Jumper’s Knee: Symptoms, Causes, Treatments
Are you experiencing pain at the front of your knee? Is it at the base of the kneecap? If so, this article may be for you! Patellar tendinopathy (also known as Jumper’s knee) is a common condition experienced by those who engage in sport that involves lots of jumping (surprise, surprise) and change of direction (think basketball, volleyball, netball etc.) (Malliaras, Cook, Purdam & Rio, 2015). That said, patellar tendinopathy is also prevalent among runners, particularly those who find themselves running up and down hills (anyone who runs in Brisbane!).
This blog will discuss what patellar tendinopathy is, its symptoms, causes and considerations for management.
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This blog will cover the following topics on Jumper's Knee:
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What is Jumper's Knee?
The patellar tendon
Let’s start with what the patellar tendon is and it’s purpose. The patellar tendon originates at the bottom of the kneecap and inserts onto the shin bone at the tibial tuberosity (a little bony lump you may feel at the top of your shin bone). It’s job is to work with the quadriceps (muscles at the front of your thigh) to straighten the knee and allow you to kick, jump and run.
More specifically, the tendon’s purpose is similar to that of an elastic band – it stores and releases energy through the knee as you land and then take off again. This allows for explosive and agile movements within sport.
Patellar tendinopathy
Patellar tendinopathy (patella = kneecap, tendinopathy = painful tendon) is characterised by pain at the bottom of the kneecap (where the tendon inserts into the kneecap) and less frequently, at the bony lump at the top of your shin (where the tendon inserts onto your shin). Patellar tendinopathy is more common in younger populations (15-30 years old), particularly in males who play sports involving frequent jumping, change of direction and deceleration (Malliaras et al., 2015).
Patellar tendinopathy is an overuse injury, meaning that the patellar tendon has been subjected to loading that it has been unable to withstand. Often this condition occurs following large increases in load such as: starting a new sport, returning to sport after a break or, increasing load too quickly (for example adding another training session or two to the calendar).
Excessive load on the patellar tendon with inadequate rest time between sessions reduces the ability for the tendon to recover and may cause changes within the tendon that could lead to pain. Although the relationship between tendon pathology and pain is unclear, pathology appears be a risk factor for developing knee pain and therefore may be relevant.
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Symptoms of Jumper's Knee (Patellar Tendinopathy)
Pain at the base of the kneecap or (less often) at the top of your shin bone is the most common symptom of patellar tendinopathy.
Often pain is experienced when the patellar tendon is placed under significant load, for example jumping, squatting, prolonged sitting and descending stairs. This is because these activities require the patellar tendon to absorb forces that cross the knee when decelerating (to prevent the knee from collapsing!). Pain is rarely felt when resting, however, pain may also be felt after prolonged sitting, as the tendon has been elongated and stretched for an extended amount of time.
Pain often correlates with the magnitude of force the patellar tendon has to absorb, that is, the lower you squat the more painful it becomes and progressing from a shallow hop to a deeper hop will be more irritating (Malliaras et al., 2015). Pain on loading (squat, step down, hop), that eases quickly when unloaded, is typical of patellar tendinopathy.
Finally, pain may be more prominent on days following those that involve lots of patellar tendon loading (e.g. sports carnival, running).
Another symptom for patellar tendinopathy can be stiffness in the front of the knee, in the location of the patellar tendon. Stiffness in the knee is often experienced first thing in the morning when you wake up or during the first few minutes of exercising. Typically, stiffness (and sometimes pain) can be felt when commencing exercise for the first few minutes then will subside. In more severe cases though, pain may be felt at the beginning of exercise and gradually become worse.
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Causes of Jumper's Knee (Patellar Tendinopathy)
Load – As previously mentioned, patellar tendinopathy is an overuse injury, meaning that the tendon cannot cope with the demands being placed on it. Usually, these injuries are caused by excessive and repetitive loading by activities such as jumping.
Therefore, patellar tendinopathy is often apparent when
1; starting a new sport (or returning to sport) as there is a sudden increase in load on the knee, or
2; when there is poor load management – e.g. increasing running distance too rapidly.
There is some evidence for several other risk factors for patellar tendinopathy, though it’s important to note this evidence is not strong. That said, with more long-term presentations of patellar tendinopathy, the below factors might be worth taking into consideration if load management alone isn’t resolving pain.
Weight – There is some evidence to suggest that increases in body weight, Body Mass Index (BMI) and waist-to-hip circumference ratio have led to higher loading of the patellar tendon, especially during exercise
Leg length discrepancy – Some evidence suggests that if one leg is longer, it is likely to be the preferred take off leg when jumping, thus leading to an increase in repetitive loading compared to the other leg (Van der Worp et al., 2011).
Low or flat arches in feet – Running research shows that those with low arches are more subject to knee injuries than those with high arches due to the increased knee bend (and subsequent forces) when running (Van der Worp et al., 2011).
Poor flexibility – Tight quadriceps (muscles at the front of your thighs) and tight hamstrings (muscles at the back of your thighs) are thought to increase strain on the patellar tendon during exercise (Van der Worp et al., 2011). This is thought to create an overload effect as the tendon is under more strain compared to what it would be if the muscles weren’t tight.
Treatments for Jumper's Knee (Patellar Tendinopathy)
Load management!
The first step for rehabilitating from patellar tendinopathy is reducing the intensity and frequency of high patellar tendon loading activities (e.g. jumping) (Everhart et al., 2017). The second key element is a robust exercise program, consisting of progressive tendon loading. This is essential for building tolerance in the patellar tendon, so that it can adapt to withstand desired loads (Breda et al., 2021).
Rest alone may reduce the pain but if you want to remain active or return to normal activity levels, you will need a well thought out strength program. Returning to the same level of physical activity without conditioning the tendon gradually, may lead to pain occurring again.
Our team at PhysioTec can build you an individualised program to suit your current pain and functional levels, and ensure your rehab program builds your muscle and tendon conditioning to a level that matches the sort of activity you need or want to do. The same program will NOT suit everyone's needs!
Address Contributing Factors
As mentioned above, recurrent or chronic presentations of patellar tendinopathy may warrant further investigation to other possible contributing factors such as weight, BMI, leg length difference, arch height and flexibility. Small interventions such as using orthotics for flat arches might be beneficial in helping relieve pain in some people.
Manual Therapy
Getting some “hands on” treatment by a physiotherapist can assist in reducing the pain associated with patellar tendinopathy in the early stages of rehabilitation. This might involve massaging tight muscles (such as the muscles at the front and back of your thighs or your calves) or mobilising stiff joints that may be contributing to overload at the knee (for example stiff ankles!).
How PhysioTec Can help with Jumper's Knee
If you’ve got knee pain and think it might be a patellar tendinopathy, the first step is visiting a physiotherapist. A PhysioTec Brisbane, one of our knowledgeable physiotherapists will be able to conduct a thorough examination to determine the cause for your pain and develop a management plan to get you back to what you love doing.
Book an appointment with one of our friendly physiotherapy team today!
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Author
This blog was written by Dr. Molly Connolly, one of our Sports Physiotherapists and Pilates Instructors. Molly's undergraduate degree was in Exercise and Sports science and she completed a PhD of the title: A multidisciplinary approach to understanding low back pain in elite adolescent tennis athletes. She also has a love of triathlon! Molly completed a post-graduate Masters in Physiotherapy at the University of South Australia.
You can read more about Molly here.
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References:
- Breda, S. J., Oei, E. H., Zwerver, J., Visser, E., Waarsing, E., Krestin, G. P., & de Vos, R. J. (2021). Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. British journal of sports medicine, 55(9), 501-509.
- Everhart, J. S., Cole, D., Sojka, J. H., Higgins, J. D., Magnussen, R. A., Schmitt, L. C., & Flanigan, D. C. (2017). Treatment options for patellar tendinopathy: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 33(4), 861-872.
- Malliaras, P., Cook, J., Purdam, C., & Rio, E. (2015). Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. Journal of orthopaedic & sports physical therapy, 45(11), 887-898.
- Van der Worp, H., Van Ark, M., Roerink, S., Pepping, G. J., Van Den Akker-Scheek, I., & Zwerver, J. (2011). Risk factors for patellar tendinopathy: a systematic review of the literature. British journal of sports medicine, 45(5), 446-452.