Knee pain can be really annoying. Most people use their knees all day long, from getting out of bed, to walking to the kettle, to running the Boston Marathon! So if you suffer from knee pain, it can really get on your nerves!
Knee pain can be caused by a number of things such as ligament injuries, meniscus tears. But for now, we're going to have a look at tendinopathy (or "tendonitis" as it's more commonly known).
What is Tendinopathy?
Tendon's are the connective tissue in your body that connects your muscle to your bones, allowing the muscles to move them, like the strews to a door hinge, attaching the hinge to the wall, allowing it to open and close. The term "tendinopathy" just refers to an injury to the tendon. "Tendinitis" as it's more commonly know, suggests inflammation of the tendon, which is a little more specific... either way, if you've got tendonitis/tendinopathy, you're probably in pain!
It can be caused by a number of things, but in 99% of cases, it's an over load of the tendon through overuse. So thing's like going from a sofa surfer to training for an Ironman Triathlon... probably going to get tendinopathy somewhere, if not in your knees! There are a number of factors that can cause this, and they can be broken down into intrinsic and extrinsic factors:
Extrinsic causes of tendinopathy
- Training load: generally speaking, if training load is causing your tendon issues, it's probably that you've done too much too soon or you don't rest/recover well enough. If you are training too much, your connective tissues don't have time to repair between training sessions. Taking a step back back be frustrating to start with, but in the long term your results will be progressive rather than having to stop completely because of an overuse injury! If it's a lack of good quality rest or recovery, then the similar principles apply. If you're feeling fatigued and DOMS are really kicking in (mostly at your joints) then that's your body telling you that you need to take a chill pill and have some rest! There are loads of recovery methods out there such as cryotherapy, stretching/foam rolling/ LISS cardio... to name a few.
- Training surface: I have noticed this particularly this pre season (summer 2018) with footballers. With the continuous hot weather and limited rainfall, the ground has been extremely hard. Some players, particularly those with a history of patella tendinopathy, have reported an increase in knee pain. I'll go through a couple of things that might help below, but in this case, footwear and load management are really important while the ground is hard; and this applies to anyone who does a lot of road running. Your tendons absorb force applied through your body so with running, your knees are taking a lot of the force your body generates, repetitively over a workout. Stretching your quads, hamstrings and calves will help relieve any tightness that may add extra stress onto your tendons.
- Footwear: if you're training for any kind of endurance event and you're wearing "fashion" trainers such as Converse or Vans... go home, you're drunk! As I touched on above, your tendons store energy during movements such as running, walking and jumping. If you imagine a ball bouncing, when it lands, the ball squashing slightly before springing back up. This is kind of how your tendons work. When you land on one foot, as your knee bends your tendons store energy before springing back to extend your knee and stride forwards/jump up. If your footwear doesn't provide any support, it isn't absorbing any of the force... so that means your poor tendon's are taking all the grief! Get yourself some "fresh creps", as my little brother said to me the other day...!!
There are a lot more external factors that may contribute to your knee pain such as injury so it is important to remember each individual is different.
Intrinsic causes of tendinopathy
There are a number of intrinsic factors that maybe causing your tendon pain, however they will almost all relate to some kind of overload/overuse. Things like muscle imbalances, unilateral weaknesses and pre-injury can all contribute to putting added strain onto your joints. If you have injured one leg at some point relatively recently, let's take an ACL injury as an example, which is one of the ligaments inside the knee joint; you may have favoured your "good leg" to prevent walking on your injured leg (because it's painful). Because you're now walking with the majority of your weight on your good leg... instead of each knee taking 50% of your body's weight each... now one leg is taking say 75% and the other is taking 25%. This means your good one is doing 25% extra work, without any extra training. A bit like doing 100 miles a week in your Fiat 500... to 125 miles a week. Although it may only seem like a small increase straight away, thats an extra 25 miles a week... 100 miles a month... 1200 miles a year! Do you get my drift? So the extra work of your good knee may eventually be too much and cause issues down the line.
This is the same principle with tightness/weakness. If you have weak or tight hamstrings, your posture may change meaning natural loads are a lot different. This in turn leads to additional loads being placed on structures, the same was as I explained above with injuries. You must try and keep everything level and balanced in order to remain injury free.
There are more intrinsic factors that may contribute to your tendon injury such as the menopause, stress, poor ankle mobility and lack of sleep, so again remember each person is individual.
How to treat knee tendonitis?
1. As always with any injury, it's important to treat the acute condition first. As explained here, cryotherapy or ice will reduce inflammation caused by injury. This compression device from Amazon will compress your knee while icing it. This reduces swelling in two ways which has scientifically been proven to improve recovery.
2. As mentioned, de-loading the tendon allows it to recover so that you can begin rehabilitati