Rehabilitation program for Jumper's knee or patella tendonitis based on reducing pain and inflammation, stretching, strengthening and returning to full fitness.
The following guidelines are meant for information purposes only. Always seek professional advice before attempting any rehabilitation. Jumper's knee is graded 1 to 4 depending on how bad the injury is. The stage of the rehabilitation process you start at will depend on the grade of your injury.
Aim of jumper's knee rehab
- Reduce initial pain and inflammation.
- Stretch the quadriceps muscles.
- Strengthen the tendon and muscles.
- Gradual return to full fitness.
- Prevention of recurrence.
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 for a while may be sufficient.
For example reduce running mileage or cut out plyometric jumps. Substitute swimming or cycling if it is not painful.
Apply cold therapy or ice for 15 minutes every hour if it is bad, at least three times a day otherwise. Ice should not be applied directly to the skin as it may cause ice burns. Wrap in a wet tea towel or use a commercially available hot and cold pack which is often more convenient in the long run.
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. A jumpers knee strap is a band which wraps around the tendon just below the patella. By compressing the tendon the direction of forces passed through the tendon changes taking the strain off. It is also thought to have a shock absorbing effect.
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 recurrence. In addition to the quadriceps muscles it is important to stretch the hamstrings, calf muscles and iliotibial band as well.
Strengthening should begin as soon as possible provided it is pain free. Initially you may be only able to manage static contractions of the quadriceps muscles.
Progressive eccentric quadriceps exercises are particularly important in rehabilitation of patella tendinopathy 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 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. If you are causing more pain the chances are that you are making the injury worse. Apply cold therapy or 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.
See more detail on strengthening exercises for jumper's knee.
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.