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Not All Tendons are Created Equal

Have you ever experienced knee pain when beginning a new activity or increasing training volume? Does this pain go away after the warm-up, but come back the day after or when stopping the activity? You may have been of the lucky ones if these symptoms were short lived and went away within a few days. For many, this pain can become a chronic issue and affect everyday activities like sitting, stair climbing, and walking. This chronic condition is characterized by pain in the patellar tendon.

Jumper’s knee, runner’s knee, or patellar tendinopathy are all synonyms for this common condition. It generally affects the adult population ranging from 16-40 year olds, but can affect anyone if a training schedule is not properly developed. The tendinopathy is generally due to overstressing a poorly conditioned tissue, which can eventually lead to tendon dysrepair. Just like your muscles, bones, tendons, and ligaments also have to be trained to meet the demands you are putting on them. The reasons for pain with this condition is poorly understood, but it is believed that the brain and central nervous system play a big role in sensitization of the tissue. Once this process begins it is hard to reverse, which is likely why symptoms can last anywhere from a few weeks up to 2 years.  

No matter the activity, whether you are increasing your training volume, load, surface, or equipment the degenerative process may begin. The importance of ramping-up training or allowing appropriate time for tissue adaptation can not be overstated. This is why this injury is more prevalent at the beginning of a sporting season or training regimen. Have you ever wondered why marathon runners are very calculated in their training regimens in terms of increasing mileage? This condition is one of the reasons, as all tissues take time to adapt. Remember, the preseason is what prepares your body, and may be the most important part of the season to reduce injury risk.. Check out our upcoming blog in the spring on how to prevent training injuries.

As always, better outcomes are seen with more timely interventions versus the wait and see method. Treatment is generally aimed at reducing pain, reconditioning the tissue, and improving proprioception in the joint and surrounding tissues. Eccentric and heavy slow resistance exercises have been shown to be the most beneficial in treating this condition, and certain protocols have been established. Since everyone’s tendon quality and pain levels may be different, it’s essential to ensure you are starting at the right level for your state; if the tendon is stressed too much during recovery, the tendinopathy cycle will repeat itself and may become worse. Remember, there is no established timeframe for recovery, so being patient with recovery is important. The good news is that you can usually continue training, but it is best to consult your physical therapist about possible changes in impact training, training load, or training volume. Cookie cutter approaches to treatment won’t work, so be sure treatment is properly adjusted to meet your needs.

Bryan Esherick PT, DPT