What is jumpers knee / patella tendonitis?
The patellar tendon / ligament joins the kneecap (patella) to the shin bone or tibia (video). This tendon is extremely strong and allows the quadriceps muscle group to straighten the leg. The quadriceps actively straighten the knee in jumping to propel the individual off the ground as well as functioning in stabilizing their landing.
As such this tendon comes under a large amount of stress especially in individuals who actively put extra strain on the knee joint such as those who regularly perform sports that involve direction changing and jumping movements. With repeated strain, micro-tears as well as collagen degeneration may occur as a result in the tendon.
This is known as patellar tendinopathy or Jumpers Knee. It should be distinguished from patella tendonitis as this latter condition indicates an inflammation of the tendon whereas tendinopathy is more about degeneration of the tendon. For the purpose of this article we have used the term patella tendonitis as well as tendinopathy but strictly speaking tendinopathy is usually the correct term.
What are the symptoms of jumpers knee / patella tendonitis?
- Pain at the bottom and front of the kneecap especially when pressing in or palpating (video).
- 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 Vastus medialis obliquus (VMO) function
- Calf weakness may be present
Click here for the VISA interactive questionnaire to assess how bad your jumper's knee is.
Warning!! - This injury may seem like a niggling injury that is not that bad. 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. However, neglect jumpers knee at your peril! If left to become chronic it can be very difficult to treat and may require surgery.
What can the athlete can do about patella tendinopathy?
This depends on the extent or grade of the injury:
Grade 1: Pain only after training
- Continue training but apply ice or cold therapy to the injury after each training session. Cold therapy can be applied by by ice massage or the use of ice packs. It is important the cold is applied at the point of pain on the tendon.
- Wear a heat retainer or support.
- See a sports injury specialist / therapist who can apply sports massage techniques and advise on rehabilitation. An eccentric strengthening programme is generally recommended.
Grade 2: Pain before and after exercise but pain reduces once warmed up.
- Modify training activities to reduce the load on the tendon. Stop jumping or sprinting activities and replace them with steady running or swimming / running in water if necessary.
- See a sports injury specialist / therapist who can apply sports massage techniques and advise on rehabilitation.
Grade 3: Pain during activity which prevents you from training / performing at your best.
- Rest completely from the aggravating activity. Replace it with swimming / running in water (if pain allows).
- See a sports injury specialist / therapist who can apply sports massage techniques and advise on rehabilitation.
Grade 4: Pain during every day activities which may or may not be getting worse.
- Rest for a long period of time (at least 3 months!).
- See a sports injury specialist / therapist who can apply sports massage techniques for patella tendonitis / tendinopathy and advise on rehabilitation.
- If the knee does not respond to rehabilitation then consult an Orthopaedic Surgeon as surgery may be required.
Treatment of patella tendinopathy / patella tendonitis
- Treatment of patellar tendonopathy 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.
- During rehabilitation the VISA questionnaire may be filled out to monitor the progress of the tendonopathy.
Two modes of treatment may be advised - conservative treatment and surgical treatment:
Conservative (non-surgical) Treatment of patella tendonitis / patella tendinopathy
This is normally advocated initially after diagnosis of patellar tendonopathy. Care must be taken so as to not overload the tendon. Treatment may involve:
- Quadriceps muscle strengthening program: in particular eccentric strengthening. These exercises involve working the muscles as they are lengthening and are thought to maximise tendinopathy recovery.
- Muscle strengthening of other weight bearing muscle groups, such as the calf muscles, may decrease the loading on the patellar tendon.
- Ice packs to reduce pain and inflammation.
- Massage therapy-Transverse (cross) friction techniques may be used.
- Aprotinin injections may help tendinopathies by restoring enzyme balance in the tendon.
Surgical Treatment of patella tendonitis / patella tendinopathy
This is normally advised as a last resort. Also, there is little convincing evidence to support the use of surgery over conservative treatment for patellar tendinopathy. Surgery either includes excision of the affected area of the tendon or a lateral release where small cuts are made at the sides of the tendon which take the pressure off the middle third.
An intensive rehabilitative program is normally advised following surgery. In particular the use of eccentric strengthening exercises may help stimulate healing.
A Sports Injury Specialist or Doctor may:
If the injury becomes chronic then surgery is an option. A lateral release of the patella tendon is usually successful.
Similar or related knee injuries that are sometimes confused with this injury include Patello femoral pain.
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