Conservative Management of Patellar Tendinopathy

The act of straightening the leg during walking, running, jumping, or standing is accomplished
through a coordinated anatomical mechanism involving the quadriceps muscles that attach to the patella
(kneecap), which is connected to the tibia (shin bone) via the patellar tendon. Repetitive and forceful
knee-extension movements can overload this tendon, leading to injury or inflammation known as patellar
tendinopathy, commonly referred to as jumper’s knee. This raises an important question: can conservative
treatments such as chiropractic care effectively manage this condition or is surgery required?
The classic presentation of patellar tendinopathy is pain at the front of the knee associated with
physical activity, typically localized to the patellar tendon itself. The condition occurs more frequently in
males, particularly those participating in high-intensity sports during adolescence and young adulthood.
However, adults who engage in repetitive jumping or high-load activities are also at increased risk.
Diagnosis is usually made through a detailed patient history and physical examination, though diagnostic
ultrasound may be used to confirm the condition. Treatment is generally divided into three phases: pain
reduction, strengthening and load progression, and functional training with return to sport.
The initial phase focuses on pain reduction and involves a temporary modification of activity.
This may include limiting jumping activities, reducing training volume, avoiding hard surfaces, and
allowing for increased recovery time between sessions. Complete immobilization is discouraged, as it can
lead to muscle atrophy and weakness that may delay recovery. Ice and other anti-inflammatory strategies
may be used between training sessions to help manage symptoms.
The second phase emphasizes progressive loading through isometric and isotonic exercises such
as wall sits, leg presses, and squats to gradually increase tendon stiffness and load tolerance. Because
kinetic-chain dysfunction often precedes patellar tendinopathy, care may also include manual therapies—
such as those provided by chiropractors—and targeted exercises to address contributing factors including
quadriceps weakness, hip abductor and external rotator weakness, limited ankle dorsiflexion, and poor
landing mechanics.
Once pain during rehabilitation scores no higher than 3 on a 10-point scale (0 = no pain; 10 =
worst pain imaginable), symptoms resolve within 24 hours of activity, and discomfort during normal
daily tasks is minimal, patients can begin a gradual return to sport. Full recovery typically takes three to
six months; however, if the condition becomes chronic before treatment begins, the rehabilitation process
may take considerably longer.
Surgical intervention is generally reserved for cases in which symptoms fail to improve after
approximately twelve weeks of well-supervised conservative management. The good news is that
conservative care results in satisfactory outcomes for most individuals with patellar tendinopathy.
Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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