Effective pain management for patellar tendonitis: What runners should know
Pain is often the biggest obstacle to recovering from patellar tendonitis, which is why effective pain management is key to successful recovery.
Many people either ignore their pain and push through it or fear pain and avoid it at all costs. Unfortunately, neither of these approaches is optimal for healing. The key is to find a balance between these two extremes.
Patellar tendonitis pain management relies on two crucial aspects:
This article covers both, so you can confidently manage your patellar tendonitis pain, progress with your recovery, and get back to running
Using pain to guide you through rehab
First, why does your tendon hurt?
With patellar tendonitis, your tendon becomes sensitive and loses some strength, which explains why activities that used to be pain-free now hurt.
But, as mentioned earlier, pain is your inner alarm system. And, the more often you trigger it (by doing activities that are too high level for your tendon’s current strength), the “louder” the alarm sounds out, and the easier it triggers.
Does pain always mean injury?
Not all pain means something is wrong. MRI studies have shown that people often have pain long after their injury has healed, which means that pain can be present even in the absence of injury.
So, besides an injury, many factors can affect how often and how loud your "pain alarm" sounds. For example:
- Feeling pain for longer than 3 months (this can make your tendon more sensitive and quick to sound the alarm)
- High stress and anxiety levels and low mood (reduces your pain tolerance)
- Reduced activity levels (increases your pain sensitivity)
Even though pain doesn't always mean harm, you shouldn't ignore it. Instead, learn to use it as a guide to helping you stay safe during rehab.
How to use pain as a guide for patellar tendonitis recovery
Some pain is OK, but how much?
Know that some pain is normal and expected during your rehab and recovery. During your exercises or after a session, it is usually OK to feel pain if:
- It's less than 3/10 (0 = no pain; 10 = intense pain), AND
- it settles back to your baseline within a few hours after your session, AND
- doesn't increase your baseline symptoms the next day (24-hour response).
What if pain increases beyond these ranges?
If something hurts more than you expected, it's important to back off, assess what may have caused it, and adjust your activity accordingly.
To manage patellar tendon pain effectively, you should:
A pain management strategy for patellar tendonitis
There are several ways to help temporarily calm your patellar tendon pain, but no single approach will be effective for everyone.
A good pain management strategy usually involves a combination of modalities and techniques. In that way, you can target pain in different ways and maximize your chances of finding relief.
Of course, some methods are also more effective than others. Knowing this will help you know where to start.
Common pain management modalities and techniques for patellar tendonitis include:
What is relative rest?
Relative rest means temporarily reducing activities that excessively load your patellar tendon and avoiding activities that aggravate your tendon pain so it can have time to repair.
You can do this in various ways, including:
- Scaling back sporting activities involving running and jumping
- Reducing everyday activities that load your patellar tendon, such as kneeling, stair climbing, and squatting
Patellar tendons work quite hard during all these activities. And when injured, they don’t have the same strength and endurance to tolerate these higher-load activities. That’s why continuing to do activities at your pre-injury levels can worsen your pain.
How long will you need to rest?
The length of time your need to reduce your activity levels for depends on your unique injury. For example, some people only need a few days away from aggravating activities, while others need weeks to months.
Why not complete rest?
Maintaining some activity level is crucial for patellar tendonitis recovery because complete rest can lead to your tendon losing even more strength - further contributing to your patellar tendon pain. Complete rest is, therefore, only recommended in severe cases and for short periods to prevent strength losses.
Patellar tendon straps (or taping)
Do patellar tendon straps and taping work?
Patellar tendon straps and tape may help reduce your pain during rehab exercises and sports, but you shouldn't use them alone to treat patellar tendon pain. Instead, use them alongside a graded strength training program to support your patellar tendon while you work on strengthening it.
How do patellar tendon straps work?
Researchers say that patellar tendon straps can help reduce patellar tendon pain by:
- Holding the kneecap in a more favorable position, reducing excessive pulling on the tendon
- Changing the tendon angle, redirecting the force away from the painful area
- Improving knee proprioception (joint position sense), helping optimize your movement
Although these theories are promising, the research is inconclusive, so they may work for some, and not for others.
If you’re considering using a patellar tendon strap for your pain, be sure it's
- Comfortable: Snug but not too tight
- Fitted correctly: Over the lower edge of your kneecap, with the padded portion resting on the tendon
- Adjustable: Be able to loosen or tighten as needed for comfort
Shockwave therapy may help reduce pain and stiffness associated with patellar tendonitis, but the evidence shows mixed results overall. As a result, it's best to use it in special cases only.
For instance, if your pain keeps you from staying active or doing rehab exercises, shockwave therapy may help reduce your pain to help you get back to activity and progress your recovery. But, if you can exercise, there's evidence that shockwave therapy will likely not be more beneficial for your pain than doing tendon loading rehab exercises.
Consult a doctor or physical therapist if you want to know if this option is for you.
There is little evidence supporting massage for pain relief, but many people find it helpful. This may be because massage reduces anxiety and depression (low mood), which improves your sense of physical and emotional well-being. And since your emotions and beliefs affect your pain perception, massage may help reduce your pain.
Remember that massage only provides temporary pain relief and doesn't change the structure of your tendon. The most effective way to restore your tendon's strength so you can heal from patellar tendonitis is by following a structured exercise-based rehabilitation plan.
If you use massage to complement your recovery, as a precaution, you should avoid using vigorous massage techniques over the tendon itself. It can irritate your patellar tendon injury and may increase your pain.
Isometric exercises cause your muscles to contract without moving your joints and can help provide immediate relief from patellar tendon pain while keeping you active and maintaining muscle strength.
Studies show they work by reducing your pain perception on a cortical (brain) level, meaning the exercise "turns down the volume" on pain signals from your patellar tendon, making you experience less pain.
A common isometric exercise for patellar tendonitis pain relief is the isometric squat.
How to do an isometric squat:
- Place your feet far enough from the wall, so your knees stay behind your toes when you slide down the wall.
- Your feet should be hip-width apart.
- Slide down the wall, stopping before your knees reach a 30-degree angle.
- Ensure that your knees stay in line with the middle of your feet and do not turn in.
- Aim to build up to holding the position for 45 seconds, but don't force it. If you find it hard, do what you can and add a few seconds as you get stronger.
- Rest for 2 minutes.
- Repeat 3 times.
If your knee hurts during or after this exercise, hold the squat for a shorter time or start at a higher position.
The isometric squat is a good starter exercise, but to restore the full strength in your tendon, you have to progress them to include more dynamic exercises and weights. You can read more about squat exercise progressions in our patellar tendonitis exercises article.
Icing during your recovery
Athletes often use ice as part of the PRICE regime (Protect, Rest, Ice, Compression, Elevation) for controlling pain and swelling in new injuries, but you can also use it during rehab to manage pain as you recover.
You should only use ice when necessary because it can reduce your strength gains if used too regularly. One way to ensure you're not overdoing the icing is monitoring how often you need to use it.
Using ice after exercise
If you need ice to control pain after every workout or exercise, you may be working at a too high level. In that case, instead of continuing to use ice to ease your pain, reassess your exercise level, adjust it, and test to see if your pain improves.
Using ice before exercise
It's also best to avoid icing before exercise. Some studies show icing slows down your nerve and muscle responses. As a result, it leads to reduced balance, proprioception (joint position sense), and muscle strength, which can increase your risk of worsening your injury or developing a new one.
Extra guidelines for using ice safely
- Protect your skin: Place a wet towel or cloth between your skin and the ice
- Apply it for the right amount of time: 10min on - 10min off - 10min on again
- Don't use ice if you have poor circulation, loss of sensation, or an open wound in that area
You may come across electrotherapies such as ultrasound, laser therapy, and electrical stimulation as potential treatments for patellar tendonitis. But, the evidence for their effectiveness is poor, so they're not considered first-line treatments for patellar tendonitis.
What about NSAIDs?
Although NSAIDs (non-steroidal anti-inflammatory drugs) can reduce pain, they can delay tendon healing. So, avoid them or use them cautiously and only as directed by your healthcare provider.
You can read more about how NSAIDs affect your healing in this article, where we discuss it in more detail.
Which pain relief strategies are best to use and when?
We advise using strategies backed by the best evidence and that work best for you
Successful recovery from patellar tendonitis relies on effective pain management. This depends on selecting the right pain relief strategies and knowing how to use pain as a guide through your rehab. Changing your mindset around pain will also ensure you stay on track with your rehabilitation program and help you get back to running pain-free.