In the last blog post, we discussed chondromalacia patella. Today, we take a look at patellar tendinopathy, also known as jumper’s knee. Patellar tendonitis or tendinopathy can result from an overuse injury from running or jumping, and produces microtears and degeneration in the patellar tendon(or ligament) in the case of tendinopathy or inflammation in the case of tendinitis. Most people feel pain at the bottom of their kneecap. In addition to pain, you may also get swelling here. As with many of the common injuries and ailments we’ve discussed, poor biomechanics and weak muscles may predispose you to this condition.
As with chondromalacia patella, addressing your faulty biomechanics and strengthening the muscles surrounding your knee are an integral part of rehabing jumper’s knee. Your therapist will look at your jumping and landing techniques, and target strengthening and re-education of any muscles they find lacking here. Often, weak gluteal muscles can contribute to your knee falling in towards the middle of your body when landing (more so in women than men), which contributes to this problem. Again, strengthening and neuromuscular re-education will be huge here, as will how you plié, your knee alignment while climbing stairs, and your techniques for jumping and landing. Taping or bracing may also help.
Your strengthening exercises may include targeting your VMO, including quad sets with your foot turned our slightly, short arc quads (SAQ’s) in parallel or turned-out, SAQ’s or long arc quads (LAQ’s) with a ball or pillow between your knees, mini squats against a wall or ball squats, single leg mini squats or heel drops off a step, stationary lunges, and step-ups or step-downs. Exercises should be done in pain-free range and only done as long as you can control the movement and maintain proper alignment. If your hamstrings are weak, you may also include hamstring curls on a machine or using ankle weights or a Theraband (latex-free version here). To target gluteals (so that your knee doesn’t fall in towards mid-line when landing), you may incorporate hip abduction with some extension (think somewhere between a la seconde and arabesque….. that dreaded position dancers are always cautioned against). This can be done in standing, in side-lying (S/L), on your hands and knees (quadruped), or prone. If your adductors (inner thigh muscles) are weak, then you may have to do standing or S/L adduction, squeezing your legs together against resistance as you might do while using a Magic Circle in Pilates, or using the hip adduction machine at the gym (while a viable option, this is not my favorite).
Stretching may also be necessary to attain muscular balance. For instance, the outer thigh is typically not weak, but tight. Make sure to stretch the outer thigh possibly using a strap or roll it out using a foam roller. If your hamstrings or quads are tight relative to one another, make sure to stretch these, as well, which can be done with or without a strap. Inner thighs can be stretched in a straddle position. Hip flexors can be stretched in a lunge. Gluteals can be stretched using the figure 4 stretch.
After muscular balance has been achieved, you’ll have to re-educate your body on how to land properly, maintaining proper alignment so as to not put pressure on the front of the knee again. Your physical therapist will guide you in this process. Using a mirror or videotaping are also great ways to provide you with feedback on exactly what’s going on as you land from a jump. Utilizing technology and your therapist’s expertise can be immensely helpful during your rehab, and get you back to class faster and safely.
That wraps up our look into jumper’s knee. Stay tuned next week as we conclude our investigation into common knee injuries by discussing plica syndrome.
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