Q: My doctor recently told me that I have patellar tendonitis in my left knee. I just started my basketball season and was wondering if there is anything I can do to lessen the pain? Do I have to stop playing?
A. Patellar tendonitis is a fairly common problem either in the acute form or a chronic condition in athletes involved in repetitive jumping sports like basketball and volleyball. In most cases, there is a predisposing physical impairment in patellar tracking causing tendonitis. Patellar tracking is the term used to describe the movement of the knee cap (patella) inferiorly and superiorly (down and up) during knee flexion and extension. The most common underlying causes of disturbed patellar tracking include patella alta (a small, high sitting patella) and vastus medialis (front, inside thigh muscle) deficiency.
In the clinic, patellar tendonitis rehabilitation focuses on improving the medial quadriceps strength. The main goal of the program is to do exercises that place the patellar tendon on stress without causing significant discomfort. The increase in tensile stress placed on the tendon will hopefully strengthen the tendon allowing greater loads with jumping activity. One of my favorite exercises to accomplish this is a single leg squat. Most current research emphasizes eccentric movements for knee tendonitis, meaning that the squat should be done slowly going down (about a 5-7 second count) and a quick explosive movement going up. Focus on going as deep as you can without pain and keep your knee, hip, and ankle in alignment. If your knee drifts inward then your patella will most likely track laterally and this is not the tensile stress we are trying to create.
If the patellar knee pain is too great to bear now, then the ultimate answer is to take some time off jumping activity. Maybe you can coordinate a week off for the holidays to see a physical therapist or your athletic trainer for cross friction massage, ice massage, and manual hamstring stretching. You will need to incorporate a proper active movement and stretching warm-up routine prior to training sessions and games to help diminish the discomfort. Getting fitted for a patellar tracking knee brace will help you get through this season. Ultimately, if you do not have time now, you will need to begin a rehab program in the off-season to prevent reoccurrence next year.