Dealing with injuries and pains are not fun when you’re an athlete. Especially, when they cause you to miss practice and competitions. Sometimes you don’t even know what wrong with you just that something hurts. Does sound familiar? We are glad to have Dr. Nicole Canning Surdyka give an in-depth explanation of a common injury among athletes called Jumper’s Knee.
What Is Jumper’s Knee?
Jumper’s Knee is a known term for a fairly common problem among athletes – patellar tendinopathy, which is mostly pain and dysfunction in the patellar tendon. You may have heard the phrase patellar tendonitis; this is when there are actually inflammatory cells present in the tendon and generally refers to an acute condition or injury. Tendinopathy is a more chronic problem in which no inflammatory cells are present, but there may be structural changes to the tendon over time. The patella tendon is the tendon of the quadriceps muscle in the front of the thigh where it attaches to the kneecap (aka the patella) and then to the front of the shin bone (the tibia).
How Does An Athlete Get Jumper’s Knee?
Patellar Tendinopathy is an overuse injury that results from overload to the tendon. When the structure of the tendon is not strong enough to bear loads of activities such as jumping, decelerating, and changing direction quickly, there is an overload to the tendon. Tendon overload is reported as the key factor associated with the onset of pain.
What Is Overload?
Overload is when an athlete is performing activities above what the tendon is capable of handling at that time. This can be the result of a sudden increase in the number of jumping activities (pre-season or new training program) or the return to full sports participation without a proper ramp-up period. This tends to happen after a period of rest following a holiday, off-season, or another injury. This is a representation of why it is so important to follow a maintenance program during breaks from competition and to work with both your Sports Medicine and Sports Performance staff when returning from an injury before jumping (pun intended) right back into full sport participation.
Who Gets Jumper’s Knee?
Patellar Tendinopathy (Jumper’s Knee) is most prevalent among jumping athletes with volleyball players having the highest incidence and soccer players having the lowest. Athletes may present with this condition from young adolescence up until the 4th decade of life. Interestingly, male athletes are 2-4 times more likely to develop Jumper’s Knee than female athletes are. Aside from participating in a jumping sport and being a male athlete, some other risk factors of developing Jumper’s Knee includes decreased hamstring length and reduced quadriceps length (having tight hamstrings and quads).
Jumper’s Knee has also been associated with periods of excess loading, increased fat pad size in your knee, altered landing strategies, and mechanics, decreased dorsiflexion (pulling your foot up towards your shin), and increased waist circumference. Playing and competing on harder surfaces has also been associated with the onset of Jumper’s Knee. As mentioned before, however, the most common trigger of knee pain caused by Jumper’s Knee is increased training volume and frequency.
I Have Knee Pain – Is It Jumper’s Knee?
Jumper’s Knee presents with point tenderness at the patella tendon’s attachment site to the patella (knee cap). Generally, athletes will feel soreness at the beginning of an activity that may or may not fade during the warm-up. The pain will usually feel worse the day after activity but usually does not cause night pain or generalized morning stiffness. Athletes with Jumper’s Knee will often complain of pain while climbing stairs, squatting, sitting for prolonged periods, and rising to stand from a seated position.
If you have pain elsewhere in your knee, or pain that is not associated with jumping or cutting, you may want to consider getting evaluated by a Physical Therapist to find the cause of your pain. [Fun Fact: In most states, you can go straight to a Physical Therapist without needing a prescription or referral from a doctor!] Some other causes of knee pain are patellofemoral pain syndrome, plica dysfunction, patellar subluxation, or Osgood-Schlatter.
I think I have Jumper’s Knee, what do I do?
Passive therapies such as taping, bracing, cross-friction massage, and ultrasound have not been proven to have actual intended results. Several studies have found that there is no difference between extracorporeal shockwave therapy (sound waves applied to the body to help stimulate healing) and placebo for in-season athletes. Another study found that corticosteroid injection, oral steroidal medication, or iontophoresis helped give short-term relief, but the long-term results were worse than those in the group of patients who performed specific therapeutic exercises. A study looking at the effect of the commonly used patellar strap found that the strap, sports-tape, and placebo taping all helped to decrease the pain during functional activities and still had an effect for up to 2 hours after performing the athlete’s given sport. Sports-tape and placebo taping was helpful in decreasing pain during the actual sport itself.
Physical Therapy can help to decrease pain in the long-term and address the issues causing Jumper’s Knee in the first place. The first goal of Physical Therapy is to reduce the load put on the patella tendon while helping to avoid complete stoppage of activity. This is done by having the athlete eliminate high-load drills (plyometric and agility training), reduce the frequency of training to twice per week, and decrease volume (time of training).
Physical Therapists will also implement a strengthening program to enable the tendon to better handle higher loads. This program begins with sustained isometrics at 45 degrees of knee flexion. One study cites that an isometric contraction at 70% maximal contraction held for 45 seconds for 5 repetitions with a 2-minute rest in between can help to reduce pain for at least 45 minutes. This might be an excellent exercise to do as part of a warm-up for a competition or game to help the athlete decrease pain while performing. Then, heavy, eccentric, isotonic, and isometric exercises are initiated to help promote tissue adaptation so the patellar tendon can better handle tensile forces.
Once pain has decreased, and strength has improved, the program may progress to include skipping, jumping, and deceleration/change of direction drills. Next, sport-specific movements and exercises can be incorporated until the athlete is ready to return to full sport participation. Once the athlete has been cleared by the Physical Therapist to return to the sport, it is important that the athlete maintains strengthening exercises to keep strength and prevent another onset of Jumper’s Knee.
When can I play my sport again?
Once the athlete has been deemed fit for return to play, it is unwise to simply return to the level they were at before the onset of pain. A gradual reintroduction to the demands of the sport is advised. Maybe the athlete will be able to participate in the warm-up before a training session, then the next week can try to participate in technical skill activities and drills, and then gradually back into game/match like situations. A good rule of thumb to follow is the following:
- If you have pain 24 hours after an activity, then you did too much.
- If you have pain 24 hours after an activity, but it goes away during the warm-up, then you did just enough – do not do more or less than you did the previous session.
- If you have no pain 24 hours later, then you can progress to do a bit more than the previous session.
As always, if you are experiencing pain or unable to perform the sports and activities you enjoy, go find a physical therapist for guidance.
Dr. Nicole Canning PT, DPT, CSCS