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Knee Tendonitis and Tendinopathies

Tendinopathy and tendonitis are often used interchangeably. They both have almost identical symptoms, however, they are different conditions.

What’s the difference between tendinopathy and tendonitis?

Tendonitis and tendinopathy of the knee refer to the inflammation, irritation and breakdown of the thick fibrous cords that attach muscle to bone.

Tendinopathy is a degeneration of the collagen protein inside of the tendons.

Tendonitis is inflammation of, or around, the tendon.

Both conditions cause burning pain in the tendon or where it attaches to the bone. It will also cause the joint, in this case, the knee, to feel stiff after rest resulting in a reduced range of movement.

The pain will depend on the tendon that is involved. There are a number of tendons that attach to the knee in different places and the easiest way to identify the pain is often by the movement that brings it on;

  1. Straightening the leg (knee extension) – Quads or hip flexor
  2. Bending the knee – hamstrings or groin
  3. Going on tip toes – Calf muscles
  4. Pulling your foot towards you – shin or foot muscles.
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Often there is an overlap in the cause of the tendonitis due to the large number of tendons that attach to the knee.

 

Muscles of the upper leg.

  • Quadriceps muscles. These are located on the front of the thigh. As they reach the knee they come together to form the quadriceps tendon and attach to the top of the knee cap (patella).
  • Hamstrings. The two hamstring muscles are located at the back of the thigh. One attaches to the outside of the knee the other attaches to the inside of the knee.
  • Groin muscles. There are a number of muscles that make up the groin but two of the longer muscles attach to the inside of the knee. One above the joint line and the other below the joint line.
  • Hip Flexor. There is a small muscle in the hip that joins to the ITB which runs all the way down the side of the thigh and attaches to the outside of the knee.

 

Muscles of the lower leg.

  • Calf muscles. There are two main ones the Gastrocnemius, often referred to as the Gastroc, and Soleus, a flat muscle that lies underneath Gastroc. Soleus attaches on the outside of the knee and the Gastroc attaches behind the knee on the thigh bone.
  • Shin. The long muscle that runs up the side of the shin bone starts on the outside of the knee.
  • Foot Muscles. There are a number of muscles involved in the movement of the foot but one of the longest ones, that moves the big toe, actually starts from the outside of the knee.

What do Tendonitis and Tendinopathy feel like?

  • A dull constant ache with moments of sharp pain with specific movements
  • Pain and tenderness on palpation
  • Mild swelling to the area.

 

What Causes Tendonitis and Tendinopathy?

Both tendinopathy and tendonitis are often caused by the overuse of a tendon through repetitive movements such as running.

 

Muscle imbalance. Biomechanical differences such as muscle strength imbalance or weakness can be a large contributing factor. If an athlete is returning from injury or a period of rest some muscles will be stronger and better conditioned than others resulting in one of two things happening;

  1. The stronger muscles take on the additional workload during exercise. They will reach a point where the level is too high and the forces through the tendon become too much resulting in a breakdown in the collagen fibres as they cannot recover between sessions.
  2. The weaker muscles will fatigue faster as they are unable to maintain the output of the stronger muscles. Over time the muscles will become tighter applying additional force through the tendon causing inflammation and pain.

 

A sudden increase in training intensity and volume can also be a contributing factor to tendinopathy, especially if there has been insufficient build-up training or inadequate recovery time. If the body, specifically the tendons, does not have time to adapt to the training load or is not given time to repair and recover the tendons will start to break down.

How to treat Tendonitis and Tendinopathy.

If you suspect that you are suffering from any form of tendon damage then it is recommended that you do the following:

The POLICE protocol

When acute pain first appears follow this protocol:

  • P: Protect the area. This can be changing footwear or wearing a supporting knee brace
  • OL: Optimal Loading. Take as much weight as you can without making things worse. You may need rest or crutches.
  • I: Ice the area for 20 minutes at a time to relieve inflammation.
  • C: Compress the area to help reduce any swelling.
  • E: Elevate the area by putting your leg on a few pillows

 

Avoid aggravating the tendon. This can be as simple as reducing your training load or in some cases, you may be required to completely rest the knee to allow the tendon to repair itself.

Reduce impact-based exercises such as running, especially running on an incline or declined surface as this will only increase the forces through the knee.

 

Exercises that can help to treat Tendonitis and Tendinopathy.

Standing Hamstring Curl

This exercise is designed to strengthen the hamstring muscles on the back of the thigh.

  • Stand on one leg with one foot behind you.
  • You can lean on a pole or wall for stability.
  • Raise your heel to your bum making sure to keep your knees aligned.
  • Lower your foot back down until your toes are touching the ground.

Frequency and duration

  • Raise for a count of 2 seconds.
  • Hold for 1 second.
  • Lower your foot for a count of 2 seconds.
  • 3x sets of 12 on each leg.

Alternatives

  • Easier - reduce the height you lift your foot off the ground.
  • Harder - add weight to the ankle.

Single Leg Dips

This exercise is designed to improve leg strength and knee control.

  • Stand with both feet planted shoulder width apart and your hands by your side.
  • Place one foot out in front of you keeping the leg straight.
  • Lower yourself down bending at the knee into a seated position.
  • Raise yourself back into the standing position.

Frequency and duration.

  • Lower down for the count of 2 seconds.
  • Hold at the bottom for a count of 1 second.
  • Raise back up for a count of 2 seconds
  • 3x sets of 10 on each leg

Alternatives 

  • Easier - hold on to a pole or the wall for support
  • Harder - hold weights in your hands or place a chair behind you and lower to a seated position.

Single leg step-up

This exercise is designed to improve leg strength and neuromuscular control.

  • Stand with one foot planted on a step or a block and your arms by your side
  • Step onto the block driving your knee through to 90°.
  • Hold at the top then reverse the movement lowering your leg back down till your foot is back on the floor.

Frequency and duration.

  • Step up for the count of 2 seconds.
  • Hold at the top for a count of 2 seconds.
  • lower down for a count of 2 seconds
  • 3x sets of 10 on each leg

Alternatives 

  • Easier - step onto the box then step down off the box like marching.
  • Harder - hold weights in your hands

Single leg step-down

This exercise is designed to improve leg strength and neuromuscular control.

  • Stand with both feet planted on a step or a block, your arms on your hips or by your side.
  • Lower yourself down from the block until your heel touches the ground.
  • Push through the leg that is still on the block to raise yourself back up to the standing position.

Frequency and duration.

  • Lower down for the count of 2 seconds.
  • Hold at the bottom for a count of 1 second.
  • Raise back up for a count of 2 seconds
  • 3x sets of 10 on each leg

Alternatives 

  • Easier - hold on to a pole or the wall for support
  • Harder - hold weights in your hands

Ski squats

This exercise is designed to improve single-leg strength.

  • Start with your back against the wall and your knees slightly bent in a half squat position.
  • Lower into a deeper squat and at the same time shift your weight over to the right leg.
  • Return to the centre in the half squat position
  • Lower into a deeper squat this time shift your weight over to the left leg.

Frequency and duration

Starting from the centre:

  • Lower for a count of 3 seconds
  • Hold for a count of 2 seconds
  • return to the centre for a count of 3 seconds.
  • 3x sets of 12 on each leg

Alternatives 

  • Easier - reduce how far you slide over to the left/right
  • Harder - Make the squat deeper and hold for a count of 4 seconds.

 

The information on this site is intended for educational purposes.

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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