Patellar Tendonitis: Recovery Time & Tips from a Physio

What is meant by tendonitis/tendinopathy?

Tendonitis is a term used in everyday language to refer to pain and other symptoms occurring in various tendons throughout the body. We have more than 600 of them!

A tendon is:

• a fibrous band;
• that connects a muscle to a bone;
• very resistant to tension.

Tendons can tear, become inflamed, or get damaged.

The tendons of the knees are among the tendons that are most prone to damage (Abat 2017).

In medical terms, when tendons cause pain, discomfort, or injury, we use:

• Tendinopathy: to refer to tendon pain without specifying the specific pathology;
• Tendonitis: an inflammatory reaction that accompanies tendon injury. This is actually rare;
• Tendinosis: tendon pain with damaged tendons (degenerative state) with few or no inflammatory cells.

But this doesn’t change much in everyday life. Therefore, I will sometimes use the term “tendonitis” instead of “tendinopathy” or “tendinosis” in the rest of this article because it is more widely understood.

Source: Charnoff 2022

Some people look for information about “knee ligament tendonitis” or “meniscus tendonitis of the knee.” It is likely that these individuals are seeking information about pain they feel in these areas.

However, in the case of tendonitis/tendinopathy, it is always the tendon that is affected, and the meniscus or ligaments are not tendons.

What type of tendonitis are we talking about in the knee?

There are several tendons located in and around the knee. Therefore, theoretically, any of them can be the site of tendonitis/tendinopathy.

Research teams and healthcare professionals have given names to the various types of knee tendinopathies based on their location or the mechanism of their occurrence.

So, I will list the main knee tendinitis categorized by healthcare professionals. But each time, I will also try to list the terms that patients commonly use for the same issue, based on the most frequently typed keywords in search engines.

The location of the pain is just one element among many others that help establish a diagnosis. It’s possible to experience pain in one area while having a damaged tendon elsewhere, or another structure may be involved.

This way, you should be able to better navigate the information!

Finally, I will provide details on the recovery time for patellar tendonitis.

Patellar Tendonitis: Jumper’s Knee

Patellar tendonitis, also known as patellar tendinopathy, is the most common tendinopathy of the knee (Millar 2021).

It affects the patellar tendon, which connects the kneecap/patella to the tibia below the knee and in front. It is also one of the terminations of the quadriceps.

English speakers also call it Jumper’s Knee because it often occurs in individuals engaged in activities that involve frequent jumping, such as basketball, volleyball, etc.

Pes Anserinus Tendinitis

The pes anserinus is the name given to a part of the body located under the knee, on the inner side. It’s where three tendons come together, forming a goose’s foot, hence its name:

1. Tendon of the sartorius muscle,
2. Tendon of the gracilis muscle,
3. Tendon of the semitendinosus muscle.

These three tendons are especially engaged when bending the knee and turning it inward.

Another expression commonly used to refer to this tendinitis, based on my research: “knee inner tendonitis.“

Quadriceps Tendonitis, Quadriceps Tendinopathy

The quadriceps is the muscle at the front of the thigh. It is connected to the kneecap by a tendon: the quadriceps tendon, located just above the knee.

This tendon can be damaged or inflamed, leading to quadriceps tendinosis or tendonitis.

People who use the term “thigh knee tendonitis” are probably referring to this type of tendinopathy.

Popliteal Tendonitis

At the back of the knee, there is a relatively unknown muscle: the popliteal muscle.

It inserts at the tibia, under the condyles, under the knee, at the back.

People who use the terms “back of the knee tendonitis” or “calf knee tendonitis” are probably referring to this type of tendinopathy.

People generally know about popliteal cyst more than popliteal tendonitis. A popliteal cyst is another type of problem, but it is usually easy to differentiate between the two.

Hamstring Tendonitis of the Knee

The hamstring is the muscle located at the back of the thigh. It breaks down into three bundles: semitendinosus (1 tendon towards the knee), biceps femoris (1 tendon towards the knee), semimembranosus (3 tendons towards the knee).

At the knee, the hamstring ends in several tendons:

1. A tendon we’ve already discussed: the tendon of the semitendinosus muscle, involved in the case of pes anserinus tendinitis.
2. 4 other tendons that can be affected (individually or together) when talking about “hamstring tendonitis”:
   • The tendon of the biceps femoris muscle. The biceps femoris inserts at the bottom and outside of the knee, at the head of the fibula, one of the two leg bones. When talking about “outside knee tendonitis,” it probably refers to an issue with this tendon, the biceps femoris, or to iliotibial band tendonitis.
   • The 3 tendons of the semimembranosus muscle. Sometimes referred to as “semimembranosus tendonitis.”

Iliotibial Band Tendonitis / Iliotibial Band Syndrome

The iliotibial band is a fibrous membrane that surrounds and envelops the muscles of the thigh, while the iliotibial band is a narrow structure that extends from the iliac bone (at the hip) to the tibia (at the knee).

When you have “iliotibial band tendonitis,” you generally feel discomfort on the outer part of the knee.

It is also called the “windshield wiper syndrome”: the iliotibial band rubs against the lateral condyle of the femur during knee flexion and extension movements. This friction resembles the movement of a car’s windshield wiper.

⭐ Summary: Several tendons around the knee can be damaged or inflamed, although it is more often the patellar tendon (below the knee) that is affected. In this case, it is referred to as tendinopathy/tendonitis.

How to determine the recovery of knee tendonitis?

Here are 3 ways to know the average recovery time for knee tendonitis/tendinopathy:

1. Ask people you know around you how long it took for the pain to go away. Since it’s a fairly common condition, you’re likely to know one or more people who have had it before.
2. Ask healthcare professionals (physical therapists, doctors, pharmacists) for their opinion on the duration of recovery. Since they see many people with health problems, they might have a more precise idea as they have access to a broader sample.
3. Look at statistics on the timeline of recovery in studies that follow individuals with knee tendinopathy for an extended period.

Personally, I prefer to rely on this third option when such data is available. I find it to be the most reliable:

• It provides access to the largest number of people.
• It is the most methodical in collecting information and trying to be as reliable as possible.

That’s why in the rest of the article, I will rely on data from clinical studies, in addition to my own professional experience.

What is the recovery time for knee tendonitis?

Before looking at the progress of people with specific knee problems, here are general data on the time it takes for a tendon (any tendon) to heal, to be repaired.

What is the healing time for a tendon?

The process occurs in 3 overlapping phases:

Phase	Approximate Duration
Inflammation	48 hours
Proliferation	7 to 21 days
Remodeling	Begins 1 month after the initial injury and can last up to 12 months

This is highly theoretical data, more applicable to a sudden tendon injury (in the case of rupture) than to a gradual onset injury, as is the case with tendinosis or tendonitis.

However, it still illustrates that it takes several months for a tendon to heal properly.

Regardless of the treatment implemented, it should not be surprising that it takes time (even though we would prefer things to be different!).

Nevertheless, it’s entirely possible to have a tendon that is not fully healed and still experience no pain or resume physical activities. The healing state of the tendon and the pain or discomfort felt are two different things.

Hence the importance of looking more specifically at what happens to people diagnosed with knee tendonitis!

Moreover, moving and tensioning the tendon is a factor that can facilitate its healing. Here’s what the research team I rely on for the previous table says on this matter:

The goal of treatment is to identify the minimal amount of movement to promote healing and attachment to neighboring tissues while avoiding jeopardizing the repair site.

Chartier et al. 2021

How long do the pain and discomfort of patellar tendonitis last?

I bet that when you wonder, “How long will it take for my tendon to heal,” you’re actually asking, “How long until I can do everything as before: walking, sports, etc.” or “How long until I have no more pain.”

Here are the scientific publications I have identified to better answer this question. I will then provide a more concise answer on the expected “healing time.”

Reference	Type of Tendinopathy	Key Findings
Ogon 2017	Chronic patellar tendinitis in 30 individuals aged 18 to 49, competitive athletes, treated with arthroscopic surgery	Resumption of sports took an average of 4 ± 3.2 months. Athletes should refrain from sports for at least 3 months after arthroscopic release of the patella.
Cook 1997 (cited by Muiadi 2020)	100 athletes with patellar tendinitis	2/3 were able to resume sports within 6 months after the onset of symptoms.
Silva 2015	Patellar tendinitis lasting over 9 months in a volleyball player, following an 8-week supervised rehabilitation protocol	The volleyball player continued to practice, including in competitions. After the rehabilitation protocol, he had no symptoms related to tendinopathy even during sports practice.
Kettunen 2002 (cited by Muiadi 2020)	20 high-level athletes with patellar tendinopathy	50% had to give up high-level sports.
Bahr 2014 (cited by Muiadi 2020)	Athletes with patellar tendinopathy	Only 46% of athletes were able to regain full pain-free activity after 12 months of supervised rehabilitation.
Breda 2021	58 individuals (average age: 24) suffering from patellar tendinopathy for an average of 2 years, underwent a month of self-rehabilitation with various exercises	43% of patients and 27% of patients in each group were able to resume sports within 6 months following rehabilitation.

Some classify tendinopathies into 4 stages (Leadbetter 1992):

Stage I: Pain that quickly regresses after exertion. The duration is brief, less than two weeks.

Stage II: Pain present for two to six weeks persisting after exertion. Clinical examination, especially palpation, reproduces the pain.

Stage III: Pain persists for several days after exertion and lasts for more than six weeks. It appears with the first sports movements and significantly limits functional capacities.

Stage IV: Permanent pain preventing any sports activity.

One criterion for operating on people with tendinitis is that there is no improvement in pain and discomfort for at least 3 consecutive months.

⭐ Summary: Patellar tendonitis or tendinopathy lasts a minimum of 2 weeks and does not necessarily prevent sports participation. However, it is quite common for symptoms to last for several months or even years. Pain is not a formal contraindication to sports; a balance must be found.

Can the healing time of patellar tendonitis be accelerated?

Wondering how to speed up the healing time of tendinopathy is akin to considering treatments for patellar tendinopathies (an article on this topic will be forthcoming).

Typically, conservative treatment is initiated, which may include one or more of the following options:

Globally, the idea is to:

1️⃣ Modify the quantity and type of physical activity practiced. It’s important to avoid complete cessation of activities, as it can further reduce the tendon’s load capacity.

2️⃣ Reduce the volume and frequency of training.

3️⃣ Eliminate activities such as running and jumping.

4️⃣ Perform specific muscle strengthening exercises: isometric exercises where the quadriceps or hamstrings are contracted without bending or straightening the joints, in a static position.

5️⃣ Understand that pain is not necessarily synonymous with harm, and that some pain during rehabilitation or sports is acceptable.

6️⃣ (Long-standing priority) Introduce more demanding muscle strengthening exercises, possibly adding weight in addition to body weight gradually, eccentrically.

OR

6️⃣ (Increasingly favored) Gradually load the entire lower limb (pain below 3/10) + strengthen the gluteal muscles.

8️⃣ Gradually reintroduce more demanding sports activities.

Physical therapists are among the professionals who can assist you if you want to implement this type of rehabilitation and feel the need for supervision.

Can you walk with patellar tendinitis?

Yes, you can absolutely walk with knee tendinitis, regardless of its stage.

Walking does not worsen tendinitis. You just need to find the right balance: reduce the amount of daily or weekly walking if you feel it worsens the pain, but don’t stop it altogether.

Then gradually increase the amount of walking, the intensity of the sessions, and their duration.

Physical therapists are among the professionals who can help you implement this if you’re having difficulty doing it on your own!