Q: I'm not a super athlete but I do like to compete in several areas such as soccer, cross country, and tennis. I notice whenever it's soccer season, I seem to have the most problem with my patellar tendon. I keep tweaking it and it never heals all season long. This doesn't happen with any of the other sports I engage in. Can you help me figure out what I'm doing wrong?

A: Sports injuries command a lot of attention in the orthopedic world. Keeping athletes in tip top shape and in playing or competitive mode is a top priority for sports medicine specialists. Toward that end, researchers are trying to understand what causes tendon problems (called tendinopathies) in this group of individuals.

Sports athletes like you are often faced with chronic problems like this that they can't seem to rehab or exercise away. If we can understand how and why tendon disorders develop, then maybe we can prevent them from occurring in the first place.

If the idea is correct that repeated overload of the tendon is the underlying problem, then examining the way you move, your postural alignment, and your training techniques should help. It may be possible to find ways to prevent abnormal loads on the patellar tendon and thereby reduce your painful symptoms. Your coach, athletic trainer, or a sports physiotherapist can be consulted for help in this area. By observing the way you move on the field, an objectively trained individual may be able to see something that is contributing to the problem and could be easily changed or modified.

You can review the number of hours you are on the field practicing each week and see if that is a contributing factor. Patellar tendinopathy has been linked in other soccer players with a high number of hours and number of training sessions per week.

It has been suggested (but not proven yet) that overload deforms the tendon cells until they can no longer support the repeated stress of weight-bearing loads. Some experts think that the patellar tendon is getting compressed or pinched (called impingement) by the lower edge of the patella (kneecap) when you bend your knee. Again, postural and/or biomechanical factors such as muscle weakness leading to imbalance of muscle pull may be part of the problem.

The patellar tendon is also more susceptible to injuries when athletes train (especially running) on hard surfaces such as concrete (e.g., sidewalks). Any areas of decreased joint motion above or below the knee (hip, ankle) can contribute to the problem. Females seem to be at greater risk than males for patellar tendon disorders. There may be a hormonal factor but evidence suggests differences in the female anatomy also contribute.

Jonathan D. Rees, MSc,MRCP (UK), FFSEM (UK), et al. Management of Tendinopathy. In The American Journal of Sports Medicine. September 2009. Vol. 37. No. 9. Pp. 1855-1867.