with proper recovery, will heal stronger before the next run.  But, most runners don’t allow this recovery to happen during periods of high volume and high intensity training.  Also, most runners are doing other activities in between runs that may keep the tendon aggravated.  Below is a list of factors that can aggravate the patellar tendon:

  • Too much hilly running
  • An increase in volume or intensity of greater than 10-20% per week
  • Running too many days in a row without proper recovery
  • Tightness in the IT Bands, hamstrings, quadriceps, and hip flexors
  • Worn shoes that result in inadequate cushion or foot control
  • Kneeling on the tendon often, especially on hard surfaces
  • Poor strength in the gluteal muscles resulting in poor leg alignment
  • Faulty running form and a lack of variety in training routine

How Can I Fix It?
Patellar tendonitis, like most tendonitis, responds best if treated early.  That means eliminating the things that are contributing to the pain and proactively helping the tendon heal.  Following is a list of first steps:

  • Rest, Ice, Compress, and Elevate for the first 3-5 days
  • Modify your training routine so there is no pain during & after runs
  • Stretch the IT Band, hamstrings, quadriceps, and hip flexors
  • Refer to the IT Band handout for more information about it’s role
  • Gently massage side to side across the tendon (strumming a guitar)
  • A PT can help with taping for swelling and kneecap alignment.
  • Strengthen your gluteal muscles and hamstrings
  • Replace your worn shoes with an appropriate pair for your foot type
  • Trigger point dry needling to your quadriceps and the tendon
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