Knee Pain: Tendinitis or Tendinosis?

Whether you are a serious competitive athlete, weekend warrior or participate in sports recreationally, chances are you’ve experienced some sort of knee pain. Annually, knee pain results in over 1 million trips to the ER and nearly twice that in visits to primary care providers. Patellar tendon overuse injuries are a common culprit in many of these cases, particularly for individuals who run, play high-impact sports (basketball, volleyball, tennis) or have physically demanding jobs.

Common diagnoses you might hear from your physician include: Patellar Tendinopathy, Patellar Tendonitis and Tendinosis affecting the front of the knee joint.

So what is the difference between them?

  • Tendinopathy is an umbrella term that means a disease of the tendon, and can refer to either tendinitis or tendinosis.
  • Tendonitis is an acute injury, involving an active inflammatory process. If treated properly, symptoms can improve and heal within 3-6 weeks.
  • Tendinosis refers to a chronically overused tendon with microtrauma and physical degenerative changes to the tendon. Symptoms may last up to 6 months.

What is the best course of action to treat these injuries?

 Early diagnosis by a medical professional is important, as treatment may vary depending on your activity level and specific diagnosis. Don’t allow weeks to pass thinking that it will “get better on its own”, particularly if the pain is getting worse or not improving.

  • Depending in the severity or acuity of the injury, activity level should be modified to avoid additional injury to tissues. “Playing through the pain” will only delay healing and return to activity.
  • Early application of ice to a painful knee can be very beneficial in reducing pain levels and controlling any inflammation that may be present

What is the role of Physical Therapy?

Physical therapy is important in reducing pain and permitting a safe return to normal activities.  Individuals experiencing knee pain may resort to compensatory movement patterns with walking, stairs and other daily tasks.  This creates muscle imbalances and heightens the risk for further injury to the affected knee and to other joints above and below the knee as well. Physical therapy will help to identify and correct these improper movement patterns in order to reduce pain and facilitate a safe resumption of daily activities and return to sport.

Additionally, your physical therapist will help you determine what activities and/or exercises are safe to promote healing and prevent reoccurrence.

General guidelines for treatment of patellar tendonitis/tendinosis

Acute tendonitis

–       Inflammation control is essential to decrease pain and to progress with activities.

–       Strengthening of surrounding muscles

–       Relative rest from use of affected area


–       Gradual progression of eccentric strengthening (muscle lengthening) in pain free ranges

–       Strengthening of supporting and stabilizing muscles

–       Dynamic and static stretching

Examples of exercises to maintain proper muscle function and control while protecting your knee include:

Quad setting

Heel slides

SLR 4 way

Make sure all exercises are done in pain free ranges. If you experience pain, stop or reduce the intensity of the exercise.  Check out the video below for demonstration of how to perform the exercises above.

Check out CPMC Sports Wellness for more information on injury prevention and fitness tips.


–        Chronic Tendiopathy . Marsha Rutland et al. North American Journal of Sports Physical Therapy, Vol 5, N3, September 2010, pg 166-178

–        Comparing the effects of eccentric training with eccentric training and static stretching exercises in treatment of patellar tendinopathy. A controlled Clinical Trial. Stasinopoulos Dimitrios, et al.  Clinical Rehabil DOI: 10.1177/0269215511411114. downloaded from at Samuel Merrit Univ 2011

–        Risk Factors for Patellar Tendinopathy in Basketball and Volleyball players: a cross sectional study. H. Van der Worp, M. van Ark, J. Zwerver, I. van den Akker-Scheek. Scand J. Med Sci Sport 2011 1-8


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