What is tendinitis and when it affects the knee
Tendonitis is an inflammatory process that involves one or more of the 267 tendons present in the human body.
There are three different types of tendinitis in the knee: tendinitis of the patellar or patellar tendon, tendinitis of the quadriceps muscle and tendonitis of the popliteal arch.
Precisely because it connects two bones together and not a muscle with a bone, it is often referred to as a patellar or patellar ligament.
This type of knee tendonitis, also known as the "jumper's knee" generally arises due to chronic overload of the patellar tendon. Jumpers are more subject to this type of injury, which is also common among hauliers and among people who regularly make long car journeys.
In sport the patellar tendon is particularly stressed during explosive activities such as leaps and jerks. This fibrous tape acts as a powerful stabilizer of the patella (or patella) during the extensor movements of the knee. Together with the muscular and tendinous component of the quadriceps, of which it represents the natural continuation, the patellar tendon is an integral part of the extensor apparatus of the knee.
For all these reasons, knee tendonitis is common in sports such as volleyball, basketball, soccer and athletics.
The tendon of the quadriceps muscle, which is inserted in the upper (proximal) part of the patella, can also undergo tendonitis and injury. However, this tendon is particularly robust and rarely injures itself. Sports disciplines that involve strong acceleration of the lower limbs followed by sharp braking are more prone to this type of tendonitis.
Popliteal tendinitis is infrequent and affects the insertion of the popliteal tendon on the lateral epicondyle of the femur. This injury is common in runners and people forced to walk downhill with overload (for example, a backpack). The pain, which generally appears under load with the knee slightly flexed (15-30 °), is located in the outer part of the knee (lateral femoral condyle).
NOTES: knee tendon injuries are rarely due to excessive overload or an accident. A healthy tendon is in fact extremely resistant and breaks with difficulty. Elderly subjects are more sensitive to this type of injury, given that the tendons with age and disuse lose much of their original elasticity and resistance.
The patellar tendon can undergo degenerative processes also due to joint defects, such as a flexion conflict between the distal surface of the patella and the tendon itself, excessive valgus of the knee or a disproportion between the lower limbs.
Tendonitis can also affect the patellar tendon at the level of its insertion into the tibia: in this case we speak of Ogod-Schlatter disease. This condition is common in adolescents who have undergone rapid growth.
Sinding-Larsen-Johansson disease, which affects the tendinous insertion in the lower pole of the patella, is also common in growing subjects.
Symptoms
Superficial pain well localized in the lower part (patellar tendinitis) or high (quadriceps tendonitis) of the patella and that is accentuated under stress, especially during jumps and when kneeling. If the pathology is not treated the pain is increasing over time: at first it appears only during heating, then it interferes with normal physical activity and finally appears even at rest.
The pain is evoked by the palpation of this area and is sometimes associated with local swelling, heat and redness.
In the event of complete injury to the quadriceps tendon, the injured person cannot actively extend the leg and experience intense pain. The same applies if there is a rupture of the patellar tendon. Both of these situations are extremely rare and usually affect weight lifters during the pushing phase.
Diagnosis
The most suitable test to diagnose knee tendinitis is magnetic resonance imaging associated with radiography. In this way it is possible to visualize both the extent and extent of the tendon lesion, and the presence of any alterations affecting the patella.
Even an ultrasound scan, if performed by an experienced radiologist, allows an accurate diagnosis, inexpensive and without side effects.
Treatment, prevention and rehabilitation: treating tendonitis
First of all, the athlete must suspend the sporting activity that generated the tendonitis. The administration of pain-relieving drugs promotes the reduction of swelling and reduces pain in the acute phase of the disease. To learn more, read: Tendonitis Treatment Medications
In the 24-48 hours following the trauma, especially in the presence of important tendon injuries, the local application of ice is useful three times a day for ten to twenty minutes.
At the same time stretching of the flexor muscles of the thigh (ischiocrural) is recommended. Subsequently, when the pain decreases, it is good to start strengthening the thigh and leg muscles, combining it with stretching exercises:
Isometric contractions of the quadriceps: sitting on the ground, with the injured leg extended and adherent to the ground, the other bent. Push the injured knee towards the ground by contracting the quadriceps (anterior thigh muscle). Hold for 10 seconds, relax and repeat 3 times
Extensions of the lower limb: seated on the ground, with the injured leg extended and adherent to the ground, the other bent. Contract the quadriceps muscles to lift the injured limb by 20 cm keeping the knee fully extended. Hold for 10 seconds, relax and repeat 3 times
Full leg extension: sitting on the edge of a chair with your hands, knees bent at 90 °. Slowly straighten only the knee affected by tendonitis extending it completely. Hold for 5 seconds, slowly return to the initial position and repeat 6 times.
Extension of the knee against resistance: standing, with the hands resting on the chair, at a table or at the back. Attach the end of an elastic band to the support (eg a chair leg) and the other behind the knee to be rehabilitated. Take a step back to tighten the elastic. Holding the other limb taut, bend the injured knee slightly (30-45 °), stop and straighten the leg by contracting the thigh muscles. Repeat 10 times.
Half squat: standing, hands at your sides, feet shoulder-width apart with spikes turned 30 ° outwards. Flex both knees 45 large, push on the heels by contracting the thigh muscles and return to the starting position. Repeat 10 times.
Step up and down: train all the muscles of the thigh and buttocks. Step onto a 5 cm step using the injured limb, then slowly descend until the heel (not the fingers) of the other foot rests. Rise upwards by applying strength to the heel of the painful limb and repeat. During flexion The injured knee must never exceed the vertical projection of the toe. The height of the step will be increased progressively seat after session (10-15-20 cm).
NB: before performing these exercises to prevent knee tendonitis, ask your doctor for advice. Add stretching exercises for the quadriceps and for the hamstrings.
The exercises for stretching the lower limbs, if performed at the beginning and at the end of the workouts, are also useful to prevent tendonitis. Additional preventive measures include:
- correction of any muscular or articular imbalances
- strengthening also of the muscles not directly involved in the athletic gesture
- execution of a rational training program, suited to one's physical characteristics and providing for the right recovery times.
It is also important to prevent knee tendoning:
- do not overdo the alternative sports activities to the main one, especially if they are not correlated to the athletic gesture
- wear comfortable shoes and avoid excessively rigid, soft or uneven ground
- learn to listen to the signals that the body sends: in particular it is good not to ignore pain and local stiffness even if slight and temporary
- avoid local injections of corticosteroids as they increase the risk of rupture of the patellar tendon
To promote recovery from tendinitis of the knee, the doctor may prescribe accessory therapies such as iontophoresis, tens laser therapy and ultrasound.
Normally a knee tendonitis resolves within a few weeks. The use of surgery is rather rare and limited to cases in which tendonitis becomes chronic without adequately responding to rehabilitation treatment. The surgery involves the incision of a specific area of the tendon that will stimulate the spontaneous regeneration. The operation, which can now be performed in arthroscopy, may also correct any abnormalities of the lower apex of the patella.
In case of complete rupture the surgical procedure of suturing is a must.
