For most people sporadic aches and pains are just part of being an athlete. One of the more common areas that an athlete will experience pain is the knee. Typically after a day or two of rest the pain subsides and the athlete is able to return to their prior level of activity with minimal to no discomfort. But there can be a cause for alarm when the pain doesn’t subside, especially if the pain begins to worsen. If left untreated knee pain can prevent an athlete from competing, and in severe cases the pain can make simple activities such as climbing a flight of stairs difficult. A common culprit of knee pain in an athletic population is patellar tendonitis or jumper’s knee.
The patellar tendon is located directly below the knee cap (patella) and attaches on the shin bone and the knee cap. Its function is to work with the quadriceps muscle to straighten out the leg. Jumper’s knee usually occurs when the patella tendon is repeatedly overstressed. This stress can lead to inflammation which can lead to pain and swelling. The patella tendon is most stressed when a person is jumping, running or kicking.
There are several causes and risk factors for developing jumper's knee. Individuals are more at risk if they are involved in a sport that require running and repeated jumping (i.e. basketball volleyball, football etc.). Athletes who rapidly increase their intensity and/or the volume of training are at risk as well. People who are not flexible especially around the quadriceps and hamstring are also at greater risk of developing jumper’s knee. Athletes may also develop jumper’s knee if they demonstrate poor hip and knee control during the landing phase of a jump. In rare cases jumper’s knee can occur in individuals who sustain trauma to the knee and do not allow for an adequate amount of time for the patellar tendon to heal before returning to their sport.
Symptoms include tenderness of the patellar tendon, pain with jumping and prolonged running. Knee pain will often become gradually worse as the athlete progresses through a practice/game. The knee may actually become swollen and feel warm to the touch as well. The knee may also begin to feel stiff in the morning. In severe cases the patellar tendon will become thicker and appear larger than the unaffected knee.
After a physical therapist diagnoses a patient with jumper’s knee the therapist will then provide several interventions in order return the athlete back to playing their sport pain free. If the patient presents with a very mild case of patellar tendonitis then RICE (rest, ice, compression, and elevation) may suffice as a treatment. But in more moderate to severe cases a more extensive approach will have to be taken. Often if a patient has muscle imbalances or demonstrates compensation patterns while running or jumping trigger points will begin to form and this will lead to the muscle being tight and painful. The physical therapist will identify if the athlete has any muscle imbalances and trigger points and they will use hands on techniques to release these trigger points. The physical therapist will also instruct the patient on how to properly use a foam roller to help release these trigger points on their own. This will aid in decreasing the tissue tension of the quadriceps and as a result place less strain on the patellar tendon.
To further reduce any built up tissue tension the therapist will also prescribe exercise that help stretch the quadriceps and hamstrings. To reduce the overall force on the patellar tendon the physical therapist will also utilize specific taping techniques. The physical therapist will also evaluate the athlete’s running and jumping mechanics. If compensation patterns are observed the therapist will provide feedback and prescribe exercises to strengthen any deconditioned muscle(s). Once the patient’s symptoms begin to improve, plyometrics will then be introduced to help grade the athlete’s exposure to sport related movements.
For more chronic cases, the physical therapist will employ eccentric exercises for the quadriceps muscle. Typically when a muscle is firing it shortens or contracts. An example of this is when a person is performing a biceps curl. The bicep shortens as you lift the weight. Here the physical therapist will prescribe exercises that make the quadriceps fire while in the lengthened position. This increases the force and the work load onto the quadriceps and the patellar tendon. These exercises help the quadriceps and the patellar tendon to better cope with the intense workloads an athlete must endure during training, a game or a practice. At first these exercises may be painful to perform or the patient my experience increased soreness afterwards, but this is expected. Research has consistently shown a significant reduction in symptoms and a better chance of returning to their sport after performing an eccentric based exercise program in athletes with jumper’s knee.
With jumper’s knee the key to a great prognosis is early detection. If left untreated patellar tendonitis can manifest into patellar tendinopathy. This is where the patellar tendon sustains small tears. As a result the patellar tendon thickens in order to attempt to compensate. In these individuals the overall treatment does not change, but the recovery time can be much longer and the reoccurrence rate tends to be higher. If an athlete does not try to push through the pain and seeks care early on then the chances of them returning to their sport at a competitive level with no pain increases dramatically. For more information on physical therapy services visit www.totalperformancept.com.
If knee pain has been impeding your ability to run or play your favorite sport make sure to contact Total Performance Physical Therapy for an evaluation today.