Patellar Tendinopathy (Jumper's Knee)

Last summer I was working with an athlete that had missed some time from his sport due to some knee pain. In order to speed his return to action and prevent further issues he took some time off from his sport and worked on his strength and movement quality.

The knee pain was diagnosed as patellar tendinopathy or jumper’s knee. The patellar tendon runs from the quadriceps muscle group to the knee cap (patella) and into the shin (tibia). When injury is sustained to this tendon pain is felt below the knee cap. The injury is often called patellar tendinitis, however ‘-itis’ refers to inflammation and with the exception of a little inflammation at the beginning the tendon actually degenerates.

Programming

Patellar tendinopathy is an overuse injury, so the first thing that needed to be done was to reduce training for his sport. The exercises that I gave him were really exercises that are a part of any good program with a careful eye on completing them with the absence of pain. 

Foam Rolling

This form of self-massage was done for all the muscles that cross the knee joint: the hamstrings, adductors, calves, glutei maximi and tensor fascia latae (indirectly through the iliotibial band), and in particular the quadriceps. 

Mobility Work

I subscribe to Mike Boyle’s and Gray Cook’s Joint-by-Joint Approach to Training. It’s based on the theory of regional interdependence, which means that dysfunction in one area can lead to injury at a distant location. Indeed, recent research shows that poor shoulder flexion range of motion is associated with low back pain in male high-divers (Narita and colleagues, 2013). In the case of a knee injury it’s important to focus on ankle and hip mobility. Interestingly, this athlete has been treated for reduced mobility in his right big toe which causes that foot to turn out especially while running. 

Isolated Muscle Strengthening

According to Chuter and colleagues (2012) there is an increased risk of leg injury due to core weakness, weakness of the hip abductors and hip external rotators, and poor control of the lumbopelvic hip complex. This is supported by Shirley Sahrmann’s two textbooks which show that just about all knee pain can be treated by strengthening the hip abductors/external rotators as well as the quadriceps.* It was previously determined by both myself and a physiotherapist that this athlete had weak glutei maximi which – when functioning properly – are the strongest hip external rotators.

*Note: Sahrmann warns that quadriceps strengthening could accelerate knee osteoarthritis, so if your client has knee OA please refer them to a physiotherapist for guidance.

Band Resisted Terminal Knee Extension

Band Shuffle

Integrated Strengthening

It’s great to train weak muscles and improve joint mobility, but the body is much more than a bunch of parts. This is where lower body movements such as squatting, lunging, and hip hinging come into play.

I employed the use of the front squat, Romanian deadlift, Bulgarian split squat, single leg squat, and the single leg Romanian deadlift. These muscles strengthen the quadriceps, hamstrings, and glutei. Research shows that patients with patellar tendinopathy benefit from eccentric strengthening of the quadriceps, and stretching of the quadriceps and hamstrings (Dimitrios, 2012). The stretch in the rear leg while performing the Bulgarian split squat is great for training the first two qualities. In addition, a review by Kristensen and Franklyn-Miller (2012) shows that heavy weight training leads to better results than eccentric strength training due to reduced swelling of the tendon as well as increased vascularization and increased collagen turnover. The latter three exercises improve control of the lumbopelvic hip complex (i.e. improve balance through improved hip stability).

Bulgarian Split Squat

I prefer to hold dumbbells at my side.

In order to prevent or recover from patellar tendinopathy it's beneficial to foam roll the muscles of the hip and thigh, stretch the quadriceps and hamstrings, perform single leg strength exercises, and lift heavy weights.

References

Comparing the effects of eccentric training with eccentric training and static stretching exercises in the treatment of patellar tendinopathy. A controlled clinical trial, by Dimitrios, Pantelis, and Kalliopi, 2012.

Critical factors for the prevention of low back pain in elite junior divers by Narita, Kaneoka, Takemura, Sakata, Nomura, and Miyakawa, 2013

Diagnoses and Treatment of Muscle Impairment Syndromes by Shirley Sahrmann, 2002.

Movement by Gray Cook, 2010.

Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines by Shirley Sahrmann, 2011.  

Proximal and distal contributions to lower extremity injury: A review of the literature, by Chuter, Xanne, and de Jonge, 2012.

Resistance training in musculoskeletal rehabilitation: a systematic review by Kristensen and Franklyn-Miller, 2012.

Stay fit,

Jonathan Pratt

Pratt's Pro Fitness