Have you ever experienced pain at the bottom of the knee?

This pain may be aggravated by loading and an increased in the demand on the knee, through extension movements such as jumping, prolonged sitting, squatting or walking upstairs.
What I usually hear in the clinic is "pain in at the front of the knee" (anterior knee pain), often with a description of aching and the symptoms of this pain has either been gradual or sudden, after some of the listed movements above.

Predisposing factor

In one study low ankle dorsiflexion range was a risk factor for developing patellar tendonitis in basketball players (Backman & Danielson, 2011). Another study looked at Volleyball players and their predisposing factors to jumpers knee due to the high volume of jumping in Volleyball, and they found that having a natural ability for jumping high did increase the subject's risk of developing jumper’s knee (Visnes, 2014). Furthermore, the prevalence of jumper’s knee is high in sports characterised by high demands on speed and power for the leg extensors (Lian, Engebretsen, and Bahr, 2005).

Examination

A full knee examination by a medical professional is and should be, used to examine the knee in question. Bassett Sign is a test that I will use, and also at times, the single-leg decline squat can help assist in the diagnosis of jumpers knee. I do like to use a squat analysing protocol looking at all the components and areas that influence your squat. I could also refer you for an ultrasound as this is a great tool to help guide myself and other clinicians in the diagnosis of jumpers knee.

A continuum model of Tendinopathy

The continuum model of tendinopathy has the most overt clinical correlation, as it describes the three distinct stages of the jumpers knee, thus its inclusion in this article.

Reactive tendinopathy
Tendon disrepair
Degenerative tendinopathy

(Rudavsky & Cook, 2014) — (Rudavsky & Cook, 2014)

The load is considered to be the primary stimulus which drives tendon health forward and back along the continuum.

Reactive tendinopathy

This is the first and short-term change to the tendon due to an acute (sudden) tension or compression overload, which causes a non-inflammatory increase in the cell and matrix response. Thus thicking the tendon to reduce the stress to allow for change. This is different from the normal tendon response to load, which generally occurs through tendon stiffening. Clinically, reactive tendinopathies occur with out of the ordinary physical activity. Less common after a direct blow such as falling directly onto the patellar tendon.

Tendon disrepair

This is where the tendon continues to attempt its healing process, following the reactive stage but on a greater scale. Due to this healing phase, the tendon sees an increase in the number of cells that are presented in the matrix, thus resulting in an increase in protein production. Therefore, an increase in the protein production in an area where it should not be disrupted and causes an disorganisation and separation of collagen. There also may be an increase in vascularity (blood supply) and neuronal growth. Clinically, this stage of the pathology is seen in chronically overloaded tendons and appears across a range of ages and loading environments.

Degenerative tendinopathy

This is when cell death due to apoptosis, trauma or tenocyte exhaustion. There are large areas of the matrix that are disordered and filled with vessels, matrix breakdown products and little collagen. There is little capacity for reversibility of pathological changes at this stage. This stage is primarily seen in the older person.

Intervention

What can you do about this? Reducing the amount of load through requires a load management program. This can be implemented with an osteopath, like myself, or your strength and condition coach. This will reduce the load capacity of the tendon promoting less pain at the joint.

Exercise programs

Rudavsky & Cook (2014) in painful patellar tendinopathy (Jumpers knee) exercises program of heavy sustained isometric contraction with certain load strategies can have a hypoalgesic effect and can have relief be for periods of 2 to 8 hours. This loading can be done before a game or training and can be done several times a day. Pain medication can be used as well, however, this is out of my scope of practice so best to talk to your Doctor about this. Furthermore, eccentric and heavy slow resistance training, isotonic and isometric exercises have all been investigated in patellar tendinopathy and been shown to be of benefit. (Rudavsky & Cook, 2014, (Van Arkab et al. Cook, Docking, Zwervera, Gaidia, Van den Akker-Scheeka & Riob, 2016). All these exercises are best to get from your trained health care professional and if they don't know what to do find someone that does.

Manual therapy

Manual therapy techniques, including myofascial manipulation of the knee extensor muscle group, have had a positive effect on reducing pain in patellar tendinopathy patients in not only short-term but also in long-term follow-up (Pedrelli, Stecco, Day, 2009). However, exercise programs, pulsed ultrasound and transverse friction massages have been compared, and exercise had the best effects in the short and long-term (Stasinopoulos & Stasinopoulos, 2004).

As mention above if you have jumpers knee, there are methods of rehabilitation for you to partake in. From the evidence shown, rehabilitation is a multitudinous approach and thus should be promoted through exercises and manual therapy. This is not medical advice and if pain persists with your jumpers knee you should seek diagnosis and treatment from your local therapist. To book an appointment, click the below link to for a consult.

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Conclusion

Making sure you are in the right hands with your treatment is super important, not only for your rehabilitation but also your injury prevention. At MotionPlus Osteo this is what our goal is to do, make sure that you bulletproof yourself so that injuries are less frequent and you can do what you love to do.

Reference List

Lian, Engebretsen, and Bahr, (2005). Prevalence of Jumper’s Knee Among Elite Athletes From Different Sports A Cross-sectional Study. retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.529.6876&rep=rep1&type=pdf

Ludvig J. Backman, L, J., & Patrik Danielson, P. (2011). Low Range of Ankle Dorsiflexion Predisposes for Patellar Tendinopathy in Junior Elite Basketball Players; A 1-Year Prospective Study. American Journal of Sports medicine; 39(12), 2626-33. doi: 10.1177/036354651142055

Pedrelli, A., Stecco, C., & Day, J, A (2009). Treating patellar tendinopathy with Fascial Manipulation. Journal of Bodywork and movement therapies; 13(1), pp. 73-80. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19118795

Rudavsky. A., & Cook, J. (2014). Physiotherapy management of patellar tendinopathy (jumper's knee). Journal of Physiotherapy; 60(3), pp. 122-129. Retrieved from https://www.sciencedirect.com/science/article/pii/S1836955314000915#bib0255

Stasinopoulos, D., & Stasinopoulos, I. Comparison of effects of exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy. Clinical Rehabilitation; 18(4), pp. 347-352. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15180116

Van Arkab, M., Cook, J, L., Docking, S, I., Zwervera, J., Gaidia, J, E., van den Akker-Scheeka, I., & Riob, E. (2016). Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. Journal of Science and Medicine in Sport; 19(9), pp. 702-706. Retrieved from https://www.sciencedirect.com/science/article/pii/S1440244015002315

Visnes, H. (2014). Risk factors for Jumpers knee. University of Bergen. Retrieved from http://bora.uib.no/bitstream/handle/1956/8824/dr-thesis-2014-H%C3%A5vard-Visnes.pdf?sequence=1

MotionPlus Monthly: Patellar Tendinopathy aka Jumper Knee