Patellar Tendonitis (Jumper’s Knee)
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Patella tendonitis is a painful condition of overload and breakdown of the patella tendon which attaches the quadriceps muscle to the shin bone, at the front of the knee. Pain is localised in the patella tendon and with some cases there will be a thickening of the tendon so it might feel like there is a bump or lump. Normally the rest of the knee is free from swelling or bruising. As this is a condition of overload it is common in sport, some sports are particularly at risk due to the type of movements involved, the intensity and the training volume.
Basketball is the sport with the highest incidence of patellar tendonitis, hence why it is also known as Jumper’s knee. The combination of high force through the patellar tendon from jumping and landing, as well as the high volume of jumping, creates the perfect environment for overload of the tendon. In the UK, netball would be the next most common sport in which patellar tendonitis is seen. To overcome this risk, strength and conditioning for the athletes that play basketball and netball to a high level is essential.
You can still play basketball with patella tendonitis if symptoms are mild and well managed. If symptoms are severe or if they last for a long time following playing it is not advised as it will have a detrimental effect on your recovery. A general rule to follow is that pain should be low, no more than 3/10 during and after play. And symptoms should return to pre-play intensity within a few hours.
Gymnastics for similar reasons to Basketball has a high incidence of patella tendonitis. In addition, falls are common and the volume of training is very high. A significant difference is age. Many gymnasts start high volumes of training at a very young age when they are still growing. This means that their bones are still soft and their tendons are very elastic. Therefore the high load of force over the knee joint results in a different injury in the young athlete. Osgood Schlatter is a condition of overload to the growing bone where the patella tendon attaches at the top of the shin bone, the tibial tuberosity. A similar injury can occur at the quadriceps tendon insertion onto the knee cap, the patella, which is called Sinding Larsen Johansson. This needs correct diagnosis and a different treatment and management plan for the tendon injury found in adults.
The most common injuries to the knee are sprains and torn cartilage, followed by overuse injuries such as Osgood Schlatter and Sinding Larsen Johansson in growing athletes, and patella or quadriceps tendonitis in adults (Caine & Nassar, 2005).
Cycling is a low impact sport and on the whole has a low injury rate. Typically cycling injuries are related to poor bike fit, or falls. For the knee specifically, a saddle height and position that is incorrect for the rider will increase the risk of injury. If the saddle is too far forward or too low, there will be an increased angle of knee flexion and greater load on the knee joint and quadriceps muscle. This can result in greater risk of patella tendonitis due to the increased load and stress on the patellar tendon. Getting a good bike fit is essential for anyone who is taking their cycling seriously, and advisable for any one cycling in cleats or cycling for durations over 1 hour several times per week.
While cycling isn’t a high-risk sport for tendonitis it can be the cause, or it can be an aggravating factor. If your tendon pain is low and eases soon after cycling it is safe to continue, however, you might want to check your bike fit, especially your saddle height, and avoid very long duration or high intensity to help your recovery from your injury faster.
Running, and in particular trail running has a lot of patella tendonitis injuries. Running is high impact and requires high repetition of flexion and extension of the knee. This stresses the patellar tendon with each repeat. If the strength and conditioning of the runner are insufficient, this stress can develop into a degenerative tendonitis over time. Trail running has a much higher incidence than road running as the downhill elements of trail running will require the knee to take more load in a greater angle of flexion. Thus a greater stress due to the greater length through the quadriceps muscle and tendon unit while it is working. Similarly, hiking will have these same positions, but lower stress due to the slower speeds of descent.
Running can be ok with patella tendonitis as long as the severity of symptoms is low and reduces quickly after running. It may be better to avoid high-intensity running and downhill running while you feel pain. Additionally, it may be better to reduce your overall run volume and integrate more strength and conditioning into your program. Best to get the advice of a physical therapist to guide this.
Weight lifting, can involve heavy and slow movements for some people, this has a low risk of patellar tendonitis. For others, it may involve more powerful or plyometric movements, which comes with greater risk of patellar tendonitis. CrossFit has become hugely popular in the past decade and with it there are common injuries seen in its population of athletes, such as patella tendonitis, or Jumper’s Knee. The variety of movement involved can be difficult for the body to become conditioned for, especially for the less dedicated athlete. And at the top of the sport the loads and volume are very high and thus tendonitis is typically seen in these two groups within this sport.
Squatting can both aggravate and fix patella tendonitis. The correct movement and dose are important. Some rehab protocols involve squatting on a decline board where your feet are at an angle pointing downhill, this puts more load on the quadriceps muscle and patella tendon. Typically this is done as a 45-60seconds static hold or slow squats for the same time, with several minutes of rest between the 4 sets (Kongsgaard et al, 2006). If squatting is aggravating your pain the weight, volume, or range of movement might be too much. A physical therapist will be able to advise you.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.