Patellar tendinitis, also known as jumper’s knee is a common knee injury we see at REP Physio. In fact, it is one of the most common injuries in sport. Jumper’s knee is an injury that affects the tendon that attaches the knee cap to the anterior shin bone (tibia). Jumper’s knee is an overuse injury. Athletes in jumping sports (basketball and volleyball especially) can sometimes put ecxessive repetitive loads on their patellar tendon, which can lead to tendon irritation, inflammation (tendinitis) and eventual tissue break down (tendinosis). At REP Physio in Edmonton, we typically see jumper’s knee in teenage/pediatric populations. Generally speaking the clinical presentation includes subjective complaints of front of your knee pain at or below the kneecap that is made worse by jumping, knee bending and/or running/sprinting. An MRI (magnetic resonance imaging) or diagnostic ultrasound is not required for a diagnosis. Typically, a jumper’s knee diagnosis can be made clinically with a orthopedic physical exam. The tissue surrounding or below the patella may be swollen and/or the patellar tendon may be painful to touch. If left untreated, the acute inflammatory phase may give rise to patellar tendinopathy, where there is a change in the quality and orientation of the fibers that make up the patellar tendon. This can result in increased irritability and lack of capacity for loading. Often this can result in a prolonged recovery. Risk factors for jumpers knee include a rapid increase in activity and/or a volume of activity greater than 12 hours per week. Basketball and volleyball players (jumping sports) are also at greater risk for jumper’s knee.
Load Management and Strengthening Exercises for Jumper’s Knee (Patellar Tendonitis) Recovery
Strengthening exercises play a key role in the management of jumper’s knee. In fact, strengthening exercises and physical activity are considered to be the foundation of recovery for jumper’s knee (more on this in a moment).
However, first and foremost, the foundation for recovery for jumper’s knee should being with a discussion on load management. Even the best rehabilitation plans will have limited success if the overall volume of activity is not addressed. Signs that a young athlete is doing too much include moderate to severe pain with activity (a little pain does not mean damage, and the pain should always be tolerable to the athlete). Second, if the pain with activity persists greater than an hour, or is worse that evening, or lasts greater than 24 hours, then the amount of activity needs to be reduced. Lastly, when it comes to load management a simple guide for parents is that your child should not compete in organized sport for more hours in a week than their age in years. For example, a 12 year old should only being playing basketball for no more than 12 hours per week.
At REP Physio, every pediatric athlete’s recovery and exercise plan is unique to their specifc needs. This starts with a thorough physical assessment and understanding of their goals and needs. Appropriate strengthening exercises are critical in the management of any type of tendon disorder, including jumper’s knee. While the exercises may hurt at the start, it does not mean they are doing damage, but rather that the tissues around your knee are sensitized. Typical exercise programs can include body weight or weighted exercises that address the quadriceps (thigh muscles) , hamstring (back of thigh) and glutes. Some examples include a squat, a seated knee curl/knee extension exercise, single leg Bulgarian split squats, walking lunges, etc. with very specific parameters. Concentric (where the muscle is shortening), and/or eccentric (where the muscle is lengthening under load) exercises can be included when appropriate. Sometime if the injury is very painful, an isometric exercise (where the muscle and tendon is under load, but the length of the muscle stays the same throughout the entirety of the exercise, such as a wall sit) is provided. In some cases a combination of both eccentric and concentric strengthening (a heavy slow resistance or HSR) protocol can be provided. Again, the specific exercises selected and protocols (reps, sets, rest etc.) will be determined by your physiotherapist and will be based on the latest research evidence. What is certain, an active approach to the management of jumper’s knee is medically essential. This is exactly what REP Physio does. We provide an active, client centered care approach that puts you at the centre of your recovery. Jumper’s knee is not condition that will improve with passive approaches such as hot pack and TENS machine. Don’t worry, we don’t do that at REP.. Generally speaking a corticosteroid injection is not recommended in the management of jumper’s knee (or any tendon injury) as it has been shown to lead to weakening of the tendon and potential rupture. Said differently conservative treatment (physical therapy based, non-surgical, no injections) leads to excellent results.
A Treatment Plan and Pain Management Options for Patellar Tendon Pain
Some simple pain management tips for jumper’s knee include:
- Decreasing overall volume of activity and demand on the knee extensors (quadriceps)
- Applying heat and/or ice to the affected area to relieve pain
- Consider pain relievers (speak to your MD or pharmacist about medications)
- Modifying activities and ranges of motion of the knee as tolerated
- Committing to a strengthening program to improve tissue capacity
- Ensure you are getting adequate rest and recovery between episodes of activity
- The use of a jumper’s knee and/or patellar tendon brace/strap to help support the knee
- Being aware of lifestyle factors that can play a role in pain such as stress, sleep quality, medications, diet etc.
- Following a training program that progressively increases load over time as appropriate that allows for successful return to sport
- In some cases, radial shockwave therapy may be appropriate for chronic achilles and patellar tendon pain or tendinopathies in general
- Speak to your physical therapist at REP Physio to learn more about knee issues and their management for pediatric athletes
When to seek medical help and rehabilitation for patella pain
Jumper’s knee, patellar tendinopathy, patellar tendinosis etc. are all typical overuse injuries. When your patellar tendon pain is preventing your from participating in sport and/or affecting your overall quality of life, it is time to see the experienced physiotherapists at REP Physio. It is important to note that any knee injury that involves an audible “pop” or “tearing” sound or sensation, followed by swelling within 24 hours, as well as an inability to bear weight and/or continue on with activity should be seen to immediately to rule out any internal injury to the knee (ACL, meniscus tear, tibial plateau fracture, MCL injury etc.) that may require surgery. A patellar tendon tear, including complete tears to the patellar tendon, which typically result from a hyperflexion injury (think hyperflexing your knees by landing forcefully on your heels with your buttocks) should also be seen to urgently to allow for the best possible outcome. Typically an MRI and/or diagnostic ultrasound along coupled with clinical findings can diagnose a complete patellar tendon (or quadriceps tendon rupture). Signs of a complete tear to either the patellar or quadriceps tendon include the inability to straighten your knee, swelling and bruising following a traumatic event, and a knee cap that is sitting noticeable higher or lower than the unaffected side. Fortunately, these types of injuries are relatively rare compared to jumper’s knee and surgery for patellar tendon complete tears are necessary.
Conclusion
A well thought out training and progressive conditioning program for jumping athletes can go a long way to help prevent patellar tendon pain and keep your knee functioning well for the long term. Remember, proper load management is essential for a positive prognosis for jumper’s knee, and to prevent knee injury in general. If you have further questions about jumper’s knee treatment, the patellar tendon, or physical therapy in general, please do not hesitate to contact us at REP Physio in Edmonton.
