Jumper’s Knee: Why Your Patellar Tendon Hates You

patellar tendon

Many athletes have experienced knee pain. One of the more common issues is referred to as jumper's knee. The technical name for this condition is patellar tendonitis. The patella is more commonly known as the kneecap. A tendon is a piece of tissue which attaches muscle to bone. The muscle group which uses the patellar tendon are the quadriceps. As the name suggests, there are four individual muscles: vastus lateralis, vastus intermedius, vastus medialis, and rectus femoris. Quadriceps are the large bulking musculature on the front of your thigh. Their job is to extend your knee or straighten it out. The patellar tendon attaches the quadriceps to the tibial tuberosity, a bony attachment site on your shin. This is the area that develops a knot when an individual suffers from Osgood-Schlatter disease.

Anatomy to know:

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    Tibia - shin bone
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    Quadriceps - large muscles on front thighs
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    Tendon - soft tissue that connects muscle to bone
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    Patella - knee cap

This injury develops when chronic or long-term or reoccurring, inflammation occurs in the patellar tendon. Chronic inflammation can be difficult to deal with. The body heals its self in a circular cycle. Occasionally injured tissue will get stuck in the inflammatory-response phase. Moving from this phase is essential to proper recovery as the next step is fibroblastic-repair phase. This is where your body rebuilds to itself to be stronger. 

Typically, people experience pain in the lower portion of the tendon but you can also irritate the area above the patella. That is referred to as quadriceps tendonitis. For a visual aid, imagine the patella tendon like a Twizzler that has a Spree (hard disc-shaped candy) settled in the middle. Of course, size varies and that example does not give an exact ratio.

Key signs of jumper's knee:

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    Dull ache after running or jumping
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    Pain subsides with rest, returns with activity
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    Pain worsens until the athlete is unable to continue
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    May have difficulty climbing stairs; feeling of "giving way"

Some may be curious as to why the patella exists. After all, we managed the first two years of life without them so why are they important now? Mathletes will love this. The patella acts as a fulcrum giving the quadriceps more power helping us to be more powerful. Let's take a line from Spiderman: "with great power, comes great responsibility." The patella and patellar tendon are constantly being used and abused. 

Improper training loads and poor mechanics create a vulnerability to the tendon and patella that are working so diligently. Every step, every jump, every squat. The quadriceps will eccentrically, an elongation of the muscle fibers similar to a stretch, control the load, absorbing most of the forces. Some strain is transferred to the tendon. When the quads become tired and overworked, additional stress is laid upon the patella tendon and it will be overworked.

There are two avenues of treatment for patellar tendonitis. The more traditional approach aims to reduce the inflammation. This method includes rest, ice, ultrasound (a modality used by healthcare professionals) and anti-inflammatory medications. The second path is more aggressive; designed to intensify the inflammation in hopes it will catapult the injury into the repair stage of healing. Cross friction massage is the most common technique used. It is important to understand that if one is trying to aggravate inflammation, all anti-inflammatory attempts must be stopped. Typically, the tendon will be massaged for five minutes every other day for about a week. After four or five treatments, if the pain has not decreased it is unlikely this method alone will work.

Ways to treat yourself:

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    Foam roll quadriceps
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    Cross fiber massage over tendon ​Learn how here!​​​
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    Hip flexor stretches

If the inflammation within the tendon is not treated and remains over prolonged period, the tendon becomes weak. This makes it vulnerable to rupture. While this is not common in young athletes, as one ages the potential to tear increases. 

As an athlete prepares to return to activity it is essential for them to engage in a thorough warm up. During the early stages of return, avoid jumping and intensive running activities. Alternative exercise such as biking can provide ample cardio training while healing occurs. The most important factor to include in the return is eccentric quad strengthening. Slow, control drop squats are one example of this type of exercise. When an athlete can jump and run without causing an increase in swelling or pain, they can return to normal activity.

To help reduce pain, athletes can wear patellar straps. The amount of benefit varies from individual to individual. These straps can be purchased at a variety of locations. Large chains such as Wal-Mart and Target often carry basic sport braces. A quick Google search will provide an aray of choices online as well. A cost effective way to test how you will respond is to use pre-wrap. Wrap the pre-wrap around your lower thigh just above your knee five to eight times. Then, beginning at the top edge of the wrap, roll it over itself until it becomes rope like. Then slid it down your knee until it lies over the patellar tendon, below the knee cap.

Some physicians may offer an injection of cortisone. While the pain will be less and inflammation will be reduce, this medication weakens tendons and will make it vulnerable to rupturing. 

To best protect the tendon from future issues, it is vital to work on jump-landing technique. Controlling the force from jumping takes strength, neuromuscular control and flexibility. Coaches, strength coaches, athletic trainers, physical therapists and chiropractors should all be able to help assess this technique. If you're unable to get help from someone, start researching online and video tape yourself. Watch how your feet, ankles, knees and hips move. 

Good jump ques:

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    Two feet, shoulder width apart
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    Soft knees
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    Load hips (fire those glutes!)
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    Quiet sound
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    toe-to-heel contact

Another anatomical structure to consider when suffering from knee pain is a bursa. A bursa is a fluid-filled sack that helps to lubricate various joints throughout your body. A bursa injury can be acute, chronic or recurrent. Common cause include falling on a bent knee on a hard surface or repetitive crawling. Swelling over or right around the patellar tendon can mean either tendonitis or bursitis. The most common bursa to experience irritation in the knee is the infrapatellar bursa. The name tells us it is located below (infra) the patella.  

If an athlete has been dealing with knee pain for a prolonged period, it may be time to consider seeking help from a healthcare professional. Chiropractors, physical therapists, athletic trainers and massage therapists are just a few allied health providers that can help ease pain and restore optimal health and function to an athlete's body. Search for a sports rehabilitation clinic near to you to help speed up your recovery time. Call and ask if the clinic requires a referral from a primary care physician. If insurance is a concern, the clinic should be able to give you an idea on cost and coverage if you have your card available. For those without insurance or a plan that does not cover athletic related injuries, ask what other financing options they offer. Many high schools employ an athletic trainer at least part time. They are a great resource for student athletes. Trained specifically to deal with athletic related injuries, an athletic trainer will be able to evaluate, treat and rehabilitate an injury. 

Have another injury you'd like to learn more about? Comment and let Athletic Courage know what you're interested in! Or ask your injury question here. 

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