Physical Therapy for Knee Tendonitis

The patella is usually the tendon behind knee tendonitis. It encases and extends above and below the kneecap. The kneecap should move inward slightly, then outward as the quadriceps contract. Mistracking through this arc causes friction and chronic injury.

Shoes

• Flat feet cause patellar mistracking when the foot is loaded. Without podiatrist-tailored orthotics before therapy begins, mistracking will likely inhibit the recovery rate between sessions.

Warm-up

• Warm-up is essential to warm brittle tendons and to activate muscles enough to properly time their contractions through the kneecap's arc -- the reason pain can disappear during warm-up.

Leg strength

• Quadricep strength stabilizes patellar tracking. In particular, the vastus medialis (inner lower quadricep) atrophies quickly without exercise. Leg extensions emphasize the medialis.

Leg exercises

• Motion should be slow, avoiding the unstable 90-degree and 180-degree points. Pain means the load should be reduced. Gradually add new stresses to conventional quad exercises, such as eccentric contractions to prepare for walking and running: jumping in place, hopping laterally, then reduced-weight leg presses as little jumps. Lateral foot exercises and balance board work can compensate for flat feet.

Stretching

• A tight vastus lateralis (outer quadricep) has the same effect as a weak medialis, mistracking the kneecap outward. Stretching mitigates the problem. Tight hamstrings and calves also cause significant patellar mistracking. Gentle stretching each morning to work off night stiffness avoids damage from morning walking.

Icing

• After the post-workout icing, the patient should wait for his knees to warm again before leaving therapy. Cold tendons are more brittle and prone to tendonitis.