What is the patella tip syndrome and how does it develop?
Patellar tendonitis (jumper’s knee) develops when the patellar tendon is irritated by unusual or severe tensile stress. Male sportspeople between the ages of 20 and 40 who train in a jump-intensive sport (such as basketball, volleyball) several times a week are often affected. Activities with lots of stop-and-go movements (such as tennis) and quick changes of direction (such as football) can also lead to patellar tendonitis.
Patellar tendonitis is also widespread among runners, which is why it also called jumper's knee or runner's knee1.
The pain is felt around the tip of the kneecap.
The following synonyms are used for patellar tendonitis:
- Patellar tendinopathy
- Patella tip syndrome
- Runner's knee
- Jumper's knee
Risk factors and causes of runner’s knee
Sports
- Sports that involve intensive jumping – volleyball, basketball, some disciplines in light athletics such as long jump or high jump
- Jogging and running marathons
- Sports with rapid changes of direction – football, handball
- Sports with abrupt stop-and-go movements – tennis, squash, badminton
External factors
- Unsuitable footwear
- Wrong sporting techniques
- Excessively hard surfaces, for example asphalt
- Excessively intensive training sessions
- Unusual stress, for example. when learning a new sport or when training is started too enthusiastically and the knee is subjected to extreme forces.
Anatomical factors
- The elasticity of the tendons diminishes with increasing age
- Malalignment of the knee and foot deformities
- Shortened tendons or muscles
- Congenital ligamentous weakness (lax ligaments)
The various degrees of severity of the patella tip syndrome
Doctors do not normally divide the patella tip syndrome into different stages. This four-part classification helps patients understand the clinical picture better.2
- Initially, the pain is usually only felt after sports.
- In the further course, the patient develops "start-up" pain and feels pain during exercise, or even during everyday activities such as climbing stairs or after sitting for long periods.
The persistent character of the symptoms is typical. It is often a chronic clinical picture that persists for many months or even years. Phases with relatively little pain are repeatedly followed by phases when pain develops again after exercise. Patellar tendinopathy can affect both knees, this occurs in 20 to 30 percent of patients.
Treatment of runner’s knee: What helps in patellar tendonitis?
Patellar tendinopathy is usually treated conservatively, i.e. without an operation. Surgical intervention is only needed if the patellar ligament actually ruptures. The following methods relieve pain and can stop progression of patellar tendinopathy.
Therapy-accompanying exercises
Special exercises strengthen the muscles and increase mobility. They can also boost the healing process when carried out regularly. A doctor can prescribe physiotherapy. Depending on the findings, ultrasound treatment, electrotherapy (TENS), transverse friction (a special form of massage of the affected muscle and tendon fibres), shockwave therapy or manual therapy may be advisable as add-ons.
Stretching
Regular stretching of the muscles over the front of the thigh reduces the tension that acts on the kneecap.
Supports
Special medical supports stabilise the knee joint. Knee supports with a strap system, such as medi's Genumedi PSS, are particularly suitable for a specific reduction of the peak pressure and tension forces that act on the patellar ligament.
Cooling
Mild cold treatments with cold packs relieve pain (refrigerator temperatures of about 7°).
Warmth
A heat pad, a hot water bottle or a massage with a warm towel roll (towel immersed in warm water) promote the circulation around the tendon insertion.
Medication
If necessary, patients may take an anti-inflammatory drug such as ibuprofen or diclofenac for a week or two. But always ask the doctor treating you first.
Ointments
Anti-inflammatory creams or ointments can be massaged into the affected site several times a day. This promotes recovery.
Insoles
Orthopaedic insoles (for example, igli Allround) spread the pressure over the whole tread surface area at every step. They support the arch of the foot and correct the individual position of the foot.
Massages
Massages ease muscular tension and relieve pain. Experienced physiotherapists can relax the muscles with just a few massage strokes and increase the circulation.
Physio programme for runner’s knee: Exercises for patellar tendonitis
Important information: slight pain may occur when performing exercises. As the healing process takes place over 12-16 weeks, it’s possible that you may not notice any improvement in the first four weeks, possibly even a slight worsening, due to the unfamiliar stain. Please be patient and consistently perform the exercises.
If the pain becomes too much, reduce the number of sets. If no improvement occurs or symptoms increasingly occur in everyday life, stop the exercises and please contact your treating doctor.
Cycling with one leg
Aim: Warm-up
Starting position
- Lying with your lower back on the floor, propped up on your forearms
Exercise
- Bend the right leg and bring it upwards
- Circular movements with the right leg (pedalling in the air)
- Repeat the exercise with the left leg
Note: Keep the lower back on the floor.
Dosage
- 2 sets, 45 seconds each
- 60 seconds rest
Eccentric knee flex with one leg with reclining board
Aim: Strengthening the anterior thigh muscles (quadriceps)
Starting position
- Stand upright on the board, reclined at 25°, on one leg, keeping the knee of the standing leg slightly bent
- Raise the other leg (one-leg standing position)
Exercise
- Perform knee flexes up to 60° with the standing leg
- Now set your other leg on the floor, shift the weight onto this leg and straighten it until standing upright
Note: Perform the exercise in a slow and controlled manner. Avoid bringing your legs into an X-position.
Variations
- Easier: Perform the exercise on a flat, stable surface, without a reclining board
- Easier: e.g. hold onto a hand rail or broom handle
- Harder: Use additional weight
Dosage
- 3 sets, 15 reps each
Side lunge with reclining board
Aim: Strengthening the anterior thigh muscles (quadriceps)
Starting position
- Stand upright on the board, reclined at 25°, with one leg, keeping your legs hip-width apart
- Take a long backwards lunge, keeping the heel of the rear leg off the floor
- Stay upright and keep your back straight
Exercise
- Now lower your rear knee and bring your front knee forwards
- Then raise your body once again
Note: Perform the exercise in a slow and controlled manner.
Variation
- Easier: Perform the exercise on a flat, stable surface, without a reclining board
Dosage
- 3 sets, 15 reps each
Bridging
Aim: Strengthening the posterior thigh muscles (ischial muscle)
Starting position
- Lying on your back
- Place both feet firmly on the ground
Exercise
- Tense your buttocks and pull your abdomen towards your spine
- Now raise your pelvis upwards towards the ceiling
- Slowly bring your pelvis back down
- Then slowly raise your pelvis again
Note: Ensure you maintain the right distance between your heels and your buttocks. When your pelvis is raised, the angle of your knee flexors should be about 90°. Perform the exercise in a slow and controlled manner.
Dosage
- 3 sets, 10 reps each
Stretching the knee extensors
Aim: Stretching the anterior thigh muscles (quadriceps)
Starting position
- Lie on your side with the leg you wish to train on top
- Bring the lower leg forwards into a 90° angle
Exercise
- Bend the upper leg backwards
- Hold your foot in your hand and bring your heel up towards your buttocks until you can feel the stretch in your anterior thigh muscles
Dosage
- 3 sets, 45 seconds hold each
- Relaxing in between
Stretching the hip flexors
Aim: Stretching the lumbar hip muscles (iliopsoas)
Starting position
- Perform another lunge
- Kneel with your rear leg on the floor
Note: Stay upright and keep your back straight
Exercise
- Using your hands, push your pelvis forwards until you feel a stretch in your groin
Note: Do not allow your knee to move past your toes. If you experience discom fort in your kneecap, use a soft pad to perform this exercise.
Dosage
- 3 sets, 45 seconds hold each
Information material for download:
The orthoses from medi for patellar tendonitis
medi has developed the knee orthosis Genumedi PSS for conservative therapy of patellar tendinopathy. It combines the tried-and-tested properties of a support with the additional benefit of a patellar support strap: the support safely and reliably guides and stabilises the knee joint and relieves tension on the insertions of the patellar ligament.
A: A stable range of motion in the kneecap by means of a patellar dilator
B: Stimulation of the patellar tendon through a special tendon dilator
A belt can be used to adjust the pressure applied to the tendon to your liking.
Click here for more information about medi's Genumedi PSS knee orthosis.
Diagnosis & treatment
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Highlights
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1 The term "runner's knee" is often also used as a synonym for the iliotibial band syndrome (ITBS) or iliotibial tract friction syndrome. ITBS is considered the most common cause of pain over the outside of the knee. It occurs predominantly in long distance runners. The iliotibial tract is a fibrous band. It runs from the anterior superior iliac spine on the front of the pelvis over the hip joint and the knee joint to the outer border of the tibia. Due to the constant flexion and extension of the knee joint when running, the tract rubs against the epicondyle of the thigh – like a rope over the edge of a rock – and this irritates the fibrous band and thus leads to ITBS.
2 Roels et al., 1978
3 Eccentric training means loading a muscle or a tendon by slowing down a weight or a resistance.
4 Purdam CR et al. Br J Sports Med 2004;38(4):395-397.
Jonsson P, Alfredson H. Br J Sports Med 2005;39(11):847-850.
Health personnel will make the diagnosis and can prescribe medical aids, e.g. from medi if necessary.
Your medical retailer will fit them individually for you.
