How to Treat an Inflamed Patellar Tendon
1. Check the knee that is hurting and look for soreness and inflammation of the patellar tendon (around the knee). Also, note any feeling of pains when resting the knee. If you have any of these symptoms call your doctor to get an x-ray of the knee. By reviewing this test, the doctor can determine which is the problem affecting your knee and recommend the proper treatment.
Some Patellar tendon swellings are mild and may heal with simple home remedies and with a little bit of time.
2. Give your injured knee rest and relaxation to heal an inflamed patellar tendon. If you exercise or run regularly, stop for a few days to rest the tendon or knee ligament. Stop exercising until the swelling and pain are completely gone.
3. Use cold therapy to treat the swelling on the knees. Use ice or cold therapy pads for 20 minutes three times a day until the inflammation and pain disappear. Avoid heat and moist therapies, heat may make the swelling on the knee even worse.
4. Take an anti- inflammatory medicine to treat an inflamed patellar tendon. Advil, Motrin and Aleve are some of the anti inflammatory, over the counter medications that may help to reduce the swelling on the knees. Follow the directions on the product’s package or a doctor’s recommendation for dosage.
5. Use proper care when working out, running or practicing sport activities to avoid future inflamed patellar tendon problems. Use proper shoes that provide shock absorbency and support for your legs. Warm up your legs using stretching exercises before and after your routines. These exercises relax the tendons and muscles helping to avoid injuries.

Question about Surgery for inflamed patella tendon?
I had a car accident two years ago and hit my knee cap. Since then I have had pain in my knee. I just had an MRI and my doctor told me I need knee surgery for a very bad inflammed patella tendon. Please tell me, if anyone has had the surgery.

Best Answer: If the tendon is just inflammed, have you tried NSAIDS, physical therapy, friction massage, icing, resting, iontophoresis, ultrasound treatment, etc? If the tendon has a tear or damage, then surgery may work if other treatments have not. You would have to ask your orthopedist about what the surgery would involve. They might repair a tear (if there is one), scrap off damaged tissue, stimulate healing etc.
As far as I know, an inflammed patella tendon is patella tendinitis is pretty much what patella tendinitis. Surgery is the last resort and not 100% successful. However, if there is damaged tissue or a tear, then surgery might be a better solution.
Talk to your orthopedic surgeon, maybe get a second opinion before consenting to surgery.

How can I prevent patellar tendonitis?
Patellar tendonitis is usually caused by overuse during activities such as jumping or running. It can best be prevented by having strong thigh muscles.

Inflamed Patellar Tendon - Image Results

Images for Inflamed Patella Tendon

Images for Inflamed Patella Tendon

Images for Inflamed Patella Tendon

Images for Inflamed Patella Tendon

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The other contributors have addressed the physical therapy side of things, so I thought I would address the shoes and inserts.

Orthotics can be very helpful in treating patellofemoral pain syndrome (there is significant research to support this). But what needs to be identified is if there is a biochemanical problem with the way your feet and legs are working to be causing this pain.

Patellofemoral pain syndrome is often seen in people with rolled in (excessively pronated), flatter feet. This is because it can cause twisting of the lower leg, causing the knee cap to mal-track.

Have you a look at your foot type and see if you have problems with fallen arches, rolled in feet etc.

Custom Foot Orthotics are commonly implemented for patellofemoral pain syndrome.

Usually, putting ice on your knee, changing your activities, and following a physical therapy program works best. This type of program may include exercises to make your muscles stronger and more flexible. Taping the knee or using shoe insoles can be helpful for some people. It may take weeks or months of treatment for the pain to go away.

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Dynamic patella brace with floating patella pad
A dynamic patella brace useful for both diagnosis and treatment of patella subluxation, wherein the position of a patella bracing pad is allowed to float to be automatically dynamically repositionable depending upon the amount of flexion and movement of the knee and the amount of tension and…
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You can download the [Full text - PDF]

2. The patella thinning osteotomy. An experimental study of a new technique for reducing patellofemoral pressure.
Abstract
The authors describe an original procedure, the patella thinning osteotomy, as an alternative to advancement of the tibial tuberosity or patellectomy in cases of severe anterior knee pain. They present an experimental study on cadaveric knees prior to a clinical trial. This study on 13 knee specimens, using Fujifilm Prescale barosensitive film, shows that thinning of the patella by 7 mm diminishes to a significant degree the patellofemoral contact areas from 16.07% at 60 degrees of flexion to 27.90% at 30 degrees of flexion. Patellofemoral joint reacting forces, measured in 12 knees, also diminish in both medial and lateral surfaces at 30 degrees, 60 degrees and 90 degrees of flexion, the level of statistical significance being over 0.05, except for the lateral surface at 60 degrees of flexion. This technique decompresses the patellofemoral joint, and produces the biological effects found after other osteotomies.

3. The patella thinning osteotomy
Abstract
The authors describe an original procedure, the patella thinning osteotomy, as an alternative to advancement of the tibial tuberosity or patellectomy in cases of severe anterior knee pain. They present an experimental study on cadaveric knees prior to a clinical trial. This study on 13 knee specimens, using Fujifilm Prescale barosensitive film, shows that thinning of the patella by 7 mm diminishes to a significant degree the patellofemoral contact areas from 16.07% at 60° of flexion to 27.90% at 30° of flexion. Patellofemoral joint reacting forces, measured in 12 knees, also diminish in both medial and lateral surfaces at 30°, 60° and 90° of flexion, the level of statistical significance being over 0.05, except for the lateral surface at 60° of flexion. This technique decompresses the patellofemoral joint, and produces the biological effects found after other osteotomies.Les auteurs présentent une technique originale d’amincissement de la rotule, comme alternative à la patellectomie ou à l’avancement de la tubérosité tibiale antérieure chez les malades présentant des douleurs sévères de la face antérieure du genou. Une étude expérimentale, menée sur 13 genoux provenant de membres amputés, a permis de montrer, à l’aide du papier barosensible Fujifilm Prescale, qu’un amincissement de la rotule de 7 mm entraîne une importante diminution de la surface de contact fémoro-patellaire, de 16.07% à 60° de flexion à 27,9% à 30°. Les pressions enregistrées dans 12 cas (une fois la mesure n’a pas été possible) ont diminué aprés l’ostéotomie d’amincissement, aussi bien sur la facette interne de la rotule que sur l’externe à 30°, 60° et 90° de flexion. Le degré de signification statistique est remarquablement élevé, sauf pour les mesures réalisées sur la facette externe à 60° de flexion. Cette technique ajoute donc une décompression aux bénéfices biologiques de toutes les ostéotomies.

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- See a physical therapist to prescribe you with specific exercises to help improve the biomechanics of the knee and prevent excess pressure on the patellofermoal joint. For instance, he/she may prescribe you with leg strengthening exercises of your quadriceps and gluteal muscles.

- Apply an ice or hot pack onto the knee. Make sure that you should only apply this for around 20 minutes and put if off for 5 minutes and then re-apply back on. This is to ensure that your body won’t adapt to the temperature and therefore maintain increase blood circulation.

- Avoid any movements or activity that may aggravate the condition like climbing stairs or sitting down for too long.

- Use medications that are prescribed from your physician like NSAIDs (Non-Steriodal Anti-Inflammatory Drugs).

- Apply orthotics on your feet to correct any abnormal biomechanics of your knee. If you are not sure what orthotic you need to get then

- Use vitamin supplements to help and increase the healing rate of your knee. Glucosamine could help rebuild your cartilage around your knee cap.

Patello-Femoral Syndrome

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This report describes a case of nail-patella syndrome in a woman with a strong family history who presented with effusions in her shoulder and knees. Microscopic examination of the shoulder fluid suggested the presence of calcium pyrophosphate dihydrate (CPPD) crystals, and examination of the knee fluid suggested both hydroxyapatite (HAP) and CPPD crystals. To our knowledge, the coexistence of these two conditions has not been reported in the past. Moreover, it brings up a new element regarding the inflammatory origin of the nail-patella syndrome.

Nail-patella syndrome associated with mixed crystal deposition arthropathy

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The McConnel Taping Technique is designed to hold the patella in place when the diagnosis shows that the patella is not moving along the correct path. This technique applies a rectangular bandage over the kneecap holding it in the center of the knee joint to support it when bending and squatting.

Taping the medial or lateral ligaments involves a crisscross taping method that starts over the knee and crosses over and under the patella. The patella is left exposed and supported by the tape around it. You will add additional strips of support along the medial or lateral ligaments depending on which one is injured.

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Signs and symptoms of patellofemoral pain include:
A dull, achy pain in the front of your knee
Increased pain when you walk up or down stairs (the most common symptom)
Pain in your knee when kneeling or squatting
Knee pain after sitting for long periods of time
A grating or grinding sensation when you extend your knee
Knee stiffness
Pain around the knee. The pain is usually located at the front of the knee, around or behind the knee cap. The pain is typically worse when going up or down stairs. It may be brought on by sitting (with the knees bent) for long periods.
A grating or grinding feeling or noise when the knee moves knee (‘crepitus’).
Rarely, some fluid swelling (‘effusion’) of the knee joint.

What is the treatment for chondromalacia?
Avoid strenuous use of the knee – until the pain eases. Symptoms usually improve in time if the knee is not over used.
Painkillers – paracetamol or anti-inflammatory painkillers such as ibuprofen may be advised to ease the pain.
Physiotherapy – improving the strength of the muscles around the knee will ease the stress on the knee. Also, specific exercises may help correct problems with alignment and muscle balance around the knee. For example, you may be taught to do exercises which strengthen the inner side of the quadriceps muscle.
Taping of the patella – is a possible treatment which can reduce pain. This is where adhesive tape is applied over the patella, to alter the alignment or the way the patella moves. Some people find this helpful. Some physiotherapists can offer patellar taping treatment.

Surgery
Surgery is not usually necessary, but may be advised if the above treatments have not helped.

Arthroscopic surgery is the usual operation. A tiny flexible camera is inserted into the knee. The surgeon sees the inside of the knee joint and the cartilage, and may then operate through the camera tube, using very fine instruments. Possible surgical treatments are:

Tight ligaments on the side of the patella may be cut to allow the patella to align better and move more smoothly.
Smoothing or ‘shaving’ the cartilage behind the patella.
Rarely, if all other options do not help, the patella can be removed (the knee can still function without it).

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Exercises Can Prevent Injury

Strengthening the muscles that support the knee with knee exercises is most important in protecting your knees from injury and knee pain.

Weak or fatigued muscles cannot adequately support the knee joint or absorb shock before it gets to the knee and the extra stress placed upon the knee can cause injury to the structures of the knee. Strengthening exercises can make the muscles tight, so follow strength exercises with stretching exercises.

Stretching the muscles that support the knee with knee exercises is also important in preventing injury. Flexible muscles are not as easily injured as tight muscles. Tightness of muscles connected to the knee can also pull the knee out of alignment.

When doing stretching knee exercises, be careful to go slowly and not to overstretch. You do not want to tear a muscle.

You need to increase the duration of your knee exercises gradually to avoid overuse injuries and knee pain. Be patient. You will see results.

Strength must be built up gradually. When muscles, tendons or ligaments are stressed slightly beyond their limits, microscopic tears occur. This is normal, and as these tears heal the muscles actually become bigger, firmer and stronger. These microscopic tears must be given adequate time to heal or chronic problems can develop. Try not to exercise the same muscle groups two days in a row to give your body a chance to recover. Doing strengthening knee exercises three or four times a week is enough. Stretching knee exercises can be done more often.

The goal is to prevent injury and knee pain, not cause it.
Don’t ignore pain. Pain is your body’s way of protecting you from hurting yourself further. It is not unusual to experience mild stiffness and aching of the muscles that lasts up to a day after exercising. But hardly being able to move for a few days after exercising means you have overdone it. It’s difficult to know when to quit when you doing knee exercises. Often, the pain doesn’t’ set in until a day or two later. It happens. If it does, you will have a greater understanding of your body’s limitations.

When you have overdone your knee exercises.
Rest is important for inflamed muscles/tendons. Applying ice wrapped in a cloth can help reduce inflammation and pain and speed up healing. See Treatment for Overuse Injuries. Knee pain should be completely gone before fully resuming your knee exercises program, however, lightly exercising the sore muscle may help decrease muscle soreness.

If you are currently experiencing knee pain and/or have a very limited range of motion, or are not sure which knee exercises are safe for you to do, see a physical therapist (physiotherapist). A doctor or physical therapist can assess your condition and give you a customized treatment / exercise plan.

Main Muscle Groups Affecting Knee Stability

Several muscle groups support the knee. The two main muscle groups that control knee movement and stability are the quadriceps and the hamstrings.

THE QUADRICEPS is a four-part powerful muscle that run along the front of the thigh and attach to the front of the shinbone, just below the knee. The quadriceps control the straightening of the knees and movement of the kneecap. The quadriceps is used to extend the leg, and is essential for standing up, walking upstairs, walking uphill, and running.

THE HAMSTRINGS are muscles that run make up the back of the thigh, and attach to the back of the shinbone, just below the knee. The hamstrings are used to bend the knee and are also needed when you are pushing against something.

Other Muscles Affecting Knee Stability
Other muscles that affect knee stability, to a lesser degree than the quadriceps and hamstrings are the calf muscles, the hip abductors located on the outer thigh, and the hip adductors located on the inner thigh. The body functions as a unit (remember – the hip bone’s connected to the knee bone) and even muscles not near the knee can contribute to knee stability.

The iliotibial band (fibrous tissue on the outer thigh, extending front the hip to below the knee) also affects knee stability. The glutes (back of hip muscles / buttocks) inserts into the thigh bone and iliotibial band and also help stabilize the knee.

*It is important to do strengthening exercises for all the muscles that support the knee. For example, if you concentrate on strengthening exercises for the quads, and neglect strengthening exercises for the hamstrings a muscle imbalance can be created.

Imbalances in Muscles Supporting the Knee
A physical therapist (physiotherapist) can help determine if you have a muscle imbalance in the muscles supporting the knee and create a personalized exercise program.

Imbalance of the quadriceps is common, especially in women – The quadriceps is divided into 4 divisions. If the inner division if weak, the stronger outer division tends to pull the kneecap toward the outer side of the leg. Tightness of the quads can also pull the knee towards one side so stretching as well as strengthening of muscles that support the knee is important.

In some cases, the quadriceps is significantly stronger than the hamstrings. (The quadriceps should only be about 25% stronger than the hamstrings). This can cause weakness of the knee. If this is the case, concentrating on strengthening exercises for the hamstrings, and stretching exercises for the quadriceps are very helpful.

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Knee Exercises
*NOTE: Only do one exercise per muscle group on the same day. There are several exercises to choose from for some muscles.

Strengthening Knee Exercises
Warming up with 5 minutes of low-impact aerobics, such as walking or riding a stationary exercise bike, increases blood supply to the muscles to help prevent injury and stiffness.

Quadriceps Strengthening
Quad Strengthening Contractions:
Sit in chair. Extend legs, heels to floor. Keep knees straight (or as straight as possible if you have arthritis.) Tighten thigh muscles. Hold for count of 10. Relax for count of 3. Do 10 repetitions. You can do this several times throughout the day. You can build up to 2 or 3 sets of 10 repetitions at a time.

Quad Strengthening Leg lifts:
Lie flat on back. Bend left knee at 90-degree angle, keeping foot flat on floor. Keeping the right leg straight, slowly lift it to the height of the left knee. Hold for a count of 3. Repeat 10 times. Switch sides. Work up to 10 sets of 10 over several weeks.

Safety Tip:
Leg lifts: Lifting both legs at the same time causes excessive stress on your lower back so
only lift one leg at a time; the opposite leg should be kept slightly bent with foot on floor.

Quad Strengthening Short-Arc Leg Extensions:
Sit or lie on floor. Place a rolled up towel under your thigh for support. Keep you leg straight and raise your foot about six inches off the floor. Hold for 5 seconds. Slowly lower your foot, bending your knee. Do 10 repetitions. Switch sides.

Quad Strengthening Knee Dips:
Stand with knees slightly flexed. Point your toes straight ahead.
Make sure your kneecaps are also pointed straight ahead.
Lift one leg up and balance on the other leg. Slowly lower yourself up and down ONLY a few inches. Keep the knee of the leg you are balancing on slightly flexed. Your knees must remain pointing straight forward. Do not let them turn inward. Stand straight, do not lean you body to one side. Do 10 dips. Switch sides.
If you feel pain in your knees, start with fewer dips.

Quad Strengthening Partial Squats:
Double leg partial squat: Stand. Keep Back Upright. Knees pointing straight ahead – inline with feet and hips. Slowly lower yourself. Don’t bend your knees beyond a 90-degree angle, if 90 degrees is too difficult bend even less.

Safety Tip: Make sure your knees do not extend beyond your toes when doing partial squats. Keeping your weight behind your knees reduces the pressure on the knee joint during the squat. Bending the knees beyond 90 degrees (a right angle) places excessive strain on the knee.

Hamstring Strengthening
Hamstring Strengthening Contractions:
Sit in chair, heels on floor. Don’t move heels but pull back on them. You will feel tension in you hamstrings. Hold for count of 10. Relax for count of 3. Do 10 repetitions.

Hamstring Strengthening Curls:
Lie on stomach. Place left foot onto the back of the right heel. Slowly pull your right heel toward your buttocks – resisting with the left leg. This contracts the hamstrings. Hold for a count of 10. (Keep pressing your left foot and right heel against each other) Hold for a count of ten and relax for count of 3. Do 10 repetitions.

Walking backwards helps to develop the hamstrings. When walking backwards, your weight is distributed more evenly, resulting in less strain on your knees.

Other Strengthening Exercises for Knee Stability

Hip Adductors (Inner Thigh) / groin muscle and inner quad muscle (VMO) Strengthening:
Sit in chair, put fist between knees, squeeze together knees. Hold for count of 10. Relax for count of 3. Do 10 repetitions.

Lie on floor on your right side, shoulder and hips aligned. Use your right hand to prop up your head. Place the left hand on floor in front of you to help balance yourself. Bend left leg and bring it to the floor in front of you. Slowly raise your right leg about 10 inches off the floor then, hold for a second, then slowly lower leg to ground. Lift 10 times on each side.

Hip Abductors (Outer Thigh) strengthening:
Lie on floor on your right side, shoulder and hips aligned.
Bend right leg (leg on floor) to 90 degrees.
Slowly raise you left leg about 18 inches, hold for a second, then slowly lower leg.
Do 10 repetitions. Repeat on other side.

Glutes Strengthening Backward leg swing:
Hold onto back of chair for support. Swing leg back at a diagonal until you feel your buttocks tighten. Tense muscles as much as you can and swing leg back a couple more inches. Return leg to floor. Repeat 10 times.
Switch sides.Do 10 repetitions. Repeat on other side.

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Balancing Knee Exercises
(helps in knee stability)
Hold onto back of chair or counter top for support. Stand on one leg for one minute. Switch sides.

As your balance improves, use one hand only for support. Next use one finger only for support, then progress to letting go, but keeping your hands within a couple of inches above chair in case you lose your balance. Do not lean your trunk to one side.

To increase difficulty, shift weight onto the ball of the foot.

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Stretching Knee Exercises
No bouncing, slow & controlled fashion, 5-10 minutes aerobics warm up first (e.g. walking, stationary bike) Muscles warmed up are more responsive to stretches and less likely to tear.

Calf Muscles Stretch:
Step back with left, forward with right, lean forward with hips. Do not roll foot out to side. Keep heel flat, foot forward. Bend knees for alternate stretch. Hold 30 – 60 seconds.

Quad Muscle Stretch:
Bring heel to hip with hand. Keep knees together. Do not arch back. Do not leg go to side.
Hold for 30 seconds. Repeat on other side.

Hamstring Stretch:
Standing position
Keep one leg on ground; put one foot on chair with leg straight. Bend forward at the hip. Do not attempt to touch your toes as this will stretch your back, and the goal of this exercise is to isolate your hamstring muscles in the leg that is being supported by the chair.

Sitting in chair hamstring: Straighten one leg, keeping heel on floor. Lean forward at hips, keeping back straight. Don’t try to touch your toes. Hold for 30 seconds. Repeat on other side.

Iliotibial Band Stretch:

Standing position:
Stand up. Cross right leg behind left leg moving crossing knee beyond the midline of the body. Lean from the hips to the left, the stretch being felt on your right hip, side of the leg and knee. Hold for 30 seconds. Repeat on other side.

Sitting position: Sit in chair: Bring right foot to outside of left leg, bringing knee towards opposite shoulder so that the knee crosses the midline of the body. Hold for 30 seconds. Repeat on other side.

Hip Adductors (Inner Thigh) Stretch:
Standing: Step off to the side with the right leg. Then lean away from the leg (bending your left knee)

Sitting position: Sit on floor, spread legs into a v position. Slowly lean forward from your hips, keeping your back straight, until you feel the stretch. Do not bounce. Then lean towards the right, foot then left foot. Hold each position for 30 seconds.

Hip Abductors (Outer Thigh) Stretch:
Sit on the floor,legs extended in front of you.
Bend right leg and place right foot on floor on outside the left knee.
Twist upper body to right and use left elbow to gently push against outside of right nee until you feel a gentle stretch in the right hips, buttocks, and lower back.
Hold for 30 seconds. Repeat on other side.

Hip flexors (front of hips) Stretch:
Tightness in these muscles can affect the alignment of the knee bones.
Standing Exercise: Step forward with the right leg, bending right knee. Keep back upright. This stretches the front of the hip on the left side. Keep left knee slightly bent also.
Hold for 30 seconds. Repeat on other side.

Gluteal Stretch (back of hips / buttocks):
Stand in front of chair, about two feet away from chair. Place left foot on chair, leg bent. Bring your chest towards your knee, keeping back straight. Hold for 30 seconds. Repeat on other side.

*Of all the above knee exercises, the quadriceps strengthening contraction is probably the easiest, safest and most important exercise you can do to prevent knee pain and injury. Those who have trouble fitting in exercises into their schedule can always do this exercise while watching television.

Knee-Safe Aerobics. Low-impact exercises with minimal risk to the knee joint.

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