Introduction

Patellar tendonitis, commonly known as ‘Jumper’s Knee’, occurs when the patellar tendon becomes inflamed and irritated due to overuse. Understanding the connection between patellar tendonitis and running is crucial as it is a problem caused by overuse and repetitive strain on the knee joint. This article aims to explore what patellar tendonitis is, its relationship with running, how it could be prevented, and possible treatments. Understanding patellar tendonitis, especially if you are a runner, is very important as continuing to run on an injury can result in long-term problems.

Understanding patellar tendonitis

Patellar tendonitis is a painful knee condition caused by small tears in the patellar tendon, resulting in localised pain.¹ These tears are caused by stress on the tendon, often associated with sports that demand a significant amount of speed and power. It can have many causes, such as the long/high jump, skiing, and basketball. However, this article aims to focus on another cause – running. 

Anatomically, the patellar tendon connects the patella (kneecap) to the tibia (a bone in the lower leg) and is the link between the quadriceps muscles (in the thigh) and the lower leg. This enables the body to transmit large forces, such as those experienced during activities like running. Moreover, the patellar tendon connects with other structures within the knee joint;therefore, it has an important role in maintaining joint stability and normal function during movement and exercise.

Symptoms experienced by runners with patellar tendonitis include:

• Stiffness felt in the knee when running downhill or descending downstairs
• Pain when the knee is straightened
• Mild swelling may be present at the site of injury
• Pain when running
• Tenderness to touch, or pressure felt behind the lower part of the kneecap, where the patellar tendon attaches
• A gradual onset of pain:
  • You may feel pain when you first start exercising. This pain may improve or go away as you warm up on your run
  • A pain that does not go away after exercise – this may indicate worsening of the injury

The relationship between running and patellar tendonitis

As previously mentioned, running, particularly over long distances, is a significant contributor to the development of patellar tendonitis. Several risk factors associated with running increase the likelihood of developing this condition. These factors include: subjecting the joints to repetitive stress; rapidly increasing the duration, intensity or frequency of training sessions; running on hard surfaces; and not having the appropriate footwear.

Additionally, the biomechanics of your knee joint can be a crucial factor in predisposing you to patellar tendonitis. Biomechanics is how muscles, bones and tendons work together to facilitate movement. If you have weakness in the muscles that surround the knee joint, have had previous knee injuries, or have poor form when running, it can affect how your body responds to movement and may increase your risk of developing running injuries, such as patellar tendonitis. 

If you have an injury, it is important to seek professional help. Healthcare professionals can perform tests to identify the cause of the injury, provide guidance on how to treat the injury and advise on how to prevent it from happening again in the future. Addressing any underlying issues that may have caused the injury can also decrease the chance of it happening again, thereby promoting long-term joint health and function.

Prevention strategies of patellar tendonitis for runners

One of the most important things you can do when running is to undertake measures to prevent any injury to the joint from occurring in the first place. This can ensure that your joints remain in optimal health.

This can be achieved in the following ways:

Proper warm-up and cool-down routines

Warming up before running helps to prepare the body for physical activity and reduces the risk of injury. By warming up, the body can gradually adapt to the upcoming workload, preventing the patellar tendon from experiencing a sudden spike in loading that could lead to injury. Furthermore, warming up enhances blood flow to the muscles and tendons surrounding the joint, which makes the tendon less susceptible to injury and supports healing.

Gradual progression in training volume and intensity

Whether you have just started running or are training for a specific goal, it can be easy to get carried away and suddenly increase how much you run or the intensity of your running. However, abruptly increasing your running can put you at significant risk of patellar tendonitis, as this can overload the tendon and result in an overuse injury. Gradually increasing your training volume or intensity allows the whole knee joint, including the patellar tendon, to adapt to this increase in load and meet the demands of running. Using a running plan can be helpful to ensure that you don’t put too much strain on your tendons. These can be accessed online or through personalised running apps.

Incorporating strength training exercises to improve tendon resilience

Strength training plays a role in increasing tendon resilience by facilitating structural changes within the tendons, enabling them to better withstand repetitive loading experiences during running. Furthermore, strength training can increase muscle strength, increasing the overall stability of the tendon. Through this, and by addressing any underlying biomechanical issues that may have contributed to tendon injury, strength training reduces the risk of injury. This positively affects the whole joint, enhancing musculoskeletal health and making running a safer experience.

Utilising proper footwear to reduce stress on the tendon

When running, the use of proper footwear is essential as everyone's needs vary. For example, some people find that their foot naturally rolls inwards when they land, and they may require shoes that support their arches to prevent this roll. To ensure optimal shoe selection, you can visit a specialised running shop and ask for a gait analysis. This assessment provides personalised insights into your running mechanics and can guide you towards a suitable style of running shoe to help reduce your risk of injury. 

Listening to the body and recognising early signs of tendonitis

If you experience a gradual onset of pain whilst running, or other symptoms of patellar tendonitis like those mentioned above, it is important to stop running and give your tendon time to heal. Running through pain increases the risk of making the injury worse and prolonging the healing process. Whilst this is difficult for runners during training periods, it is important to remember that pain is protective and is a sign to stop what you are doing and seek treatment. Prioritising rest and seeking care will allow for tendon recovery and enhance your future running experience, preventing further complications.

Treatment options for runners with patellar tendonitis

In addition to resting, you can also care for the injury using the R.I.C.E protocol (rest, ice, compression, and elevatation,) for 2 to 3 days after the injury. Wearing support, such as a soft brace or bandage, can help keep the knee stable. Taking pain medication as prescribed by your physician can help alleviate pain and inflammation. This may include paracetamol or non-steroidal anti-inflammatory (NSAIDs) such as ibuprofen.²

Consulting with a healthcare professional is important to get a personalised treatment plan. This may also involve physical therapy that aims to increase tendon strength and flexibility. By following a comprehensive treatment plan, individuals can effectively manage patellar tendonitis and facilitate a safe return to activity.

Rehabilitation and return to running

If you are returning to running after a patellar tendon injury, only do so when you feel fully recovered and your symptoms have improved. It is advisable to do this under the advice of a health professional to avoid further injuring yourself.

It is best to gradually introduce running back into your routine, slowly building up the resilience of your patellar tendon to its impact. Being aware of your symptoms is very important, and you should stop running as soon as you feel that the pain has returned. Remember that tendon pain can be worse at the start of a workout and improve as time goes on; however, this does not mean that you have recovered, and you may be making the injury worse in the long term.

Running is a high-impact sport, and it is important to incorporate cross-training and low-impact activities into your fitness routine.³ This allows for you to improve your overall strength and fitness and protects against injuries by offsetting the impact of running. Such activities can include swimming, elliptical trainers and cycling. Engaging with a cross-training programme can also improve your running as it may increase your overall strength, the ability of your patellar tendon and surrounding structures to manage the impact of running, and improve your overall cardiovascular health.

Summary

In conclusion, patellar tendonitis is a common running injury due to repetitive strain and microtears in the patellar tendon. It can significantly impact your running; however, it is preventable if you take the necessary steps to prevent or respond to an injury. If you experience the symptoms of patellar tendonitis, it is important to prioritise the health of your tendon and seek guidance from a healthcare professional. Continuing to run on an injury can increase the likelihood of a more serious injury that has a long-term impact on your running. Properly caring for your tendons and maintaining a good cross-training routine can benefit you in the continued enjoyment of running whilst protecting your joint health.