Patella Tendinopathy vs. Patellofemoral Pain Syndrome | Expert Physio Guide

In this tutorial, we discuss Patella Tendinopathy vs. Patellofemoral Pain Syndrome, highlighting the key differences of their clinical features and management.
References:
*Malliaras, Cook, Purdam, Rio, 2015: pubmed.ncbi.nlm.nih.gov/26390...
*Hott et al., 2019: pubmed.ncbi.nlm.nih.gov/30958...
*Breda et al., 2021: pubmed.ncbi.nlm.nih.gov/33219...
⭐Clinical Physio Videos of Interest:
*Patellofemoral Pain and Instability: • Patellofemoral Pain an...
*Quadriceps And Patella Tendon Rupture: • Quadriceps And Patella...
⭐For more sign up to Membership for more resources including access to:
*Patellofemoral Pain Course
*Knee Anatomy Course
*Knee Differential Diagnosis Webinar
*Tendinopathies On-Demand Webinar
⭐ WEBSITE: www.clinicalphysio.com
➡️ Here you can find all our best content including Live Webinars, On-Demand Webinars, Courses and More!!
⭐ MEMBERSHIP: member.clinicalphysio.com/mem...
➡️ Monthly subscription, cancel anytime, access to all our best content including Live Webinars, On-Demand Webinars, Courses and More!
⭐ INSTAGRAM: / clinicalphysio
➡️ For Daily Quizzes and Superb Content!
⭐ SUBSCRIBE TO OUR KZbin: / @clinicalphysio

[@digitalboomer]

Excellent information. Clear as a bell. Thanks!

[@ClinicalPhysio]

Glad it was helpful! Thank you for your kind words!

[@klopiu1234]

quality stuff! keep it up :)

[@ClinicalPhysio]

Thank you so much!

[@vasileiospetropoulos2046]

Amazing as always Eucharisto and parakalo

[@ClinicalPhysio]

Thank you so much!!

[@user-dt1vz4ce2w]

😄Greek

[@vasileiospetropoulos2046]

@@user-dt1vz4ce2w yes

[@charbeltt]

Hello, I'm uncertain if you'l come across this message, but I have a question I'd appreciate if you could address Firstly, thank you for providing such content and sharing your valuable knowledge. I've been experiencing pain in the back of my right knee for the past three weeks. The team physio advised a 7-day course of anti-inflammatory pills, which somewhat alleviated the back knee pain after 10 days. However, I started feeling discomfort in the knee next to the ligament. The physio mentioned that my patella had slightly shifted (Patellofemoral ayndrome)but assured me it's not a serious issue, and I should recover in about a month. I just came across your page and wanted to ask you if those symptoms are 100% patellofemoral syndrome? My knee doesn't click, but there's persistent pain on the inner side when I bend it, walk, or climb stairs.

[@danielelosiuba7580]

🔥🔥

[@ClinicalPhysio]

Thank you!

[@mikekis6731]

Very nice! :-) 😊

[@ClinicalPhysio]

Thank you so much!

[@pedrohenrique-bx4xw]

I think you absolutely can have both, i do, maybe the idea of not being able do having both makes harder for people that do have both to find a good protocol to overcome these two patologies

[@D00MMFF]

Thank you for the information,I fell on my knee about 5 months ago and still in pain…any advice would be great

[@ClinicalPhysio]

I would absolutely advise going to see a physiotherapist to try and get some help if you find that you are struggling

[@darlingly3130]

How do you feel?

[@themcdermottway6912]

Can patellar tendonitis also hurt when knees bent for a long time? All my symptoms and MRI point towards tendonitis but it only hurts/aggrevated when my knee is bent for an extended period.

[@ClinicalPhysio]

Classically this is more in keeping with PF pain… perhaps I would ask do you get any pain with running, jumping, explosive movements as these are commonly more consistent for patella tendinopathy?

[@themcdermottway6912]

@ClinicalPhysio I didn't get any pain until playing basketball after being inactive for many years. It's hard to say, as since the pain has started I have avoided any aggressive activities. I did play tennis 2 or 3 times with no patella pain recently tho.

[@felixb.59]

I found this in a study: HomeJournal of Orthopaedic & Sports Physical TherapyVol. 45, No. 11Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations Previous Article Next Article Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations RELATED EXAMS: Peter Malliaras, BPhysio (Hons), PhD, , BPhysio (Hons), PhD Jill Cook, PhD, , PhD Craig Purdam, MSportsPhysio, , MSportsPhysio Ebonie Rio, BPhysio (Hons), MSportsPhysio, PhD , BPhysio (Hons), MSportsPhysio, PhD AFFILIATIONS Journal of Orthopaedic & Sports Physical Therapy Published Online:October 31, 2015Volume45Issue11Pages887-898 www.jospt.org/doi/10.2519/jospt.2015.5987 ABOUT Abstract Synopsis The hallmark features of patellar tendinopathy are (1) pain localized to the inferior pole of the patella and (2) load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon. While imaging may assist in differential diagnosis, the diagnosis of patellar tendinopathy remains clinical, as asymptomatic tendon pathology may exist in people who have pain from other anterior knee sources. A thorough examination is required to diagnose patellar tendinopathy and contributing factors. Management of patellar tendinopathy should focus on progressively developing load tolerance of the tendon, the musculoskeletal unit, and the kinetic chain, as well as addressing key biomechanical and other risk factors. Rehabilitation can be slow and sometimes frustrating. This review aims to assist clinicians with key concepts related to examination, diagnosis, and management of patellar tendinopathy. Difficult clinical presentations (eg, highly irritable tendon, systemic comorbidities) as well as common pitfalls, such as unrealistic rehabilitation time frames and overreliance on passive treatments, are also discussed. J Orthop Sports Phys Ther 2015;45(11):887-898. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5987 Anterior knee pain in athletes can be caused by a number of anatomical structures. Patellar tendinopathy, one source of anterior knee pain, is most commonly characterized by pain localized to the inferior pole of the patella and load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon.33 Patellar tendinopathy is debilitating and can result in prolonged absence and potentially retirement from sports participation. Cook et al16 found that more than one third of athletes presenting for treatment for patellar tendinopathy were unable to return to sport within 6 months, and it has been reported that 53% of athletes with patellar tendinopathy were forced to retire from sport.52 Patellar tendinopathy is primarily a condition of relatively young (15-30 years old) athletes, especially men, who participate in sports such as basketball, volleyball, athletic jump events, tennis, and football, which require repetitive loading of the patellar tendon.57 The power needed for jumping, landing, cutting, and pivoting when participating in these sports requires the patellar tendon to repetitively store and release energy.2 Energy storage and release (similar to a spring) from the long tendons of the lower limb are key features for high performance while reducing the energy cost of human movements.2,76 Repetition of this spring-like activity over a single exercise session,51 or with insufficient rest to enable remodeling between sessions,81 can induce pathology and a change in the tendon's mechanical properties, which is a risk factor for developing symptoms.17,61 Energy-storage load is defined in this article as high tendon load, because it is associated with tendon injury. Although the relationship between pain and tendon pathology is unclear, the presence of pathology appears to be a risk factor for an individual becoming symptomatic.17,61 Thus, it is important for clinicians to have an appreciation of tendon pathology. Briefly, tendon pathology includes increases in tenocyte numbers and rounding, and in ground substance expression, causing swelling, matrix degradation, and neovascular ingrowth.53,58 These changes have been extensively reviewed elsewhere.1,19 The purpose of this commentary was to combine available evidence and expert opinion to guide clinicians in key elements of examination, diagnosis, and management of patellar tendinopathy, including advice for difficult presentations. Examination of Patellar Tendinopathy The first clinical challenge is to establish whether the tendon is the source of the patient's symptoms. Patellar tendinopathy, as one of many potential diagnoses producing anterior knee pain, has specific and defining hallmark clinical features32,55 that consist of (1) pain localized to the inferior pole of the patella11 and (2) load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon.57,77 ➡️Other signs and symptoms, such as pain with prolonged sitting, squatting, and stairs, may be present but are also features of patellofemoral pain (PFP) and potentially other pathologies.⬅️ Tendon pain occurs instantly with loading and usually ceases almost immediately when the load is removed.75 Pain is rarely experienced in a resting state.75 Pain may improve with repeated loading (the “warm-up” phenomenon),55,75 but there is often increased pain the day after energy-storage activities.75 Clinically, it is noted that dose-dependent pain is a key feature, and assessment should demonstrate that the pain increases as the magnitude or rate of application of the load on the tendon increases.55 For example, pain should increase when progressing from a shallow to a deeper squat, and from a smaller to a greater hop height.

[@22symoo]

thank

[@ClinicalPhysio]

You’re most welcome!

[@clinicalanatomyphysio]

Nice :) I have a video on patellar tendinopathy coming out next week ;)

[@SarahOnAir3]

My doctor told me that I have Patellofemoral Pain Syndrome, a touch of Patella Tendonitis, and IFP / Hoffa's fat pad... Not an athlete, got diagnosed at 27, I am 30 now and post surgery from subtotal inflamed fat pad removal, what do I do? :(

[@user-kq1tt8so7t]

I have Hoffa's Fat Pad Syndrome, and it's actually very painful. The fat pads on both of my knees are constantly swollen and always irritated. My physical therapist tells me it's because my knees go slightly inwards, which puts the wrong load on my knees. Therefore, I need to get special soles now, which will provide extra support under the gap in my foot so my knees won't bend as much inwards. I also need to train my legs and hips

[@ClinicalPhysio]

Wishing you all the best with it! Good luck!

[@blaschito1]

so if hip and knee exercises gave he same results that may tell how much of this is in the patient mind-set e.g. catastrophizing and fear avoidance especially in the sedentary population

[@ClinicalPhysio]

That’s a really interesting point! And kinesophobia is certainly a factor for these patients… so as you said, it might be that just getting moving is the first step for your patient if they are anxious about movement!

[@edward8691]

Is this video about difference between Patella tendonitis and Patellofemoral syndrome?

[@ClinicalPhysio]

Yes absolutely

[@marsee965]

How long does patellar femoral pain last? I think I have this from injury from bending, six months now I feel my patella was not tracking properly, when I activate my quad my patella clicks.

[@ClinicalPhysio]

I would absolutely suggest consulting someone officially so you can get most accurate advice to help you 🙏🏼 How long does it take? It can take any amount of time as needed to make the changes you may need to make, but there is every possibility it improves if you can make those changes!

[@marsee965]

@@ClinicalPhysio I have seen two orthos, did two weeks of pt which is probably not enough by have found time and rest have helped the most now I feel pressure towards the end of the day. Chondromalacia patella was told by one of the doctors from maltracking but this all started with the injury

[@Knowledgeflowz]

I believe I have both of these unfortunately

[@nick63837]

The commonly do not exist with eachother but can they?

[@ClinicalPhysio]

They can! But less common as you said

[@superskateboardingentertai9228]

Patellofemoral Pain Syndrome vs quadriceps tendon pain

[@ClinicalPhysio]

👍🏼

[@TheBrumbas49]

Can you have both problems at same time ?

[@ClinicalPhysio]

Hi! I suppose yes it is possible but less likely

[@TheBrumbas49]

@@ClinicalPhysio Okay Its just i saw a patient who have sorgens in his knee while driving but also palpation pain on the patella tendon. What schould it be then ?