Jumper's Knee

Jumper's Knee

WHAT IS PATELLAR TENDONITIS (Jumper's Knee)?

Patellar tendonitis, also called jumper's knee, is pain in the band of tissue (the patellar tendon) that connects the kneecap (patella) to the shin bone (tibia).

HOW DOES IT OCCUR?

The most common activity causing patellar tendonitis is too much jumping. Other repeated activities, such as running, walking, or bicycling may also lead to patellar tendonitis. All of these activities put repeated stress on the patellar tendon, causing it to become inflamed.

Patellar tendonitis can also happen to people who have problems with the way their hips, legs, knees, or feet are aligned. This alignment problem can result from having wide hips, being knock-kneed, or having feet with arches that collapse when you walk or run, a condition called overpronation.

Pronation is the inward (medial) roll of the foot and in particular the heel and arch which occurs naturally at the heel strike as a cushioning mechanism.

Overpronation is when the feet roll inward too much.

Supination, also known as underpronation, is the opposite to pronation where the feet don't roll inward enough. Wearing the wrong type of shoe will lead to painful shins and joints, or even injury.

How do I find out if I pronate?
It is easy to find out if you're a pronator or supinator - look at your trainers! A pronator's outer soles wear down along the inside of the ball of the foot and they tend to have flat feet.
The supinator's outer soles wear down along the outer edge and their feet tend to have high arches. Shoes are designed with features to control these problems.

WHAT ARE THE SYMPTOMS?

- pain and tenderness around the patellar tendon

- swelling in your knee joint, or swelling where the patellar tendon attached to the shin bone

- pain with jumping, running or walking, especially downhill or down stairs

- pain with bending or straightening the leg

- tenderness behind the kneecap

HOW IS IT DIAGNOSED?

Your doctor will examine your knee to see if you have tenderness at the patellar tendon. He or she will have you run, jump, or squat to see if this causes pain. Your feet will be examined to see if you have a problem with overpronation. X-rays may be taken of your knee.

HOW IS PATELLAR TENDONITIS TREATED??

In the early stages you should apply ice packs for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain goes away. Your doctor may prescribe anti-inflammatory medication. He or she may also prescribe a band to wear across the patellar tendon, (called an infra-patellar strap) or prescribe a special knee brace. The strap or brace will support your patellar tendon, preventing it from becoming over-used or painful. If you have a problem with overpronation, your doctor may prescribe custom made arch supports called orthotics. You will also be given rehabilitation exercises to help you return to your sport or activity. Also, while you are recovering, you will need to change your sport or activity to one which will not make your condition worse.

WHEN CAN I RETURN TO MY SPORT OR ACTIVITY?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined by how soon your knee recovers, not by how many days or weeks it has been since your injury occurred.

In general, the longer that you have symptoms before you start treatment, the longer it will take you to get better. You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

- Your injured knee can be fully straightened and bent without pain

- Your knee and leg have regained normal strength compared to the uninjured knee and leg

- Your knee is not swollen

- You are able to jog straight ahead without limping

- You are able to sprint straight ahead without limping

- You are able to do 45 degree cuts

- You are able to do 90 degree cuts

- You are able to do 20 yard figure-eight runs

- You are able to do 10 yard figure-eight runs

- You are able to jump on both legs without pain, and jump on the injured leg without pain

HOW CAN I PREVENT PATELLAR TENDONITIS?

Patellar tendonitis is usually caused by overuse during activities such as jumping or running. It can best be prevented by strengthening your thigh muscles.

PATELLAR TENDONITIS - REHABILITATION EXERCISES

You may start doing exercise 1 as soon as it is not too painful to move your kneecap. You can do the hamstring stretch (exercise 2) right away. When the pain in your knee has decreased, you can do the quadriceps stretch and start strengthening the thigh muscles using exercises 4 through 6.

1. PATELLAR MOBILITY - Sit with your injured leg outstretched in front of you and the muscles on top of your thigh relaxed. Take your index finger and thumb, and gently press your kneecap down toward your foot. Hold this position for 10 seconds. Return to the starting position. Next, pull your kneecap up toward your waist and hold it for 10 seconds. Return to the starting position. Then, try to gently push your kneecap inward toward your other leg, and hold it for 10 seconds. Repeat these for approximately 5 minutes.
2. HAMSTRING STRETCH - Stand with the heel of your injured leg resting on a stool that is about 15 inches high. Keep your knee straight. Gently lean forward from your hips, keeping your shoulders in line with your trunk, until you feel a stretch in the back of your thigh. Hold this position for 30 to 60 seconds. Return to the starting position. Do not round your shoulders or bring your head toward your toe, as this will only stretch your lower back and not your hamstrings. Repeat 3 times.
3. QUADRICEPS STRETCH - Stand an arm's length from a wall, facing straight ahead. Brace yourself by keeping the hand on the uninjured side against the wall. With your other hand, grasp the ankle of the injured leg and pull your heel up towards your buttocks. Do not arch or twist your back. Hold this position for 30 seconds. Repeat 3 times.
4. QUADRICEPS SET - Sit on the floor with your injured leg straight out in front of you. Try to tighten the muscles at the top of your thigh by pushing the back of your knee down into the floor. Concentrate your contraction on the inside part of your thigh. Hold this position for 5 seconds. Repeat 3 times. Do 3 sets of 10.
5. STRAIGHT LEG RAISE - Sit on the floor with your injured leg straight and your other leg bent, with your foot flat on the floor. Move the toes of your injured leg toward you as far as you can, while pressing the back of your knee down and tightening the muscles on the top of your thigh. Raise your leg 6-8 inches off the floor and hold for 5 seconds. Slowly lower it back to the floor. Repeat 20 times.
6. WEIGHT LIFTING (LEG EXTENSION) - Do these if you have access to a weight lifting bench with a leg extension attachment. Sit on the bench with the weight attachment in front of your lower legs. Extend your knees by straightening your legs. Be sure that your legs straighten completely. The last 15 degrees of extension are the most important. Use enough weight to cause fatigue, but not pain. Do three sets of 10.

Advanced Jumpers Knee Exercises