A Pain in the Patellar

Knee pain may indicate patellar tendonitis. Here’s what causes it and how to treat it for long-term bodybuilding success.
By Guillermo Escalante, MBA, ATC, CSCS
Leg day is the day each week that you love to hate, but hate to love. The love-hate relationship many bodybuilders develop with leg training is only natural. Since the legs comprise the largest muscle group of the body, they require the most energy and effort to train. You also know that the benefits of training legs range from a large boost in natural testosterone/growth hormone levels to providing your physique with a well-balanced look. Unfortunately, injuries to the knees can sometimes put a damper on your efforts.

One common knee injury that bodybuilders are sometimes challenged with is known as patellar tendonitis. The patellar tendon is the common insertion point of the quadriceps muscles: the vastus lateralis (the sweep), vastus medialis (the tear drop), vastus intermedius (the deep middle quad muscle), and the rectus femoris (the superficial middle quad muscle). These four muscles join together just above the patella (knee cap) into the patellar tendon; the patellar tendon then proceeds over the knee cap and inserts into the tibial tuberosity (the small bony prominence high on the shin bone (tibia). Patellar tendonitis is defined as an inflammation/irritation of the patellar tendon either just above the knee cap (sometimes referred to as quad tendonitis) or just below the knee cap (the most common kind of patellar tendonitis).

The patellar tendon plays an important role in your leg movement, as it facilitates the extension of the legs from a bent position. Exercises such as leg extensions, squats, leg presses and hack squats place a large demand on the patellar tendons. Other athletic activities that involve excessive and repetitive jumping such as such as basketball and volleyball can also contribute to patellar tendonitis. It’s for this reason that patellar tendinotis is sometimes referred to as jumper’s knee.

According to Sachin Patel, MD, an orthopedic surgeon at Garey Orthopedics Medical Group in Pomona and Rancho Cucamonga, California. “One of the first symptoms of patellar tendonitis is a sharp pain along the patellar tendon with physical activity such as squatting, leg extensions, or running/jumping.” In the initial stages, sharp pain may only appear during the beginning of physical activity or just after a demanding workout. Pain may increase more as the activity becomes more demanding, but in many cases the pain slightly subsides as the tendon/muscles warm up. In more severe cases, the pain will persist after physical activity with a dull ache after such simple tasks as walking or with activities such as going up/downstairs.

Patellar tendonitis is usually caused by repeated stress on the patellar tendon without adequate recovery. This stress can result in small tears in the tendon that the body attempts to repair.

Unfortunately if the rate of breakdown is faster than the rate of repair, the body cannot keep up with the demands placed upon it. The result is an inflamed/irritated tendon that causes pain with activity. Patel says that contributing factors such as lack of flexibility to the quads, being overweight, sudden increases in intensity or activity that involve the tendon, or muscular imbalances may predispose an individual to patellar tendonitis.

Treatment usually involves rest, ice and compression. A period of rest ranging from 3–21 days (depending on the severity) along with the application of ice for 15–20 minutes, 1–3 times a day is a great way to start. After a few days of complete rest, implementation of quad stretches may facilitate your recovery. Knee braces known as patellar tendon straps that are applied directly over the patellar tendon can also be used to help to unload the tendon. If pain persists, you should consult your physician, who may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) and/or treatment by a certified athletic trainer or licensed physical therapist, who can implement manual therapy techniques, exercises, stretches and other therapeutic modalities to help accelerate your recovery.

Once your knees feel healthy again, you can ease your way back into your training, but it’s best to work with a sports-medicine professional to ensure you don’t re-injure your knee or slip back into pain.

Strategies to Avoid Patellar Tendonitis

1. Warm up with the bike, treadmill or elliptical trainer for 5–10 minutes at a low-to-moderate intensity before beginning weight training.
2. Perform a dynamic warm-up with bodyweight lunges and squats.
3. Perform 1–2 submaximal sets before initiating your heavier work sets.
4. Stretch your quads thoroughly with static quad stretches after your workout.
5. Allow at least 72 hours of rest between your leg workouts.

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