What happens to the link?
The patellar tendon ligament transmits the force of the quadriceps muscle to the lower leg. When jumping and landing, she experiences a load many times greater than her body weight. If there are not enough recovery pauses, micro-tears accumulate in the attachment zone. The tissue is rebuilt: collagen fibers become chaotic, new vessels and nerve endings appear - they are the ones that cause pain. There is no classic inflammation with pus and pronounced swelling here, so it is more correct to talk about tendinopathy rather than tendinitis. Most often, the upper part of the ligament at the lower pole of the patella is affected.
- Stage 1 - pain only after exercise
- 2nd – pain at the beginning of training, goes away after warming up
- 3rd – pain during and after exercise, the result suffers
- 4th - constant pain, possible ligament rupture
Causes and risk factors
The main reason is the mismatch between the load and the capabilities of the fabric. The risk increases when the volume of jumping training is increased sharply: after a break, at the beginning of the season, or when changing coaches or surfaces. The characteristics of the athlete himself are also important: weak or, conversely, overloaded thigh muscles, stiff posterior thigh and calf muscles, limited ankle mobility, incorrect landing technique. Additional factors are a hard floor in the hall, worn-out shoes, excess weight and male gender.
- A sharp increase in the volume of jumps and squats
- Volleyball, basketball, high jump and long jump
- Weakness of the quadriceps and gluteal muscles
- Tight hamstrings and calf muscles
- Limited ankle mobility
- Hard surfaces and worn-out shoes
- Insufficient rest between workouts
Symptoms
The pain is strictly local: the athlete shows it with one finger just below the kneecap. First it appears after training and goes away within a day, then it appears at the beginning of the lesson, subsides during the warm-up and returns in the evening. Jumping, squatting, going down stairs, and sitting for long periods of time with a bent knee can cause pain. There is almost no swelling, movement in the joint is full, the knee is not blocked. If pain forces you to stop training or bothers you when walking, the condition is considered advanced.
- Point pain at the lower pole of the patella
- Increased pain when jumping and squatting
- Pain when going down stairs
- Discomfort after sitting for a long time with bent knees
- Morning knee stiffness
- Maintaining full range of motion
Diagnostics
The basis of diagnosis is examination. The doctor finds a painful point on the lower pole of the patella, checks the strength of extension, evaluates the squat on one leg and landing technique. Ultrasound of the knee joint shows thickening of the ligament, areas of tissue restructuring and new vessels, and also allows you to observe the dynamics. MRI is prescribed if the picture is questionable, if there is a suspicion of a partial tear, or before surgery. X-rays are needed to rule out bone changes, ligament calcification, and in adolescents, Osgood-Schlatter or Sinding-Larsen disease.
- Palpation of the lower pole of the patella
- Single leg squat and inclined platform test
- Ultrasound of the knee joint with the patellar ligament
- MRI of the knee joint for suspected rupture
- X-ray of the knee joint to exclude bone pathology
- Assessment of flexibility and strength of the thigh muscles
Treatment and return to sports
Complete rest does not heal the ligament: without stress, it becomes weaker. The goal is to temporarily remove jumps and deep squats, but give the ligament measured strength work. The basis of the program is slow squats and eccentric exercises, in which the muscle works to lengthen; the load is increased gradually, focusing on the acceptable level of pain. Additionally, they stretch the back of the thigh and calf, strengthen the gluteal muscles, and correct landing technique. Shock wave therapy and laser reduce pain in persistent cases. Anti-inflammatory drugs are used briefly and as prescribed by a doctor; injections of glucocorticoids into the ligament are not recommended due to the risk of rupture. Returning to full training takes on average 3-6 months.
- Temporary refusal of jumping and deep squats
- Eccentric quadriceps exercises
- Gradual increase in load under the supervision of a specialist
- Hamstring and calf stretch
- Strengthening the gluteal and core muscles
- Shock wave and laser therapy for persistent pain
- Correction of jumping and landing technique
- Taping or knee brace for the period of return to sports