Makalah

What is Patella Tendonitis?

Ihsanul Pikri

201510490311059
Patella Tendonitis is degeneration of the Patella Tendon, which
is located just below the knee cap. Patella Tendonitis is also
known as 'Jumpers Knee'. Typically knee pain comes on gradually during jumping
and landing during Badminton. Over time, the strain on the Patella Tendon becomes
too great and microscopic damage develops in the tissue that makes up the tendon.
Patella Tendonitis causes pain in the tendon which is worsened by activity. The areas
of degeneration feel tender to touch. Often the tendon feels very stiff first thing in
the morning. The affected tendon may appear thickened in comparison to the
unaffected side.
Anatomy
The patella tendon, also known as the patella ligament joins the kneecap or patella
to the shin bone or tibia. The patella tendon is extremely strong and allows the
quadriceps muscle group to straighten the knee. Huge forces are transferred
through the tendon, particularly in jumping to propel the individual off the ground as
well as functioning in stabilizing their landing.
As such this tendon comes under a large amount of stress especially in individuals
who actively put extra strain on the knee joint such as those who regularly perform
sports that involve direction changing and jumping movements. With repeated
strain, micro-tears as well as collagen degeneration may occur as a result in the
tendon.

This is known as patellar tendinopathy or Jumpers Knee. It should be distinguished

from patella tendonitis (tendinitis) as this condition indicates an acute inflammation
of the tendon whereas tendinopathy is more about degeneration of the tendon. In
practice the majority of chronic cases are more likely to be degeneration of the
tendon rather than acute inflammation which should settle down after a few days
rest.
It is likely that an athlete with patella tendonitis will have poor Vastus medialis
obliquus (VMO) function. This is the muscle on the inside of the quadriceps near the
knee. They may also have significant weakness in the calf muscles.
Jumpers knee symptoms

Symptoms of jumpers knee consist of pain at the bottom front of the kneecap over
what is called the lower pole of the patella.

The bottom of the patella will be very tender when pressing in and may appear
larger or thicker than the unaffected side. The athlete is likely to experience aching
and stiffness after exercise and pain when contracting the quadriceps muscles in
acute cases. In particular jumping activities are likely to cause most pain or
discomfort. Jumpers knee is graded 1 to 4 depending on how bad the injury is with

grade one being only mild pain after training and a grade four resulting in constant
pain.

The VISA pain questionnaire is excellent for monitoring symptoms which can often
be difficult to describe or measure with a long term chronic condition.

Warning!! - This injury may seem like a niggling injury that is not that bad. Many
athletes continue to train and compete on it as it may not be a debilitating injury
and recovers after a short period of rest. However, neglect jumpers knee at your
peril! If left to become chronic it can be very difficult to treat and may require
surgery.

Treatment
Jumpers knee strap

Treatment for patella tendonitis consists of reducing the initial pain and
inflammation through rest and ice followed by a rehabilitation program which will
include eccentric strengthening exercises.

Apply the PRICE principes of protection, rest, ice compression and elevation. Apply
cold therapy on a regular basis, especially during the first 24 to 48 hours and after
any form of exercise. A cold therapy wrap or gel ice pack is ideal. If the tendon is
painful then ice can be applied for 10 minutes every hour reducing frequency as
symptoms improve.

Wear a knee support, or jumpers knee strap to reduce pain and ease the strain on
the tendon. A jumpers knee strap wraps around the tendon just below the knee
changing the angle of the tendon against the patella which changes the part of the
tendon the forces are transmitted. A simple patella taping technique can also
relieve the strain on the tendon in the same way.

Ultrasound applied to the knee

A doctor may prescribe anti-inflammatory medication e.g. ibuprofen. Do not take

ibuprofen if you have asthma and check with a doctor before taking any medication.
It is thought that anti-inflammatory medication may help in the short term with
acute inflammation and pain but may even hinder healing later on.

A professional therapist may use electrotherapy in the form of ultrasound or laser

treatment to reduce pain and inflammation and aid the healing process. Cross
friction massage to the tendon may also be beneficial, particularly for more chronic
cases. They can also advise on a full rehabilitation program consisting of eccentric
strengthening exercises.

Aprotinin injections may help tendinopathies by restoring enzyme balance in the

tendon. If the knee does not respond to conservative treatment, surgery may be
required.
Exercises
Quadriceps stretchStretching exercises for the quadriceps muscles at the front of
the thigh should be done regularly. This will lengthen then muscles and place less
stress on the tendon. Hold stretches for 10 seconds in the acute stage and up to 30
seconds later in the rehabilitation program. Testing the flexibility of the thigh
muscles is a good idea.

Eccentric strengthening exercises which are done by performing the downwards

phase of a squat exercise are though to be most important and stimulate healing.
This is done by dropping down slowly and then up more quickly using the good leg
to help on the up phase.
Prevention
Premiership Physiotherapist Neal Reynolds talks about how to prevent jumpers knee
or patella tendonitis.
Jumper's knee injury prevention
Our top tips for preventing Jumpers knee or patella tendonitis. These tips can be
used if you have already suffered patella tendonitis once and are trying to prevent it
coming back, or if you are an athlete involved in lots of jumping and want to
prevent it developing in the first place!
Do not over-train! Performing too many high impact training activities will be too
much for the tendon.
Look out for the early signs of pain and inflammation after training and act. Do not
wait until this injury becomes bad - there is a long rehabilitation period once the
injury becomes worse.
Identify any biomechanical problems that may increase the risk for example
overpronation of the foot, a loose kneecap or a tight iliotibial band. If you are not
sure, see professional help and advice.

Use eccentric strengthening exercises to make the knee joint strong enough to cope
with the demands of the sport. Continue these exercises long after the injury has
healed. They should become part of your usual training routine.
Stretch the muscles (particularly quadriceps) properly and regularly. Get a regular
sports massage to keep muscles and tendons in good condition.