What’s Patellar Tendonitis? Why it’s not tendonitis but Patellar tendinosis. This knee injury is also known as Jumper’s knee and often affects athletes and runners. It’s a degeneration of the patellar tendon due to overuse and poor healing.
Hey guys, this is Manu Kalia, physical therapist and Ayurveda herbalist. So this next video I’m going to talk about patellar tendon problems. And the problem is commonly known as patellar tendinitis, which is incorrect, and I have posted a few videos in the past discussing why it’s not tendinitis, why it’s actually tendinosis. And I talked about and had videos up on treatment also, some scar tissue mobilization or cross friction massage technique videos on how to treat this issue, but I wanted to give you a little bit more detail on the problem because a lot of you guys ask me about this issue.
And this is one of the problems I’m going to discuss in our upcoming program, as I mentioned in some of my other videos. The program’s going to be launching pretty soon, so make sure if you guys are interested and you want to be one of the first to find out about it, go to the site and sign up and I’ll be giving out some free copies also, and I’m going to go over all of these knee-related problems in that program as well as discussing a lot of treatments, both holistic treatments for the problems as well as physical therapy and exercise-science-related treatments.
So let’s talk a little bit about what the problem is exactly and what are some of the contributing factors and then treatment. So a little bit of anatomy. Your patellar tendon sits below your kneecap. Here’s your kneecap; it sits below that kneecap. It attaches to your shin, the upper part of the shin. It’s an extension of your quadriceps muscles. So your quadriceps muscles are your thigh muscles in the front of the thigh and your quadriceps tendon is just above the kneecap, and it all comes down and attaches here. So its function is to help you extend or straighten out that leg, the lower leg or your knee.
So this problem is commonly referred to as jumper’s knee or patellar tendinitis, but tendinitis is an incorrect term for this problem. And that’s why a lot of people, what is the standard treatment prescribed for a lot of these issues? You rest it, you ice it, you use anti-inflammatory medications. So if it’s not an inflammatory problem, what is the point of doing anti-inflammatory medications then? Will the anti-inflammatory medications or icing help the problem? No, it won’t help the problem.
So histological studies, and this has been documented for some time now, that when they have looked at these problems there are no inflammatory cells present, none to very few inflammatory cells present in these types of problems, so thus it’s not an inflammation. Anything that has an –itis ending has to do with inflammation, so tendinitis, conjunctivitis, bursitis, any of these things. Anything that has -itis is an inflammation. So in this problem, though it’s listed as tendinitis, it is not a tendinitis because there are no inflammatory cells present in this problem, and these are usually chronic problems that are due to overuse/overstrain injuries.
There might have been one incident where let’s say you were playing a sport, you jumped up, you came down hard, and you felt a sharp pain there. But there’s a microfiber damage, you tore some microfibers and after a while that tissue, because it was injured and you kept playing on it, kept doing things on it and the tissue didn’t heal properly, it turned into a tendinosis type of problem. There might have been some inflammation initially, a little bit of inflammation when you had the initial injury, but normal inflammatory process heals itself. Your body has its processes and inflammation is a normal part of healing, so it needs to take place. So your body initiates the process and it heals itself.
But if the process doesn’t move along properly or you continue irritating the problem, then it turns into an abnormal process and it’ll turn it into a problem that is a tendinosis. The ending -osis, in tendinosis means degeneration. So it’s a degenerative problem. Because of repetitive strain or initial injury and then not healing properly, it’s turned into a tendinosis or degeneration of the tendon, which makes the tendon weak. It can become thickened. It can have disorganized alignment of the collagen fibers. Remember, collagen makes up the tendon, so normal collagen in normal tissue lays down smooth patterns, parallel fibers that are laid down in smooth fashion. In a disorganized pattern, they’re all jumbled. They’re all knotted. So not only does that compromise the strength of the tendon but also it causes pain. It might restrict the mobility of the tendon. So because they’re all jumbled up, the tendon’s not strong because they’re not aligning properly. The second thing is they’re all jumbled up; when you do move, it might cause pain, it might be tight, and so it compromises the strength of the tendon. So a lot of these issues, not only can the tendon be thickened, the tendon can be swollen and it can be weak as well.
So the problem tends to persist for quite a while unless you treat the problem properly, which means the treatment has to do with specific things like promoting proper alignment of those collagen fibers, so cross friction massage techniques, which are to break down the adhesions on the thickening that’s formed along the tendon so the fibers realign and lay down properly. So once they lay down properly, then you can work on strengthening those fibers. Then you strengthen it so that the tendon gets stronger as well as the fibers are in proper orientation where they need to be.
What are some of the causes or contributing factors? Of course, as I mentioned, you could have an injury. If you came down wrong on that leg or repetitive strain or overstrain of that tendon, you kept playing the sport, you kept jumping or running, after a while it got irritated because it was just overworked essentially. The healing couldn’t keep up with the amount of work that tendon was doing. Keep in mind, mechanical things are going to change the amount of force that that tendon is handling, too. So what’s happening at the foot in terms of the strength, mobility of the foot, or the ankle or further up in the chain, the hip as well as even further up going into the core, for example, so anything that’s happening above and below can be affecting things biomechanically.
Then, the other thing you want to consider is internally what’s going on within the system, which makes one person more prone to getting injured than the other person – overall internal health of the system, which is causing one person to have irritation of the tendon or slowing down of the healing process. So consider from a bigger perspective internally what’s happening. Sometimes people are on medications. Are those medications affecting the healing of the tendon too? Circulation is compromising that area, so this is not facilitating the healing process, and by icing it you’re not helping any either. Same with taking anti-inflammatories. A lot of studies show that anti-inflammatories actually will decrease the healing time of a lot of these tendon-type problems or these issues.
So consider that there are multiple issues that are contributing to the problem, and so a treatment has to be multipronged. So you’re working on breaking down that scar tissue, you’re improving the strength of that tendon and the surrounding muscles – not just here, your thigh muscles, your foot muscles, your hip muscles, all these areas, improving circulation to that region to promote the healing process, facilitate the healing process, improving the internal healthy of your system so it helps the tendon heal faster.