Tendinitis
Anterior Knee Pain
Phone +971-2-4446600
Anatomy
Tendons are the ends of muscles that attach to bone. Tendons are dense and thick structures and when they get overloaded, from increased activities, they can get swollen and painful, called inflammation or tendinitis.
Since these structures are dense, swelling and pain can be difficult to get rid of and proper treatment can be needed.
Around the knee the most common tendinitis’ are from the:
Patellar tendon – below the kneecap (“jumpers’ knee”)
Quadriceps tendon – above the kneecap
Hamstring tendons – coming from the back of the thigh towards the sides
Another inflammation that can occur on the outside of the knee is called “runners knee”, or Iliotibial band syndrome. Runners knee is when a tendon layer rubs over a bony prominence when you bend and straighten your knee a lot, as you do when you run, creating inflammation. This is usually effectively treated when correctly diagnosed.
Tendinitis are common in the quadriceps and patellar tendons
Iliotibial band syndrom, ”runner´s knee”
The pain is located on the lateral side of the knee
Evaluation
The history of the patient with time frames and symptoms combined with physical examination of the knee is usually enough to diagnose tendinitis.
Treatment
First line of treatment for all these issues is physical therapy. There are different therapy programs depending on which tendon or area that is affected, but the common theme for these programs is that they need time to reduce the inflammatory process and build strength back to withstand the loading of the knee. So, commitment and patience with the physical therapy is crucial for a good result.
Often to complement the physical therapy and to get more powerful effect, anti-inflammatory medicine is prescribed in the initial phase.
Surgical treatment for inflammation in patellar tendon, quadriceps tendon and hamstring tendons are very rare. However, if the normal physical therapy treatment is done correctly and has poor result, sometimes we can do further evaluation to make sure there is no other issues in the knee causing the inflammation to come back time after time. For instance, inflammation in the soft tissue pouches deep to the tendons can be such a cause that can be in need of injection or surgery to have proper pain relief.
Regarding “runners knee” or iliotibial band syndrome with lateral pain, an injection is actually very effective and for the very few that do not respond to physical therapy or injection, a small local surgery to remove the inflammatory tissue in the area can be helpful.
Rehabilitation
As the standard treatment is physical therapy, this is a program that usually needs 4 months to appropriately treat these conditions. It should also be noted that if there is significant pain initially, the pain can actually increase during the first few weeks of the program, and it can take up to 3 months before a proper benefit it seen and felt. That is why it is so important to understand and commit to these physiotherapy programs, because otherwise it is an easy way out to stop the program after 1 month due to increased pain.
The rare occasion that surgery is needed, the rehabilitation is only a few weeks for the surgery itself, but the physiotherapy programs are thereafter similar in intensity and duration.