Rehabilitation of Jumpers Knee

The following guidelines are meant for information purposes only. Always seek professional advice before attempting any rehabilitation.

Aims of rehabilitation

At which stage of the rehabilitation process you start will depend on the extend or grade of the injury - click here if you are not sure.

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 two 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. Always consult a Doctor before taking medication. Ibuprofen must not be taken by asthmatics.
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

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 iliotibial band as well.

Strengthening

Strengthening should begin as soon as possible but pain free. Initially you may be only able to manage static contractions of the quadriceps muscles. Strengthening of the calf muscles and hamstring group of muscles is also very important.
Progressive 'eccentric' resistance exercises are particularly important in rehabilitation of patella tendinosis. This means exercises where the muscle is contracted but lengthening, for example the downwards phase of a squat involves the quadriceps muscles contracting but lengthening at the same time.
Strengthening exercises should always be done within a range of movement that is pain free. If you are causing more pain the chances are that you are making the injury worse.
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 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 programme 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.

Injury Prevention

Do not over-train! Performing too many high impact training act ivies will be too much for the tendon. Look out for the early signs of pain and inflammation after training and act. Do not wait until this injury becomes bad - there is a long rehabilitation period once the injury becomes worse.
Identify any biomechanical problems that may increase the risk for example over pronation of the foot, a loose kneecap or a tight iliotibial band. If you are not sure, see professional help and advice.
Use eccentric strengthening exercises to make the knee joint strong enough to cope with the demands of the sport. Continue these exercises long after the injury has healed. They should become part of your usual training routine.
Stretch the muscles (particularly quadriceps) properly and regularly.
Get a regular sports massage to keep muscles and tendons in good condition.

Stretching the quadricpes muscles