When the change occurs from a shortening to a lengthening activation, the tendon is stretched further as energy is absorbed resulting in the higher loading forces previously described. Repeated activity of this nature may lead to a decrease in collagen concentration and injury. The majority of athletes will describe continued participation but with increasing symptoms gradually leading to a decreased level of performance with increasing levels of pain. Patients often report that during heavier and more frequent training sessions, the pain is most acute during eccentric activity. We have found the subjective functional pattern presented in Table 1 to be quite useful in patient communication.
Evaluation is normally quite consistent.
Subjective data will point to the aforementioned slow, but somewhat progressive, process. Radiographs are within normal limits. Appropriate, careful clinical examination correlated to the subjective presentation normally will provide a definitive diagnosis. One major consistent objective finding is pain localized to the focal area of tendinous involvement. Most commonly, the patient will complain of pain with palpation of the patellar tendon at the insertion at the inferior patellar pole.