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What Is Patellar Tendinopathy?

Wolves guard Anthony Edwards recently returned to action following a prolonged bout with the condition.

Oklahoma City Thunder v Minnesota Timberwolves Photo by David Sherman/NBAE via Getty Images

Antony Edwards left knee pain wasn’t anything new. He had been dealing with it — it being patellar tendinopathy — for a large portion of the season, but recently the pain became too much to bear.

“It’s something that you can play through,” the Minnesota Timberwolves guard told Chris Hine of the Minneapolis Star Tribune following Wednesday night’s 132-102 win over the Oklahoma City Thunder. “Certain people can play through it, but if you don’t have a certain tolerance for pain, you can’t play through that.”

Edwards’ pain caused him to miss the four games prior to Wednesday when he returned to score 16 points in 25 minutes. However, while he displayed signs of the vertical burst and lateral movement we’ve come to expect from the former No. 1 overall pick, many of his jump shots landed short, an indication that his knee may not be back to 100% quite yet.

And, frankly, it may not get to 100% until after the season concludes. Such is often the case with patellar tendinopathy, a condition that requires the proper mixture of rest and activity to treat effectively.

WHAT IS PATELLAR TENDINOPATHY, EXACTLY?

“Tendinopathy” is an umbrella term covering a spectrum of injuries from tendinitis to tendinosis. The -opathy suffix is derived from the Greek pathos and defines a disease or disorder. So, the literal definition of “tendinopathy” is “a disease/disorder of the tendon,” which makes the condition sound more serious than it is.

The -itis suffix implies that inflammation is present at the injury site whereas the -osis suffix implies that the condition is more chronic in nature and often lacks a true inflammatory process (i.e. the inflammation has already come and gone). If we want to be technical, the condition that Edwards is most likely suffering from would be patellar tendinosis as his condition has been present for a prolonged period of time.

The “patellar” portion of the injury is in reference to the patellar tendon, one of two thick bands of tissue that connect the quadriceps muscle group of the thigh to the tibia (i.e. shin bone). The patella (i.e. kneecap) is located inside of the quadriceps and patellar tendons, with the quadriceps tendon attaching directly to the muscle for which it is named and top of the patella while the patellar attaches to the bottom and tibia.

The knee (credit: Johns Hopkins)
https://www.hopkinsmedicine.org/health/conditions-and-diseases/patellar-tendonitis-jumpers-knee

Tendons are composed primarily of a substance known as collagen, which provides the elasticity and strength of tendinous tissue. In a healthy tendon, the collagen fibers are often tightly packed together and run parallel to one another, not unlike raw spaghetti noodles in a box. However, in tendinopathy, the collagen fibers break down, arrange themselves further apart, and become jumbled. (To extend the analogy, tendinopathic tissue resembles cooked spaghetti noodles in a strainer.)

This process can happen for a variety of reasons, but the most common is with overuse (i.e. repetitive bouts of running, jumping, etc. without sufficient amounts of rest in between (i.e. playing NBA basketball)). “Overuse” is a nebulous term, but in short, these types of injuries occur when the cells within the body that are responsible for building up tissue are not able to keep pace with the external processes that break down tissue. The end result is relatively degraded tissue.

…WHOA. OK, SO HOW IS IT TREATED?

There are a variety of treatments that can help reduce pain and improve the quality of the tendinous tissue. Perhaps the most important is active rest. No, that is not a typo. Active rest is the process of reducing an athlete’s relative workload (i.e. giving them days off, cutting down on workout intensity, etc.) but not discontinuing activity altogether (i.e. passive rest). This allows the tissue the opportunity to heal and for the pain to subside while keeping the muscles and tissues working.

Another important component of the recovery process is exposing the tendinous tissue to targeted, heavy loading (i.e. heavy weight training). This accomplishes three things: 1. It assists in realigning the tendon’s fibers, 2. It stimulates the cells within the tendon, which promotes healing, and 3. It strengthens the muscles surrounding the tendon, which helps redistribute the force placed on the tendon during activity.

Other treatments may include massage, dry needling, and blood-flow restriction therapy, all of which promote healing.

WHAT DOES ALL THIS MEAN FOR EDWARDS?

The good news is that patellar tendinopathy is very common and very treatable. The key for the Wolves training staff is to find the right balance of activity, rest, and treatment techniques.

The less than ideal news is that the condition can be tricky to treat. Each case of tendinopathy is unique and treatment plans can vary wildly between individuals based on a number of factors, such as pain, relative strength levels, and chronicity.

Regardless, until Edwards’ schedule allows for enough time for prolonged active rest, it is unlikely that his condition will completely resolve, though it’s not impossible. If he is able to withstand the pain, he will continue to be able to get on the court.