What is Patellar Tendinitis (jumpers knee)

Patellar tendinitis also called jumpers knee, is inflammation of the patellar tendon. Tendons are cord-like tissues that connect muscles to bones. The patellar tendon connects the bottom of the kneecap (patella) to the top of the shin bone (tibia).

Patellar tendinitis causes pain in the front of the knee. The condition happens in the following stages:

• Stage 1. In this stage, there is pain only after activity.
• Stage 2: In this stage, you have pain during and after activity.
• Stage 3: In this stage, you have pain during and after activity that limits your ability to do the activity.
• Stage 4: In this stage, the tendon tears and severely limits your activity.

What are the causes?

This condition is caused by repeated (repetitive) stress on the tendon. This stress may cause the tendon to stretch, swell, thicken, or tear.

What increases the risk?

The following factors make you more likely to develop this condition:

• Participating in sports that involve running, kicking and jumping, especially on hard surfaces. These include:
  • Basketball.
  • Volleyball.
  • Soccer.
  • Track and field.
• Having tight thigh muscles.
• Having received steroid injections in the tendon.
• Having had knee surgery.
• Being 16–40 years old.
• Having rheumatoid arthritis or diabetes.
• Training too hard.

What are the signs or symptoms?

The main symptom of this condition is pain in the front of the knee. The pain usually starts slowly then it gradually gets worse. It may become painful to straighten your leg.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• A medical history.
• A physical exam. During the physical exam, your health care provider may check for tenderness in your patella, tightness in your thigh muscles, and pain when you straighten your knee.
• Imaging tests, including:
  • X-rays. These will show the position and condition of your patella.
  • MRI. This will show any tears in your tendon.
  • Ultrasound. This will show any swelling in your tendon and the thickness of your tendon.

How is this treated?

Treatment for this condition depends on the stage of the condition. It may involve:

• Avoiding activities that cause pain.
• Icing your knee.
• Taking an NSAID to reduce pain and swelling.
• Doing stretching and strengthening exercises (physical therapy) when pain and swelling improve.
• Having sound wave stimulation to promote healing.
• Wearing a knee brace. This may be needed if your condition does not improve with treatment.
• Using crutches or a walker. This may be needed if your condition does not improve with treatment.
• Surgery. This may be done if you have stage 4 tendinitis.

Follow these instructions at home:

If You Have a Knee Brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your toes become numb and tingle, or if they turn cold and blue.
• Do not let your brace get wet if it is not waterproof.
• Keep the brace clean.
• Ask your health care provider when it is safe for you to drive.

Managing pain, stiffness, and swelling

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your knee above the level of your heart while you are sitting or lying down.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use your crutches or walker as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• Your symptoms have not improve in 6 weeks.
• Your symptoms get worse.

Patellar Tendinitis Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

This exercise warms up your muscles and joints and improves the movement and flexibility of your knee. This exercise also helps to relieve pain and stiffness.

Exercise A: Hamstring, doorway

1. Lie on your back in front of a doorway with your __________ leg resting against the wall and your other leg flat on the floor in the doorway. There should be a slight bend in your __________ knee.
2. Straighten your __________ knee. You should feel a stretch behind your knee or thigh. If you do not, scoot your buttocks closer to the door.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Quadriceps, isometric

1. Lie on your back with your __________ leg extended and your other knee bent.
2. Slowly tense the muscles in the front of your __________ thigh. When you do this, you should see your kneecap slide up toward your hip or see increased dimpling just above the knee. This motion will push the back of your knee toward the floor. If this is painful, try putting a rolled-up hand towel under your knee to support it in a bent position. Change the size of the towel to find a position that allows you to do this exercise without any pain.
3. For __________ seconds, hold the muscle as tight as you can without increasing your pain.
4. Relax the muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Straight leg raises (quadriceps)

1. Lie on your back with your __________ leg extended and your other knee bent.
2. Tense the muscles in the front of your __________ thigh. When you do this, you should see your kneecap slide up or see increased dimpling just above the knee.
3. Keep these muscles tight as you raise your leg 4–6 inches (10–15 cm) off the floor. Do not let your moving knee bend.
4. Hold this position for __________ seconds.
5. Keep these muscles tense as you slowly lower your leg.
6. Relax your muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Squats

1. Stand in front of a table, with your feet and knees pointing straight ahead. You may rest your hands on the table for balance but not for support.
2. Slowly bend your knees and lower your hips like you are going to sit in a chair.
   1. Keep your weight over your heels, not over your toes.
   1. Keep your lower legs upright so they are parallel with the table legs.
   1. Do not let your hips go lower than your knees.
   1. Do not bend lower than told by your health care provider.
   1. If your knee pain increases, do not bend as low.
3. Hold the squat position for __________ seconds.
4. Slowly push with your legs to return to standing. Do not use your hands to pull yourself to standing.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Step-downs

1. Stand on the edge of a step.
2. Keeping your weight over your __________ heel, slowly bend your __________ knee to bring your __________ heel toward the floor. Lower your heel as far as you can while keeping control and without increasing any discomfort.
   1. Do not let your __________ knee come forward.
   1. Use your leg muscles, not gravity, to lower your body.
   1. Hold a wall or rail for balance if needed.
3. Slowly push through your heel to lift your body weight back up.
4. Return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Straight leg raises (hip abductors)

1. Lie on your side with your __________ leg in the top position. Lie so your head, shoulder, knee, and hip line up. You may bend your lower knee to help you keep your balance.
2. Roll your hips slightly forward, so that your hips are stacked directly over each other and your __________ knee is facing forward.
3. Leading with your heel, lift your top leg 4–6 inches (10–15 cm). You should feel the muscles in your outer hip lifting.
   1. Do not let your foot drift forward.
   1. Do not let your knee roll toward the ceiling.
4. Hold this position for __________ seconds.
5. Slowly lower your leg to the starting position.
6. Let your muscles relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.