Tuesday, March 29, 2011
Some knee injuries get all the press and others at like Rodney Dangerfield and get no respect at all. AT the top of the heap is an ACL tear, a season killer that usually requires surgery and more than six months rehabilitation and recovery time. Perhaps least appreciated is patellar tendinitis or inflammation of the tendon that attaches the quadriceps muscles of the thigh to the tibia and allows the knee to extend or straighten. For a pro athlete with this injury, the frustration must be very high since it is an overuse injury that is treated with rest and heals on its own timetable, whenever it chooses. Chase Utley ,the Philadelphia Phillies all star has been patient the past couple of months as his knee continues to hurt but opening day doesn’t wait and as spring training ends, Utley’s knee hasn’t yet healed enough for him to run.
The patellar tendon has some interesting anatomy because the patella or kneecap is contained within its fibers. The patella adds mechanical advantage to the quad muscle and increases leverage to extend the knee more forcefully. Any irritation as the underside of the kneecap glides across the knee will cause inflammation and pain in the tendon. The underlying problem can be poor quad muscle balance, poor alignment of the kneecap or even an injury to the kneecap. Intense activity can also cause microtears in the tendon leading to progressive pain. Jumping and the shock of landing)is the common activity associated with patellar tendintis but any aggressive training and running can cause stress on the tendon.
Rest is the key to recovery and conservative treatment with physical therapy are given up to a year to help resolve the tendinitis before surgery is considered. The goal of therapy is to understand the underlying cause of the injury and try to correct it, all the while working to decrease inflammation in the tendon itself. Normally, joints are rested to prevent further damage, but immobilizing the knee will cause quad and hamstring muscles to weaken almost immediately. It can help the pain but at the cost of requiring longer therapy to work on stretching, muscle balance and strengthening and body mechanics.
As with most orthopedic injuries, surgery is always an option (remember that surgeons always like to operate) but not until conservative therapy fails. There is no one recommended operation, so the surgery will be tailored to the findings in the knee. This may range from repairing tendon tears or even removing parts of the tendon that are too frayed to fix. Recovery after surgery can take up to six months and added to the year of failed treatment beforehand, it adds up to a big chunk of time trying to fix a problem that gets no respect.
Ultimately, the way to treat patellar tendinitis is to listen to knee pain and not ignore the aches and pains that often are neglected. Any pain that occurs acutely with an activity and leaves a residual ache that continues even after rest should be considered serious. Time invested early on rest, ice and anti-inflammatories may pay long term dividends in shortened recovery time. Once again, the body will tell what’s wrong with it, if only people would listen.