A Complete Guide to Treating Patellar Tendonitis (Jumper's Knee)
Patellar Tendonitis, also known as Jumper's Knee, is irritation of the patellar tendon that often presents as anterior knee pain with squatting, jumping, and landing movements.
Our complete guide to patellar tendonitis discusses ways to speed the healing, decrease the amount of pull going through the tendon itself, strengthening strategies, and how to protect from future injuries. Enjoy!
1. Healing the Patellar Tendon
The body has an amazing ability to heal itself. Which means we usually just have to stay out of the way and avoid the movements that aggravate our patellar tendon. There are some techniques we use in the clinic to stimulate the healing process including the use of Instrument Assisted Soft Tissue Massage and the K-Laser.
2. Decreasing Pull/Tension on Patellar Tendon
The best way to help the patellar tendon heal is to avoid aggravating movements and decrease the tension or pull that goes through the tendon itself. The patellar tendon is connected to the quadriceps muscle via the quadriceps tendon. Decreasing tone and tension of the quadriceps and hip flexor muscle group will help decrease the force placed on the patellar tendon. In the clinic, this can be accomplished in the following ways:
This can be applied to the quads/hamstrings or the knee itself. The idea is that we're pulling our muscles through a compressed space to break any adhesions in the fascia/muscles to decrease tension in the patellar tendon
Using K-Tape or Pre-Wrap to place a compression force over the tendon also decreases the force that goes through the tendon itself. Good for short term relief.
Tightness in the quads or hip flexors can increase the pull on our tendon. Active stretching of these muscles can ensure we decrease the pull on the tendon.
3. Isometric Strengthening
Isometric exercise has been proven to have an immediate reduction in the pain associated with patellar tendonitis. One of the experts in the field (Jill Cook) has recommended 5 bouts of 45 second contracts at about 70% max contraction. At the gym this can be accomplished with a weight machine. In the clinic, the practitioner can provide the resistance.
4. Strengthening The Patellar Tendon
As pain subsides we can start building strength in the patellar tendon with concentric and eccentric exercises. The following progressions are some of the best for targeting the patellar tendon (beginning with the easiest and progressing to the most difficult).
Single Leg Step Downs
A decline board is another great way to implement the single leg step down
Assisted Skater Squats
In this video we use a band, but can use anything to grab onto to help with the lowering.
Counterweight Skater Squats
Counterweight Single Leg Box Squats
5. Strengthening the Lower Extremity and Performance Training
Patellar Tendinopathy is never and isolated event. Weakness in the entire lower extremity is almost always a contributing factor. There are a lot of different directions to take this and will depend on what you find in the initial exam, but as a rule you'll want to look at strengthening the posterior chain (hamstrings and glute max), lateral chain (glute med and core), and then transitioning to return to sport training.
Strengthening the posterior chain (hamstring and glutes) provides better control that limits the stress that goes through the patellar tendon.
Strengthening the lateral chain controls where our foot lands when we run and jump from a single leg and is the reason it's so important to train to prevent excess strain on the patellar tendon.
For the athlete, deceleration training ensures that we can properly absorb forces when stopping, cutting, changing direction. The hop and stop exercise is a beginner deceleration exercise but can easily be progressed to more challenging movements.
6. Protecting the Patellar Tendon
Avoiding recurrence of the injury requires us to decrease the amount of strain that goes through the patellar tendon during our daily activities. This involves re-training movement patterns to emphasize our posterior chain (over our anterior chain). This means making sure we unlock at the hips (rather than the knees) with any sort of squatting, jumping, landing movement.
On Left: Anterior Chain Dominant Squat. See knees over toes (increased tension on patellar tendon) and angel of knee.
On Right: Posterior Chain Dominant Squat. See knees behind toes (less tension on patellar tendon).
The following progressions can be used to emphasize our posterior chain and take pressure off the patellar tendon and quadriceps during squatting, jumping, landing mechanics.
Learning to unlock from the hips to emphasize the posterior chain and keep center of gravity over weight bearing joints (and off the knees)
Slowly descending in the squat to emphasize unlocking at the hips to take tension off the patellar tendon.
Transitioning the hip hinge/squat patterning into a jumping motion. Be sure as we land that we unlock at the hips (not the knees).
Evolve Performance Healthcare combines full body chiropractic care with movement and strength programs for the long term recovery of patellar tendonitis and many other injuries.
Wondering if we can help? Feel free to reach out for a free consultation.
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