Ask any runner who's dealt with patellar tendonitis, and they'll likely tell you the same thing: It's much easier to prevent patellar tendonitis than treat it.
Patellar tendonitis is a complex condition to treat because there's no single cause, and multiple factors can often contribute to it. These factors can be intrinsic (within your body) or extrinsic (outside your body); some you can control, and others you can't.
To prevent patellar tendonitis, you first need to know these risk factors. So, let's start by looking at the most common risk factors and which ones are within your control.
Intrinsic risk factors
Intrinsic risk factors originate from within your body and impact patellar tendon load. The most common include:
Kinetic chain disturbances (from strength and flexibility issues)
Your kinetic chain refers to how your body’s bones, joints, muscles, and tendons align and work together to move you. When any part of this system doesn't line up correctly or function optimally, it can throw your biomechanics off and increase the strain on your patellar tendon.
Strength imbalances and flexibility issues are the main reasons for your kinetic chain to be disturbed.
For example, muscle strength imbalances (when some muscles are stronger than others) in your hips and legs can change how you move and lead to uneven forces passing through your patellar tendon.
A lack of flexibility can also cause kinetic chain problems, impacting your patellar tendon. For example, evidence suggests that reduced quadriceps and hamstrings flexibility and ankle joint mobility can increase your risk of developing patellar tendonitis.
As you age, your tendons naturally change. For example, they become thinner, can’t store as much water, and lose some elasticity and strength. Healing also takes a little longer because your circulation slows down naturally with age.
All these changes can increase your risk of developing patellar tendonitis, so addressing or adapting to these changes is crucial. More on this later.
Research shows that genes determine your athletic performance, how your body responds to its environment, and what causes you to become injured. Your genetics also control your metabolism and ability to heal.
Extrinsic risk factors impact your tendon from the outside and are considered the most common causes of patellar tendonitis. The most common extrinsic factors are:
The way you structure your training can lead to tendon overload and injury.
These include aspects such as:
Poor form during training and workouts or a running style that overloads the front of your knee can increase the strain on your patellar tendon and cause injury.
Wearing shoes that don’t provide the right type of support for your foot and ankle can impact your body alignment and add extra load to your patellar tendon.
Hard or uneven training surfaces
Running on harder or uneven surfaces can increase the forces going through your knee and, in turn, your patellar tendon.
Now that you know the main risk factors, the big question is: Which ones can you control?
Which risk factors can you control?
Great news! You can control almost all these factors. The exceptions are your age and genetics. But just because you can't change these factors doesn't mean you're destined to develop patellar tendonitis. There are ways to work around them. Here’s how.
Preventing patellar tendonitis as you age
While you can't change your age, there are things you can do to help reduce the impact of aging on your tendons and keep them safe from injuries.
An important thing to note is that age-related changes in the musculoskeletal system are generally due to inactivity rather than simply getting older. So, by being a runner, you can already consider yourself ahead of the game in preventing age-related patellar tendonitis.
As you age, you may need to take a few extra steps to support your tendon health, considering the natural changes happening in your tissues. These steps include:
- Focusing on good nutrition: Various nutrients such as proteins, amino acids (leucine, arginine, glutamine), vitamins C and D, manganese, copper, zinc, and phytochemicals can help improve tendon growth, healing, and recovery (you can get all these through a balanced diet, so speak to a doctor or dietician if you need advice on this)
- Having healthy lifestyle habits: Avoiding alcohol (and other toxins), getting enough sleep, and keeping hydrated can improve your ability to heal and recover after exercise
These simple strategies can help improve your tendon health regardless of age, but they become more crucial as you age.
Genetics and preventing patellar tendonitis
The research in this area is limited. So when it comes to genetics and tendon injuries, it’s best to be mindful of any inherited conditions you or your family have and become really good at understanding how your body responds to exercise.
If you're a seasoned runner, you've likely already learned what your body can handle and what it can't. However, if you're new to exercise or have a family history of tendonitis, it's important to take things slowly and gradually increase your activity level, allowing enough recovery time between training sessions.
Now, considering all this, let's look at some practical tips for preventing patellar tendonitis.
3 Proven tips to prevent patellar tendonitis
Tip 1: Don't ramp up your running volume too quickly
Your tendon needs time to grow stronger in response to training. Increasing your running volume too quickly means that your tendon may not be strong enough yet to take on that load. As a result, it can become overloaded and develop tendonitis.
What you can do:
Tip 2: Make rest, recovery, and variety a part of your routine
Rest and recovery are essential for tendon healing, repair, and growth. If you give your tendon enough time to recover after exercise, you can help prevent patellar tendonitis.
This doesn't mean you must take complete days off from all activity, but make sure to schedule enough rest time, easy days, and cross-training into your routine.
What you can do:
Tip 3: Optimize your kinetic chain
Any area in your kinetic chain that is out of balance or not working well can predispose you to injury.
To prevent patellar tendonitis, you need good alignment, muscle strength, flexibility, and joint range of motion to keep excess strain off your patellar tendon.
While you don't have to be super flexible or strong, some studies show that not having enough muscle flexibility and range of motion in certain areas can put you at a greater risk of developing patellar tendonitis.
The way you move can also impact the amount of load passing through your patellar tendon.
What you can do:
The Exakt Health app's prevention plan covers all of these elements (strength, flexibility, control). We’ve also included advice to help you understand and manage the other areas of injury prevention, such as scheduling training and recovery methods.
Patellar tendonitis is a common injury among runners of all ages and levels. The good news is that there are things you can do to prevent it.
In this article, we highlighted the most common risk factors (from the research) and gave you our top 3 tips to prevent patellar tendonitis. To recap, we suggest you:
- Make sure you don't ramp up your running volume too quickly
- Always allow enough recovery time for your tendon to heal after workouts, training, or events
- Keep all the structures in your kinetic chain strong, flexible, and well-aligned
Our last suggestion is to be mindful that your age and genetics may also contribute to developing the condition. So try to find ways to work around these risk factors if they apply to you.
Patellar tendonitis doesn't have to derail your running goals. Understanding the risk factors and following the tips mentioned in this article can help you prevent the condition and keep you running injury-free for years to come.