Physiotherapy in painful conditions of the patellar tendon

Patelarna tendinopatija ili skakačko koljeno nazivi su za sindrom prenaprezanja karakteriziran patološkim promjenama i oštrom boli na distalnom dijelu ekstenzornog mehanizma koljena, točnije na patelarnoj tetivi i njezinom hvatištu na vršku patele ili na tuberositas tibije. U početnoj fazi skakačkog koljena dolazi do zadebljanja tetive i upalnog procesa, a ako se na vrijeme ne liječi dolazi do mikroruptura i degenerativnih promjena. Funkcionalna nesposobnost povezana je s intenzitetom boli i kreće od lagane nesposobnosti do potpune nemogućnosti sudjelovanja u sportskim i svakodnevnim aktivnostima. Patelarna tendinopatija prvenstveno se dijagnosticira bolnošću na palpaciju vrška patele ili tuberositasa tibije. Obično ne postoje pridružena ligamentarna ili meniskalna oštećenja. Za precizniju dijagnozu zbog svoje dostupnosti i jeftinoće najčešće se koristi ultrazvuk. Prilikom analize pojavnosti patelarne tendinopatije, ali i prevencije, vrlo je važno poznavati čimbenike rizika koji povećavaju vjerojatnost nastanka tog sindroma. Neki od njih su anatomska odstupanja donjeg dijela tijela, mišićno-tetivna neravnoteža u fleksibilnosti i snazi mišića natkoljenice, tvrda podloga i neprimjerena sportska obuća. Liječenje sindroma prenaprezanja sustava za kretanje najčešće je konzervativno. Za rehabilitaciju se najčešće koriste ekscentrične vježbe, kod kojih dolazi do produljenja mišićnih vlakana, a s druge strane najviše kontrolirano opterećuju tetivno tkivo. Od ostalih terapijskih postupaka može se koristiti krio-/termoterapija, ovisno o stadiju bolesti, kako bi se smanjio upalni proces, odnosno potaknuo proces cijeljenja tetive. Liječnička se pomoć najčešće traži kasno, kad bol već u velikoj mjeri ometa sportsku ili profesionalnu aktivnost. U tom slučaju liječenje je otežano i zasniva se ponajprije na kraćem ili duljem prekidu ili znatnom smanjenju intenziteta sportske ili profesionalne aktivnosti. Ako nakon dužeg vremena nema poboljšanja odnosno smanjenja boli, ide se na kirurško liječenje koje je kod sindroma prenaprezanja pa tako i kod patelarne tendinopatije uvijek zadnja opcija. Međutim bez kvalitetne postoperativne rehabilitacije ono neće dati zadovoljavajuće rezultate.Patellar tendinopathy or jumper's knee is the name for an overuse injury characterized by pathological changes and sharp pain that occur on the distal part of the extensor mechanism of the knee, more precisely on the patellar tendon and its origin on the apex of the patella or its insertion to the tibial tuberosity. In the beginning stages of jumper's knee, the patellar tendon thickens and the inflammatory response begins. If the condition is not treated on time, microruptures and degenerative changes occur. Functional disability is correlated to pain intensity and can range from a slight incapacity to perform tasks to complete inability to participate in sports and everyday activities. Patellar tendinopathy is primarily diagnosed by pain from palpation on the apex of the patella or on the tibial tuberosity. Usually no associated ligamentary or meniscal lesions are present. For a more precise diagnosis, sonography is mostly used due to its low cost and general availability. While analizing the incidence rate of patellar tendinopathy and its prevention measures, it is crucial to know about risk factors that increase the likelihood of developing the condition. Some of the risk factors include anatomical malalignments of the lower extremity, musculotendinous imbalances in flexibility and strength of the thigh muscles, training on hard surfaces and inadequate sports shoes. Treatment of overuse injuries is mostly conservative. Rehabilitation of patellar tendinopathy usually includes eccentric exercises, in which the muscle fibers lengthen and are the best way to load the tendon in a controlled environment. Other therapeutic procedures include cryotherapy and thermotherapy, depending on the stage of the condition, to reduce the inflammatory response or stimulate the healing process of the tendon respectively. People typically ask for medical assistance too late, when the pain already impedes with their sports or professional activities. In that case, treatment is hindered and is consisting mostly of either a short or long term break, or a significant reduction in intensity regarding sports and professional activities. If after a longer time period no improvements or reduction in pain level occur, the patient will undergo a surgical procedure, which in overuse injuries and therefore also in patellar tendinopathy should always be the used as the last resort. However, without a good postoperative rehabilitation, surgery will not give satisfactory results