The so-called patellar tendon syndrome is a typical symptom of overload in the lower knee, mostly occurring in athletes. The term jumper knee is also used synonymously. To make the word more understandable – patella is the Latin technical term for the kneecap, patellar tip is the lower end of the patella. A syndrome is the presence of various signs or symptoms of a certain clinical picture.
4 simple exercises to imitate
1. “mobilization exercise” 2. “stretching exercise” 3. “strengthening exercise” 4. “coordination exercise
What is patellar tip syndrome?
At the front of the thigh we have a strong four-headed muscle (M. Quadriceps femoris), which runs with a broad tendon over the kneecap and starts at the upper tibia. This muscle is primarily responsible for knee extension. The patella, the kneecap, is a so-called sesamoid bone embedded in the tendon of the M. quadriceps femoris.
Its function is to extend the lever arm of this thigh muscle so that it can generate greater movement with less force. In other words, the patella supports and facilitates the transfer of force from the thigh to the lower leg. During movement, especially during sports such as running and jumping, but also when overweight, for example, the knee is chronically exposed to extreme stress.
Too much of this strain and the muscles overload, harden, shorten and pull painfully on their sinewy base. Frequently, complaints also occur behind the kneecap. The causes are similar to those of patellar tip syndrome.
Physiotherapeutic intervention
Overloads need protection – but not complete immobilization. Physiological movements are essential for healing as well as strengthening exercises that start at the right time. The following are examples of mobilization, stretching, strengthening, coordination and relaxation, which are the main areas of intervention for therapy.
Movement is extremely important for the healing of any structure in the body, in order to maintain and promote its physiological function and also the metabolism in the affected area. In the acute stage, mobilization is initially performed passively, i.e. by the therapist. Later the patient becomes active himself.
PassiveFor passive mobilization, the patient lies in a relaxed supine position, the knee joint is slightly underlaid and minimally bent in order to achieve the greatest possible relaxation of the structures. In this position the patella can be moved easily. ActiveThe “grinding heel” is suitable for beginning active exercises.
The patient remains in a supine position, pulls the toes of the feet together and slowly bends and stretches the knee with the heel remaining on the support. One step further, the leg is lifted off and, alternating with the other leg, the knee is angled and stretched out from the supine position. Further, the leg and thus the entire associated muscle chain can be moved through in so-called PNF patterns, which take into account and incorporate the physiological three-dimensional movements.
Further mobilization exercises can be found in the article Physiotherapy Mobilization exercises. Stretching exercises can be very painful at first, since the cause of the clinical picture is generally due to excessive traction at the bone base. Nevertheless, it is important to stretch the muscle and bring it back to its original physiological state.
Start with gentle stretching, low intensity and increase in the later stages. Never stretch or exercise into pain – pain is a warning signal and should not be ignored. To stretch the front thigh muscle, in an upright position, the heel of the leg to be stretched is moved towards the buttocks.
The hand on the same side grasps the lower leg just above the ankle joint and can increase the stretch by applying light pressure further in the direction of the buttocks. For a further increase in intensity, the abdomen and buttocks are tensed and the pelvis of the leg to be stretched is pushed slightly forward. In order not to lose grip when standing on one leg, the free hand can hold on to a chair back.
For advanced students, the balance can be trained at the same time. The same exercise can be done in the prone position. Stretches are held for 30 seconds to achieve an effect in the muscle.
Structures to be stretched are warmed up before the exercise to prevent further damage.More stretching exercises for the thigh can be found in the article Stretching exercises. Strengthening exercises after a patellar tip syndrome are important, on the one hand, to compensate for muscular imbalances (a possible cause), to prevent a recurrence and to strengthen the muscle in its physiological function. The blood circulation is increased and in turn regeneration is promoted.
It is important to dose the training without pain correctly and to observe regeneration times. The so-called eccentric training has proven to be effective for healing the patellar tendon syndrome – i.e. the muscle is strengthened by slowly giving way to tension, i.e. by lengthening itself against resistance and slowing down movement.
A simple example to understand: if you lift a heavy object, the biceps on the upper arm contracts and contracts. If you want to put the object down again, the biceps must slowly decrease again, extending against the weight in a controlled manner. How is this trained on the front thigh?
A Theraband is required. Lie on your back, the Theraband is swung around the sole of your foot, each hand holding one end. Both sides are brought to tension.
Now the leg is slowly stretched out against the tension of the band. This movement first trains the concentricity, i.e. the contraction of the M. quadriceps femoris. Now the leg is slowly bent again, the muscle slowly lengthens against the existing tension.
Another exercise is performed standing in front of a step. The leg to be trained is placed on the step and slowly pushes itself up and then sinks down again. Especially the eccentric part must be done slowly and in a controlled manner.
Further exercises are the leg press or knee bends. Further strengthening exercises can be found in the articles
- Physiotherapy exercises knee
- Exercises for cartilage damage
- Exercises knee pain.
In order to train the coordination in the leg, it is best to use wobble cushions, soft pads, balancing exercises, soft floor mats, trampolines,… The easiest way to practice at home is with a rolled up sofa blanket.
Stand with the leg you want to train on it, the other leg is held in the air at an angle. At first you try to find your balance freehand. Here, all the muscles of the muscle chains must work together and be coordinated to hold the body.
Starting from this starting position, various exercises can now be performed: Slowly get down on your knees and straighten up again without losing your balance. Stand on one leg and at the same time perform another movement, such as throwing and catching a ball. Other exercises include a parkour over various surfaces or closing your eyes on the wobble cushion in one-legged position.
These exercises not only train coordination and inter-muscular interaction, but also strengthen the muscles at the same time. You can read more coordination exercises in the article Coordination and Balance Training. Massages are an important area in the regeneration of a patellar tendon syndrome.
The muscle is loosened by various techniques, the structures are relaxed so that finally the painful pull of the tendon subsides. Techniques from the classical massage, functional massages, cross friction on the tendon directly and later, when returning to training, preparatory sports massages to increase the blood circulation. In classical massage, the individual heads of the front thigh muscle are gently relaxed by stroking and kneading – crosswise and lengthwise.
In functional massage, massage grips are combined with mobilization movements and gentle stretching: From the supine position, the leg to be treated hangs freely from the couch. The therapist grasps the lower leg with one hand to passively move the leg. The other hand performs a longitudinal kneading at the upper end of the thigh muscle, holds the pressure at the end and now simultaneously performs a passive extension of the muscle by moving the knee joint in the direction of flexion.
The tension is released again, the longitudinal kneading is carried out again slightly offset downwards and the leg is brought back into the stretching position. In this way, the entire muscle is worked through from close to far away. For the transverse friction on the tendon itself, the therapist uses his thumb or index finger and middle finger to turn it over and pulls the skin across the tendon in small strips with even pressure.This is an intensive method, which should be carried out by trained therapists and at the right stage.
The irritation triggers a new inflammatory reaction, which stimulates the body to heal. Furthermore, fascial techniques, deep strokes with the thumb along the muscle chains are suitable to loosen adhesions in the tissue. Jogging and cycling are typical sports that can trigger patellar tendon syndrome.
If suddenly too much training is done, a new start is made with the sport, the body and its structures are not used to the strain or movements are carried out incorrectly and breaks in training are not observed, overload can quickly occur. When jogging, the patellar tip syndrome manifests itself depending on the severity of the problem. At the beginning only after the load, later already at the beginning of running and after long overload already when walking, sitting, standing up,.
When cycling, especially mountain rides are dangerous, strenuous climbs or high cadence. When cycling as well as jogging, an extremely high pull on the patella tendon is created, because the quadriceps are put under heavy strain. A crucial difference when jogging is, on the one hand, that a high shock absorbing force is generated when charging and that this force is eccentrically absorbed by the M. quadrices femoris.
This means that the muscle simultaneously becomes longer as the tension increases. Many athletes do not train their thigh muscles with an eccentric working method. You can find exercises for this in the article Eccentric strength training.
The M. quadriceps femoris must therefore be made stronger and more elastic in order to avoid patellar tip syndrome. Elasticity can be achieved very well by fascial training and stretching. The duration of a patellar tendon syndrome is very individual.
Many factors play a role here – such as physical constitution and fitness, the existence of the injury, the exact cause. The earlier intervention is performed, the better the chances of recovery. If you continue training with pain, you run the risk of chronically overloading your knee – in this case the healing can take months.
It is essential to recognize the cause and treat exactly this and to avoid the triggering overload. The duration of overstrain when jogging or cycling should not exceed 3 months with a break from sports and proper strengthening exercises. Otherwise, you will have to see your orthopedist again and, if necessary, take medication.
Further measures for the treatment of patellar tip syndrome are ultrasound and electrotherapy or equipment such as bandages and taping, which will be discussed in more detail below. Taping: Depending on the system used, various tapes can relieve the knee, relax the muscle or support its function. Tapes are applied while pre-stretching the structures.
In the case of patellar tip syndrome, the tendon and muscle are lengthened by bending the knee. From this position, the kneecap can be supported and thus the affected tendon relieved by sticking a Y-strap below the knee and applying both legs of the tape under tension to the right and left of the kneecap. For further support, an I-bridle is attached lengthwise above the knee.
You will find more tape possibilities in the article Kinesiotape. Surgery for patellar tip syndrome is rare – after a chronic, very long existence and the failure of conventional therapies. Up to now, there is no evidence that surgery is more successful than conventional treatment. An example of a surgical procedure is the lateral incision into the tendon to relieve the tension. Surgery is an intervention in the body and always involves the risk of complications, which is why it should only be considered as a last resort.
