Overview
The extensor mechanism and the flexors of the knee primarily control the mobility of the knee. The quadriceps (Big 4 muscles of the front of the thigh, the patella (Knee cap), and the patellar tendon just below the knee cap attaching to the leg bone form the extensor mechanism. This plays a crucial role in our walking, climbing steps, sitting to standing position, etc. For these activities to happen smoothly, the extensor mechanism should glide smoothly up and down. The patellar tendinopathy is basically a stress injury that occurs due to poor flexibility and/or overuse.
Why & how does it happen?
Poor elasticity of the extensor mechanism leads to poor gliding of the patella. In addition, the patellar tracking also plays a role in the working of the extensor mechanism. These factors lead to increased stress accumulation either at the insertion of the quadriceps, or behind the knee cap, or alternatively in the patellar tendon. In case of quadriceps insertion and patellar tendon, this leads to micro-injuries or micro-tears in the tendon. When this affects the patella, it leads to patellar chondromalacia (cartilage changes behind the knee cap).
Who gets patellar tendinopathy?
This is often seen in the age group between 30 and 50. It occurs not only in runners, but also in other sporting population such as footballers, basketball players, cricketers, badminton and so on. The reasons for the patellar tendinopathy are
- Poor warm up
- Restarting playing / running after a long gap
- Sudden escalation in the intensity of the workouts
- Over use (Not having gap days or rotation to help heal the stress injuries)
- Genu Valgum (knock knees) and poor patellar tracking
- Pain when climbing steps, sitting to standing.
- Initially pain is not felt while doing workouts, when warmed up.
- Anterior knee pain – in and around the patella (knee cap).
When to seek medical help?
If the pain is not getting relieved with heat therapy, analgesic gels and sprays and with basic warm up stretches, then it is necessary to see a Sports Orthopedics Surgeon. The diagnosis is based on the symptoms and clinical examination. If an element of patellar chondromalacia is suspected, then an MRI scan may be necessary to assess the depth and extent of the cartilage injury.
Fate of Patellar tendinopathy without any treatment
The micro-injuries of the patellar tendon may persist and are likely to keep stopping you from doing further activities such as running. Natural healing of the tendon can take place in some, but in majority the pain persists unless the right kind of remedies is undertaken.
What happens when I visit the Consultant?
You will be asked about your sporting history, symptoms further to that so far. Consultant will examine you and discuss the treatment modalities.
What are the treatment modalities?
The treatment modalities vary from knee stretches and eccentric exercises to PRP injection. In rare instances, may need patellar tendon debridement surgery as well.