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Patellar Tendonitis from Running | with Prof. Peter Malliares

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On this episode of The Adaptive Zone, we speak to expert Professor Peter Malliares about tendinopathy, a condition characterized by persistent pain around the tendon and dysfunctional disability. We’ll learn why an individualized approach is necessary for treatment of patellar tendonitis from running and uncover the various factors that contribute to tendinopathy. 

We’ll also hear about the various treatments available to patients, including taping, manual therapy, shockwave therapy, and injections, and why evidence shows that exercise is the most effective option. 

Finally, we’ll dive into the controversial topic of injecting steroids around or directly into the tendon and the risks associated with these procedures. Join us as we break down this complex problem and learn the most effective ways to tackle patellar tendonitis in runners to promote recovery and long-term health.

What is Tendinopathy?

If you’re a runner, you’ve likely experienced pain at some point in your training. One of the most common areas of pain reported by runners is the knee, specifically a localized pain in the bottom of the kneecap area where the tendon joins the kneecap. This is often the result of a patella tendon problem, also known as tendinopathy.

Tendinopathy is a condition characterized by persistent pain around the tendon. It’s important to note that pathology observed on scans does not necessarily mean that pain is present for the patient. Many runners can have tissue changes in their tendons but don’t feel pain.

Diagnosing Painful Tendons

Diagnosis of painful conditions in tendons used to solely rely on imaging, but now it is more clinical. Diagnosis is based on pain location, what aggravates the pain, and ruling out other conditions. Additionally, diagnosis is done through questions and physical tests performed by a Physio or sports doctor.

Main Risk Factors of Tendinopathy in Runners

Conditions such as patellar tendon problems are multifactorial in nature, with genetic predispositions, past injuries, and training being some of the factors that contribute to the problem. Age is also a risk factor for patellar tendonitis in runners since it reduces the tendon’s ability to adapt to running loads.

It is essential to note that strength may not necessarily be a key risk factor, but it could develop as a weakness after the problem has already occurred.

Treatment for Tendinopathy in Runners

The approach to treating pain should be individualized. For instance, safe loading and pain acceptance levels are essential to reducing the pain caused by tendinopathy. Exercise is a key treatment options for patellar tendonitis in runners.

The mainline treatments for tendinopathies include investigating the main causes such as improper loading, overtraining, and too much intensity. Understanding proper loading and reducing load in the short term can help avoid aggravating the problem.

Exercise is key to improving strength and ability to do higher load activities. Other common treatments for tendinopathies include taping, manual therapy, shockwave therapy, and injections. Although evidence for all treatments is not very strong, the use of exercise has stronger evidence. It may take four to six months to see progress after beginning treatment.

Injections and surgical intervention may be for appropriate for treatment as well. Still, these are not usually considered primary solutions except for in instances where sudden increases in pain occur.

Final Thoughts

Runners experiencing pain in the bottom of the kneecap area might be suffering from patellar tendon pain, also known as tendinopathy. After diagnosis, it’s vital to assess the severity of the pain and the patient’s abilities before adding any exercises to their routine. Even when using complimentary treatments such as injections or manual therapy, creating an individual-specific loading program is vital to treating tendinopathy successfully in runners.

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Professor Peter Maliares has been a physiotherapist since 1998 and is considered a foremost expert in tendon pain. He is currently based in Melbourne where he works as a clinician as well as a professor at Monash University, where he conducts research focused on lower limb tendinopathy.

Chapters

  • 00:00 Introduction
  • 01:43 Understanding Tendinopathy: Pain, Dysfunction, and Pathology Explained
  • 03:54 The Nuance of Diagnosing
  • 08:38 Localized Pain: Key to Identifying Patella Tendonitis
  • 15:53 Key Treatments for Tendinopathy
  • 22:22 Patellar Tendonitis: A Multifactorial Problem
  • 26:58 Individualized Education and Exercise for Pain Management
  • 33:04 Treating Tendinitis: Injections and Shockwave Reviewed
  • 38:59  Debating the Safety of Steroid Injections Near Tendons

Q & A

1. What is tendinopathy?

– Tendinopathy is characterized by persistent pain around the tendon and dysfunctional disability, which can also involve changes in the tendon tissue.

2. What are the common causes of tendinopathy?

– The main causes of tendinopathy include improper loading, overtraining, and a lack of gradual transition to higher intensity.

3. How is tendinopathy diagnosed?

– The diagnosis of tendinopathy is more clinical now and involves assessing pain location, and aggravators, ruling out other causes, and physical tests performed by a physiotherapist or sports doctor.

4. What are the short-term goals of treating tendinopathy?

– The short-term goals of treating tendinopathy include reducing pain and improving strength.

5. How long does it take to recover from tendinopathy?

– Overall recovery from tendinopathy may take four to six months.

6. What are the main first-line treatments for tendinopathy?

– The main first-line treatments for tendinopathy involve investigating causes such as improper loading, overtraining, or lack of gradual transition to higher intensity. Proper loading and exercise to improve strength are also important.

7. Are there any additional treatments for tendinopathy?

– Additional treatments for tendinopathy may include taping, manual therapy, shockwave therapy, and injections, but the evidence for these options could be stronger compared to exercise.

8. Can injections be used to treat tendinopathy?

– Injections are still used to treat tendinopathy because they are safe and some people may get a response, but high-quality trials show they do not provide much benefit. Injecting steroids directly into a tendon is not recommended due to the risk of rupture and damage.

9. What is the role of loading in treating tendinopathy?

– Loading is the solution that the evidence supports, but it’s difficult to sell to patients who think they’re already strong and don’t understand why making their tendons stronger would help. Loading programs consist of heavy knee-loading exercises and may take several months to complete.

10. Is surgery effective for treating tendinopathy?

– Surgery is uncommon and not effective for treating tendinopathy. Active approaches, such as proper loading and exercise, are better for getting people better.

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