Tendinitis of the Knee
The knee is an amazing joint. It is uniquely designed to help propel our bodies, cushion shock transmitted up and down the leg, and act as a powerful lever with the largest muscles in our bodies. Specialized components include robust ligaments, tough meniscus cartilage, and undulating smooth gliding joint surfaces. Essential to proper knee function are well-conditioned muscles, which not only include the quadriceps, the hamstrings, and adductors of the thigh, but also the gastrocsoleus complex of the calf.
Every runner has an instinctive understanding of the need for adequate muscle strength. This is especially true with regard to the quadriceps muscles. "Quadriceps" means four heads, which refers to the four separate origins, or upper attachments, of this powerful group of muscles. The quads act chiefly to extend (straighten) the knee, but are also secondary hip flexors (benders). They act to produce knee extension via a "chain" of structures distally including the quad tendon, patella (kneecap), and patellar tendon (or ligament). During quadriceps contractions with climbing and running, forces equal to many times body weight are produced as tension within the tendons, and as compressive forces behind the patella. These areas are usually the "weak link" in the chain, and often complain the loudest during periods of injury or overuse.
Patella problems are numerous and varied, and are beyond the scope of this discussion. However, irritations or inflammations of the quadriceps and/or the patella tendons are also extremely common conditions in runners. In this context, they will cause pain immediately above or below the patella, accompanied by tenderness, and in some cases swelling may be seen. Tendinitis at these sites most often follows a sudden increase in mileage, or change in training routine, such as hill running, or speed work. For the cross-trainers, jumping or twisting sports, hiking downhill, or bicycling with hill climbing in excessively high gear (big front chain ring) may also contribute.
It is infinitely easier to treat and cure this problem with aggressive, early intervention. Once the tendinitis becomes entrenched (chronic), i.e.- greater than six to eight weeks, it is much more difficult to eradicate. Early management includes attempts to "put out the fire" using ice, anti-inflammatory medications, and relative rest, avoiding provocative activities, such as those mentioned above. Gentle knee bends, squats, and quad and hamstring stretches may provide enhanced flexibility. A knee sleeve may provide relief.
A word about strengthening. When pain is present in the front of the knee, such as with these tendinitis problems, or with patella problems, efforts to strengthen the quads are usually beneficial. However, strengthening via knee extensions, i.e.- pushing off with the front of the lower leg, will often only make matters worse. It is much better to try to strengthen the quads by using straight leg lifts with weights, or with the sole of the foot, such as with the leg press, bicycle, stair stepper, rower, etc.
Caution! Avoid steroid injections in and around the patella and quadriceps tendons! Surgery for this problem is seldom necessary, usually a last resort when all else has failed for the frustrated, incapacitated runner.
Dan Wnorowski, M.D.