Jumper Knees

(Patellar Tendonitis)

Jumper’s knee is characterized by pain at base of the patella or kneecap. It is often an overuse injury.  This occurs in sports such as basketball which require lots of running cutting, and jumping.

Symptoms

• Pain at the bottom and front of the kneecap especially when pressing in or palpating
• Aching and stiffness after exertion.
• Pain when you contract the quadriceps muscles.
• The affected tendon may appear larger than the unaffected side.
• May be associated with poor VMO (medial quad muscle) function
• Calf weakness may be present

Jumpers knee can be categorized into four grades of injury:

• Grade 1: Pain only after training
• Grade 2: Pain before and after training but pain eases once warmed-up
• Grade 3: Pain during training which limits your performance
• Grade 4: Pain during every day activities

This injury may seem like a niggling injury.  Many athletes continue to train and compete on it as it may not be a debilitating injury and recovers after a short period of rest. Make sure to treat this condition before it becomes chronic.  If it becomes chronic it can be very difficult to treat and may require surgery.

Treatment

• Apply cold therapy on a regular basis, especially after any form of exercise.
• Wear a knee support, or jumper’s knee strap to reduce pain and ease the strain on the tendon.
• See a sports injury specialist who can apply sports massage techniques to the tendon and advise on a rehabilitation program.
• Eccentric strengthening is usually recommended.
• If the knee does not respond to conservative treatment, surgery may be required.
• Treatment of patellar tendinopathy is slow and may require a number of months of rehabilitation in order to notice a decrease in aggravating symptoms. This may include several months of rest.
• Receiving ultrasound, cross friction massage, and rehab exercises from a professional can also help

Reducing pain and inflammation

• Rest from all aggravating activities. If you have knee pain during every day activities then expect to rest from training for several weeks. If you only have a little pain after training then modifying training methods (less impact / jumping) for a while may be sufficient.
• Apply cold therapy or ice for 15 minutes every hour if it is bad, at least three times a day otherwise.
• NSAID's (Non Steroidal Anti-inflamatory) e.g. Ibuprofen may help in the early stages.  
• Wear a heat retainer or knee support.  This will protect the tendon and allow it to heal, especially if you have to be on your feet.

Stretching Exercises

• Gentle stretching is important as soon as pain will allow. Exercises to stretch the quadriceps muscles are particularly important. Hold stretches for around 10 seconds and repeat 5 times. Aim to stretch at least 5 times a day.
• Later in the rehabilitation process stretches should be held for longer.
• Stretching should continue long after the injury has healed to avoid reoccurrence.
• In addition to the quadriceps muscles it is important to stretch the hamstrings, calf muscles and IT Band as well.

Strengthening Exercises

• Strengthening should begin as soon as possible provided it is pain free.
• Progressive 'eccentric' quadriceps exercises are particularly important in rehabilitation of patella tendinopathy.  (example – downward phase of a squat)  Strengthening of the calf muscles and hamstring group of muscles is also very important.
• Strengthening exercises should always be done within a range of movement that is pain free
• Apply cold therapy / ice after exercises to prevent inflammation.
• A problem that many athletes have when coming back from this type of injury is that they have been deliberately putting weight on the good leg and so have developed abnormal movement patterns. This in itself can lead to further injuries and imbalances. Athletes should be aware of this danger when returning from injury.
• Be patient! It may take between 6 and 12 months to return to full fitness following a grade 4 injury.

Return to full fitness

• This can begin when you have a pain free full range of movement, no swelling, good strength - i.e. you can comfortably manage single leg eccentric squat strength training exercises without pain.
• A gradual running program should be started. For example jog 2 minutes, walk 2 minutes, repeat 5 times.
• When you can comfortably jog for 10 minutes pain free then begin striding and sprinting repetitions - initially at 50% of maximum speed and build up.
• As the intensity and speed increases pain may result from the tendon. This is often a natural part of the rehabilitation process, however if symptoms do not improve again within a day or so you will need to reduce the workload.
• It is essential that specific eccentric strengthening exercises are continued throughout the rehabilitation process and not stopped when sports specific training begins.