How to Treat Tendonitis of the Knee?

I used the word Tendonitis in the title, but in many cases, you may have a Tendinopathy instead. A tendon is a fibrous tissue that attaches a muscle to a bone. Tendonitis is inflammation of the tendon. Tendinopathy is a degeneration of the collagen protein that forms the tendon. The two have almost identical symptoms, so we will treat them the same.

(Tendinopathy of the Patellar Tendon)

Both tendinopathy and tendonitis are often caused by stress or overuse of a tendon. Aging and lack of muscle tone can also play a role in the development of tendinopathy. There are at least two common types of tendonitis in the knee. One is felt at the top of your kneecap (directly above), and the other is felt on the bottom of the kneecap (directly below).

(ABOVE) (BELOW)

Both types of tendonitis can commonly be found in young 15–30-year-old jumping athletes. Their sports typically involve a lot of jumping. However, Bob developed a case of quadriceps tendonitis from performing daily lunges.

How to tell: The following are some signs and symptoms of Patellar and Quadriceps Tendonitis

1. Quadricep Palpation

a. With your leg straight, use your fingertips to feel along the upper edge of the kneecap and slightly above. If tender, you may have quadricep tendonitis. If you have pain in only one leg, you will want to palpate each leg to compare.

2. Patellar Palpation

a. With your legs straight, use your fingertips to feel directly below the kneecap. Feel the area below the kneecap down to the bony bump (tibial tuberosity). Stay on the tendon; you should be able to feel the side borders of it. If tender, you may have Patellar Tendonitis. However, beware of Osgood-Schlatter Disease, which can present in a similar fashion (more tenderness on the bony bump itself). Osgood-Schlatter disease typically occurs in boys ages 12-14 and girls ages 10-13.

Treatments:

If you have an acute inflammation (recent onset) or suspect a tendon rupture, then massage is not appropriate.

1. Cross-fiber friction massage

a. Directly over the patellar tendon. Take one hand and press down on the end of the quadriceps muscle-just above the kneecap. This will cause the upper part of the kneecap to push down and the lower part of the kneecap to rise (putting the patellar tendon in an optimal position). Take the other hand and place your index finger and middle fingers side by side or one on top of another. Begin massaging ACROSS the fibers of the patellar tendon. If tender, it should begin to feel numb, experience less pain, or stabilize within 30-60 seconds. If not, the patellar tendon may be too tender to massage now. Use ice for a while instead.

2. Cross-fiber friction massage

a. Directly over the quadriceps tendon. Take one hand and press down on the bottom (lower end) of the kneecap. This will cause the upper part of the kneecap to rise up, putting the quadriceps in an optimal position. Take the other hand and place your index finger and middle fingers side by side or one on top of another. Begin massaging ACROSS the fibers. If tender, it should begin to feel numb, experience less pain, or stabilize within 30-60 seconds. If not, the quadriceps tendon may be too tender to massage now. Use ice for a while instead.

Length of time for massage to James Cyriax, 30 minutes (2-3X/week) for 4-6 weeks. Not practical- hands and fingers fatigue. May try 2-3 minutes several times a day (3x per week).

A massage gun can be way easier and effective. 5-10 minutes per day. Add in a quadricep stretch.

(Quad Stretch)

Check out the full Knee Pain Relief Program series of videos, along with downloadable guide sheets, here: https://www.bobandbrad.com/health-programs/knee-pain-relief-program