Anatomy & function
Patella is the Latin name for the kneecap. As a component of the knee joint, the small, flat bone between the thigh and lower leg protects the knee joint and facilitates its movements. As the attachment point for the tendon of the large thigh muscle (quadriceps, quadriceps femoris muscle), it enables the smooth transfer of force from the anterior thigh muscles via the patellar tendon (patellar ligament) to the shin. The patellar tendon attaches to the lower end of the kneecap, the tip of the patella, and pulls towards the tibia.
Patellar tendinopathy, also known as jumper's knee, describes the painful irritation of the patellar tendon at its attachment point on the kneecap. As the name suggests, this pathology is primarily associated with repetitive and intensive jumping movements , as the landing and cushioning following the jump in particular place maximum strain on the patellar tendon. Accordingly, this condition is widespread in jump-intensive sports (e.g. high jump, long jump, volleyball, basketball) and is one of the most common reasons for visits to the doctor in this area.
Symptoms & complaints
Signs of patellar tendinopathy can include
- Load-dependent pain on the underside of the kneecap
- Pressure pain on the underside of the kneecap
- Movement restrictions
Typical symptoms of patellar tendinopathy are pulling pain in the lower area of the kneecap, which initially occurs particularly after intense exertion. As the disease progresses, the symptoms may already be present at the start of exertion. In the course of the disease, pain at rest and permanent pain up to tearing of the patellar tendon are possible.
The pain can be reproduced when pressure is applied to the underside of the kneecap. Depending on the extent of the disease, the mobility of the knee joint may also be restricted by the pain.
Causes
Causes of patellar tendinopathy include
- Overloading, e.g. due to over-intensive training, overweight
- Incorrect loading, e.g. due to incorrect footwear, unfavorable jumping or running technique
- Misalignments of the kneecap, leg axis or feet
- Muscular imbalances
Patellar tendinopathy is caused in particular by overloading and incorrect loading of the patellar tendon. Typical causes include excessive load intensity during training, incorrect footwear or an unfavorable jumping and/or running technique.
Furthermore, congenital or acquired malpositions of the kneecap (e.g. elevation of the patella or lateral deviation) can lead to increased tension on the patellar tendon and thus increase the risk of developing painful irritation in this area.
Weakened or shortened thigh muscles on one side or an imbalance between the anterior and posterior thigh muscles also favors the development of chronic irritation due to the increased tension on the patellar tendon.
Diagnosis
Our certified sports physician Dr. med. Tarek Schlehuber will ask you about your complaints in a detailed consultation. Among other things, the duration and extent of the complaints are important. A thorough physical examination will then take place, focusing on the knee joint, the thigh muscles and the kneecap in particular. Typically, pressure pain can be triggered in the lower area of the kneecap. As a rule, the medical history and physical examination are sufficient to make a diagnosis. An ultrasound examination can further confirm the suspected diagnosis if necessary.
Imaging procedures, such as an X-ray or MRI examination, can be used to rule out other diseases.
Treatment
The aim of treatment is to relieve pain and restore the original load-bearing capacity and mobility of the knee joint. In the vast majority of cases, conservative treatment measures are sufficient. Surgery is only rarely advisable or necessary.
Conservative therapy:
The following conservative therapies are possible:
- Protection
- Cold and heat treatments
- Painkillers
- Physiotherapy
The patellar tendon should be relieved as far as possible until the symptoms subside. In the vast majority of cases, this is a period of a few weeks. However, this can vary from person to person. During this time, so-called high-impact sports, which place a high load on the knee joints, should be avoided. Instead, sports that are easy on the joints, such as cycling or swimming, can be practiced in consultation with your doctor.
For acute pain, cooling pads wrapped in a kitchen towel can be applied to the affected area. In some cases, those affected also find the application of heat (e.g. in the form of hot water bottles) beneficial.
Painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) not only help to relieve pain, but also to inhibit inflammation. However, taking painkillers is at best a temporary solution and should never be taken on a long-term basis. Anti-inflammatory ointments can be applied to the affected area several times a day.
Physiotherapy, which focuses on strengthening and stretching the thigh muscles, is essential. In addition, existing imbalances in the musculature should be corrected and misalignments compensated for, for example by means of insoles.
After thorough physiotherapeutic or medical instruction, you can perform the following exercises regularly at home. If you experience pain during the exercises, please consult your physiotherapist.
- Stretching the front of the thigh: Stand with both legs hip-width apart and hold on to a wall or railing with your left hand. Now grasp your right foot with your right hand and bring it as far as possible towards your buttocks. You should feel a stretch in the front of your thigh, but it should not be painful. Hold this position for around 30 seconds. Repeat this exercise a few times on both sides.
- Strengthening the front of the thigh (squat): To strengthen the front thigh muscles, you can perform a classic squat. Stand with your feet hip-width apart and bend your knees until your thighs are parallel to the floor. You can hold this position for a few seconds. Repeat the exercise.
- Stretching the back of the thigh (trunk flexion): A balance between the front and back of the thigh is essential for optimal muscle interaction, which is why you should not neglect stretching and strengthening the back of the thigh. To do this, stand with your legs closed. Keep your legs straight as you slowly bend forward towards the floor. You should feel a non-painful stretch in the back of your thighs. If you can, place your hands on the floor. Alternatively, let your hands hang in the air.
- Strengthen the back of the thigh (glute bridge): To do this, lie on your back and place your feet hip-width apart. Your arms are at the side of your body. Consciously tense your abdomen and buttocks before performing the exercise. Now push your pelvis up. In the upper position, your thighs and lower legs should be at a 90-degree angle to each other. Your torso, buttocks and thighs form a straight line, while your head and neck rest loosely on the floor. Repeat this exercise several times.
If there is insufficient improvement despite the above measures, injection therapy or shock wave therapy may also be considered.
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