Patellar tendonitis is a repetitive overuse syndrome. Excessive use of the quadriceps muscle will eventually lead to micro tears in the tendon producing local inflammation and possibly degeneration of the tendon. Muscle imbalance and poor lower extremity alignment are common contributing factors. In severe cases the patellar tendon may rupture.

• Pain with palpation of the bottom of the knee cap.
• Pain is dull, achy and localized to the area.
• Pain is aggravated by resisting knee straightening, maximally bending knee, and contracting the quadriceps muscle in activities such as jumping.
• No palpable defects in the patellar tendon.
• Swelling and inflammation within the tendon.

Black=Bone   Red=Muscle   Green=Pain

Patellar tendonitis will most often evolve from repetitive knee extension activities such as jumping, running or kicking. It is also common to observe patellar tendonitis with sports such as basketball, volleyball and squash where there are many sudden stops and starts. Direct trauma to the patellar tendon can also be a predisposing factor to this type of injury. Again, muscle imbalance and poor lower extremity alignment are common contributing factors.

There are four stages of severity of a patellar tendonitis. Stage I is the least severe where there is pain only after activity and there is no functional impairment. A stage II injury presents a pain at the beginning and the end of activity, but is there is no pain during the activity. To begin, a warm-up prior to activity is important. The warm-up should be approximately 10 minutes in length and it must include a quadriceps stretching routine. Following activity, ice should be applied to the area of tenderness for 10 – 15 minutes and this can be repeated every hour as needed. If the symptoms continue to progress it will be necessary to modify the type of activities performed.

Activities such as swimming and biking will be less irritating to the patellar tendon than those activities involving deep knee bending.

In stage III and IV the severity of the injury has increased. There will be constant pain at rest and during activity or in the most severe case the tendon may rupture completely. With either situation it will be important to abstain from the aggravating activities.