The first time I felt the sharp and stabbing front of left knee pain was a few months ago while enjoying my usual afternoon run with my dog. It was unlike the more familiar muscle aches and pains and there was no swelling present. I remember worrying this could be a potentially serious issue because this was a knee pain I had not felt before.
I was experiencing for the first time a condition which has since been diagnosed by my Chartered Physiotherapist as patellar tendinosis. After discussing my condition with my physiotherapist he directed me to various evidence-based online information resources as well as sending on relevant journal articles to help me understand the condition better. What follows is an account of a knee problem from a patients point of view.
This condition can become a more serious and chronic issue requiring many months of rest and rehabilitation if not appropriately cared for in the early stages. My knee pain started with repeated deep squat movements in the gym with a heavily weighted bar across my shoulders. Oddly the pain did not last more than a second during the exercise and almost no pain followed in the days after. Naturally I did not give it much more thought at the time until many weeks later when the pain returned, much more intensely and persistently, during a less than demanding run.
I now find myself in a delicate situation having to manage my knee pain very carefully indeed with fear of my condition becoming a much more difficult one to cure if I don’t give it the right attention.
The knee helps facilitate many of our everyday movements and is therefore a very important and usually very active joint in the human body. The knee operates within a complex structure of bone, muscles, ligaments, cartilage and tendon - all of which are susceptible to pain or injury under specific conditions.
Knee pain and potential injury can be caused when one of its structures is placed under excess stress as a result of heavy landing, a sudden impact or a twist/ rotation beyond acceptable range of motion.
Who is at risk of patellar tendinosis?
Also referred to as ‘jumper's knee’ patellar tendinosis is a common condition seen in athletes or do a lot of running and jumping (volleyball or basketball players), repetitive kicking (football) or weight lifters who experience recurrent heavy load squatting.
This condition is more common in adults, 16-40 years old, and there does not seem to be a gender preference due to recent studies showing equal occurrences in both male and female populations.
Contributing risk factors for developing patellar tendon problems
The primary cause of knee pain from the patellar tendon is simply overuse, that is doing too much without enough rest in between.
One of the greatest challenges for many athletes is planning into their schedule adequate rest and recovery time, especially in competitive sports. Exercise or sport specific training focuses on gains like muscle strength and power, flexibility or endurance while progressively increasing one’s personal best achievements in speed, weight or time, etc. A good rule of thumb for avoiding overuse related injuries is not to increase any elements of your training; weight, repetition, intensity or duration, more than 10% per week.
Other intrinsic factors could also play a role in developing patellar tendinosis such as muscle flexibility, strength and stability or biomechanical issues. Poor technique and training errors, potentially as a result of fatigue could also contribute to the risks.
My specific knee pain and what caused it
As noted above I believe it started with a deep squat movement in the gym. I basically lowered myself too far down, taking my thighs beyond the horizontal and past my knees, repeatedly under a heavy load. The resulting forces on my knee, specifically the patellar tendon, when having to lower under load and then drive upwards again is quite likely where my problem started.
Contributing to my issue is the lack of attention I gave it thereafter and continued to train as normal. In fact, due to a niggling shoulder injury I was recovering from at the time I was doing less upper body training and favouring more leg exercises allowing my shoulder to rest. So I was actually doing more lower body training and running than usual which is a classic case for ‘overuse’.
I somehow managed to avoid any knee pain that would have caused me concern so I continued training until recently when the pain suddenly returned. Advice from my physiotherapist at Mount Merrion Physiotherapy including complementary literature “EVIDENCE–SUPPORTED REHABILITATION OF PATELLAR TENDINOPATHY” - I realise I am hovering somewhere between stage 1 - pain only after activity and stage 2 - suffering pain during and after activity. I want to avoid going to stage 3 where my physical performance declines as result of the pain and the healing process potentially becomes more complicated and a longer process.
I will leave this here for now and write a follow-up article in the coming weeks sharing my rehabilitation progress - Stage 1: ‘Initial Controlled Rest’ with graded closed chain/weight bearing exercises.
The important thing to note here is that effective rehabilitation is not achieved by complete rest alone. Graded exercise plays a vital role in strengthening the patellar tendon to pain-free function once again.
Key take-away message
Athletes who push past the point of pain and continue to train with a patellar tendon overuse injury will likely develop a chronic and problematic condition taking 3-6 months to heal. Don’t push it - get your pain assessed as soon as possible and start the right rehab approach from the beginning.
Related knee pain articles:
Lorraine has previously written about anterior knee pain, also referred to as patellofemoral pain syndrome (PFPS),
Simon shared a blog post ‘3 Self Treatment Tips For Knee Pain Relief’ focusing mainly on cartilage and ligament damage.
Until part 2 stay well, run well,
Follow on article - How To Treat Patellar Tendonosis?