Patellar Tendinopathy (Jumpers Knee):

What Is It and How Do You Treat It?

Have you ever had pain in the front of the knee with jumping, cutting, running, or kicking?  I personally have and it stinks. I played soccer growing up so the feeling of a sharp jolt to the front of the knee is not something foreign to me. To those of you experiencing the same sharp pain to the front of the knee, you will know that  it feels as if you are running or jumping on eggshells. You want to be explosive but you feel like if you bend your knees too much to really generate power or to absorb a landing, the sharp jolt is just waiting for you not far behind. I experienced this pain as a soccer player but it affects many other sports such as basketball, volleyball, tennis, track and field, football and the recreational runner.  Athletes between the ages of 15 to 30 are primarily affected, with men more commonly affected than women.     

By definition, patellar tendinopathy (Jumper’s knee) is an overuse injury thought to be caused by excessive or repetitive forces applied to the patellar tendon.     

Signs and Symptoms of Patellar Tendinopathy:

• Anterior knee pain over the patella tendon

• Tenderness at the inferior pole of the patellar tendon

• Pain made worse with jumping, landing, cutting/pivoting, or running activities

• Pain with stairs, squatting, and at times prolonged sitting

• Onset of pain is usually gradual and commonly related to an increase in sport activity

• The feeling of stiffness in the patellar tendon in the morning

• Increased thickness of the patellar tendon compared to the opposite side

What is the Function of the Patellar Tendon?

The patellar tendon attaches directly from the tibial tuberosity to the inferior tip of the patella (knee cap). The quadriceps muscle attaches into the superior tip of the patella, thus transmits forces through the patellar tendon based on the common attachment into the patella. Therefore, any tightness or weakness in the quadriceps pulls on the patellar tendon. The patellar tendon also functions in the storage and release of energy when you jump, run, cut or pivot. This means there is a lot of load that has to transfer through the patellar tendon so overtraining, insufficient rest, faulty movement patterns, mobility impairments, and hip, core and foot weakness can contribute to the development of patellar tendinopathy.

Common Impairments Found in Individuals with Patellar Tendinopathy:

• Hip Abductor and Hip External Rotator Weakness

• Altered Hip and Knee Movement Patterns upon Landing (Poor Movement Quality)

• Excessive or Restricted Hip and Ankle Mobility

  • Look for reduced dorsiflexion, quadriceps or hamstring tightness, hip Internal rotation mobility, increased varus foot alignment, etc.

• Quadriceps Weakness

• Excessive Foot Pronation: foot collapses inward upon landing which causes knee valgus (knee collapse inward) as well as the femur to then internally rotate excessively

Rehabilitation Focus:

• Eccentric Quadriceps Strengthening

• Quadriceps and Hamstring Flexibility

• Hip Abduction and External Rotation Strengthening 

• Movement Competency–May require Cueing from a Rehab Professional or Qualified Strength Coach to address running, cutting, and jumping mechanics

• Foot and Ankle Strengthening

• Ankle Dorsiflexion Range of Motion

Exercise Ideas:

Here are some exercise ideas to get you started but it is always helpful to seek help from a medical professional.

Quadriceps Flexibility:

1. Couch Stretch: https://www.youtube.com/watch?v=tABeNRBDf30

Hip External Rotation Strengthening:

1. Clamshell: https://www.youtube.com/watch?v=2OhR279AWNY

2. Fire Hydrant (can add band around knees to increase difficulty): https://www.youtube.com/watch?v=0Vk6BrtikL8

3. Side Plank with Clamshell: https://www.youtube.com/watch?v=82tKGsLrADY

Hip Abduction Strengthening:

1. Sidelying Hip Abduction: https://www.youtube.com/watch?v=Ku6QkDJqdwY

2. Side Plank: https://www.youtube.com/watch?v=TPp92f8HlG0

Ankle Dorsiflexion:

1. Mobilization with Movement: Long Sitting Position with Mobility Band: https://www.youtube.com/watch?v=sBCMIaIkP8c

2. Wall Stretch: https://www.youtube.com/watch?v=9QRVlaw9QWM

References:

Malliaras, P., Cook, J., Purdam, C. and Rio, E. (2015). Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp.887-898.

Mendonça, Luciana D., et al. “Association of Hip and Foot Factors With Patellar Tendinopathy (Jumper’s Knee) in Athletes.” Journal of Orthopaedic & Sports Physical Therapy, vol. 48, no. 9, 2018, pp. 676–684., doi:10.2519/jospt.2018.7426.

Baseball Specific Screening

The OnBase University screening stems from the belief that there is not only one technically correct way to play baseball or softball. There are an infinite number of ways to play the game. The best baseball players in history don’t all hit or pitch the same way, but they do have some commonalities in their styles that have allowed them to be the best.  The aim of a good coach or trainer is to find the one efficient style that works for that player, and that is based on what the player can physically do. If we can match an athlete’s physical ability to his/her technical skills, it will help the player play at his/her highest level possible.

Coach and Player Goals: To be Efficient and Powerful

What makes a hitting or pitching style Efficient?

• It is Reproducible

• The player has command over their pitching/hitting style

• The player is able to maximize his/her power with the least amount of effort

What makes a hitting or pitching style Powerful?

• Proper Kinematic Sequencing: how energy is transferred from the ground through the body to the ball or bat

It’s up to the coaches to guide the player into what kind of hitting or pitching style the athlete uses. Our goal is to assist the coach and player by determining how the athlete’s physical abilities relate to their technical skills.  Pitching and hitting requires involvement from the whole body, from the feet all the way through to the neck, shoulders, elbow and hand. If there is a breakdown anywhere in this chain, it could lead to poor power, poor contact on the ball for hitters, inconsistency, and pain or injury.  

How is your body limiting your performance and where exactly are the breakdowns? That’s what we want to find out.

How do we determine where the breakdowns are?

Through Movement Screening: Functional Movement Screening (FMS), Y balance testing, OnBase University pitching and hitting screening, the Selective Functional Movement Assessment (SFMA), and through joint by joint assessment.

We will provide these findings to you, your pitching or hitting coach, and your fitness coach to develop a team approach in order to help you become a better athlete.

Let us help you and your coaches. Call us at 407-718-0437 or email us at rachel@jsportsrehab.com..

Reference: http://www.onbaseu.com