All athletes will have an injury at some point in their careers. Learning how to manage these injuries is important to returning to athletic competition—understanding of the cause of the injury, the effect the injury can have on an athlete, and the necessary treatment will speed up an athlete’s return to competition at their pre-injury level.

Patellar tendonitis is inflammation of the patellar tendon, which connects the quadriceps to the tibial tuberosity. Such inflammation of a tendon typically occurs from repetitive overuse.

There are many causes of patellar tendonitis in weightlifters. Overtraining in the form of frequency, duration and intensity can cause this injury. Very often our mentality of no pain, no gain will cause us to push through this type injury and make an often minor problem far worse.

Most often, beginning weightlifters obtain this injury because of rapidly increased volume and lack of conditioning for the Olympic lifts. The force experienced by the knees during all the squatting movements—especially when the knees are past the toes as they generally are in the Olympic squat—can cause strain on the patellar tendon beyond what the body can cope with within the athlete’s training schedule.

Another cause is tightness of the quadriceps—because of the load at the bottom position of the clean and the snatch, any decreased muscle length will place undo stress on the patellar tendon.

Weakness of any of the four quadriceps muscles, especially the vastus medialis oblique, can cause compensatory stress on the patellar tendon.

Finally, weakness in the gluteals and hip external rotators forces the quadriceps to work harder, again placing more stress on the patellar tendon.

The effects this injury can have on those training in the Olympic lifts are multiple. First of all, it will most likely limit progress because of the volume of training will need to be decreased along with the frequency; depth may be limited at bottom position of the snatch and the clean; and the speed when bouncing out of the bottom of the squat will be reduced. Lingering effects are pain and swelling, which can lead to further injuries including, but not limited to, a patellar tendon tear, meniscal injuries, bursitis, osteoarthritis, and ligamentous sprain or tear.

Treatment for this injury include ice, stretching, friction massage, rest, strengthening to the weak muscles identified, taping, and bracing. In the acute stage (2 days or less), it is important to calm down the inflammation by icing 3-5 times each day. Ice massage using frozen water in a Dixie cup can be performed over the painful area for 5 minutes, or an ice pack can be placed on the area for 10-15 minutes. This should be done for 10 days to 2 weeks on a consistent basis even if the pain and tenderness have resolved. Stretching of the quadriceps can be initiated lightly when inflammation calms down and is not causing pain. The quadriceps stretch should be performed in a standing position by grabbing your foot and pulling your heel to buttocks, making sure your knees are close together. Hold this stretch for 30-60 seconds, repeat twice, 4 times daily.

Friction massage is a technique performed to increase blood flow and break down scar tissue in the inflamed patellar tendon. Essentially this technique is performed by massaging your index and middle finger over the painful area of the patellar tendon for 5 minutes, then followed up by icing. You should be instructed in this by a manual orthopedic physical therapist prior to initiating so the correct technique is performed. A rest period from training until the injury is resolved is recommended, although many athletes can continue to perform without stopping. Eventually, however, the injury may catch up with you and force you to rest.

Taping and bracing are ways to alleviate the stress on the patellar tendon. Taping should be performed or instructed by a physical therapist or athletic trainer. There are many over-the-counter patellar tendon braces. I have found the Cho-pat knee strap to be the most effective. Physical therapy can offer many modalities including ultrasound, iontophoresis, and electrical stimulation, but I believe the most effective of all is manual therapy—which includes deep and transverse friction massage.

Lower impact activities including cycling, open chain exercises, and a gradual progression to weight bearing activities will ease your return to training. Many weightlifters make the decision to return to full training instead of using a more gradual return. This can usually be attributed simply to impatience. You must be patient when returning from patellar tendonitis or the injury will take longer to heal, and you’ll risk injuring other structures that will put you out of action for extended periods. Rule of thumb: if the knee hurts while performing Olympic lifting movements, you need to stop or temporarily modify your training until the pain can be resolved. With that said, being a former athlete, competition is what we train for, therefore you must make the choice of risking further injury or reward of competition. Keeping up with a regular maintenance of ice and stretching and proper rest will both improve performance and decrease the chance of future injury.