di. nov 30th, 2021

Dear readers,

As many as 1 out of 6 runners deals with jumper’s knee. What is this injury all about? What causes this injury and how can you treat it?

Recently I finished a training session with some pain at my knee, this didn’t feel right at all. As a result, I visited the osteopath next day. He diagnosed the injury as jumper’s knee.

So.

1. What is Jumper’s Knee?

It looks like this:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/patellar-tendonitis-jumpers-knee

The definition is as follows:

Jumper’s knee or patellar tendonitis  is a condition characterized by inflammation of your patellar tendon. This connects your kneecap (patella) to your shin bone (tibia). Jumper’s knee weakens your tendon, and, if untreated, can lead to tears in your tendon. Jumper’s knee is caused by overuse of your knee joint, such as frequent jumping on hard surfaces. It’s usually a sports-related injury , linked to leg muscle contraction and the force of hitting the ground. This strains your tendon. With repeated stress, your tendon may become inflamed ( source )

2. What causes this injury?

About the causes, I understood that it mainly relates to overuse:

It is an overuse injury from repetitive overloading of the extensor mechanism of the knee. The microtears exceed the body’s healing mechanism unless the activity is stopped. Among the risk factors for patellar tendonitis are low ankle dorsiflexion , weak gluteal muscles, and muscle tightness, particularly in the calves, quadriceps muscle, and hamstrings . ( source ).

It may be associated with stiff ankle movement and ankle sprains.

In principle, four stages can be distinguished:

  1. Pain only after activity, without functional impairment
  2. Pain during and after activity, although the person is still able to perform satisfactorily in his or her sport
  3. Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level
  4. Complete tendon tear requiring surgical repair

3. How can this be treated?

It seemed quite remarkable to me, according to many articles which I read, not so much is known about effective treatments! :

  1. Evidence for treatment is poor. In the early stages rest, ice, compression, and elevation may be tried.
  2. Tentative evidence supports exercises involving eccentric muscle contractions of the quadriceps on a decline board. Specific exercises and stretches to strengthen the muscles and tendons may be recommended, eg. cycling or swimming.
  3. Use of a strap for jumper’s knee and suspension inlays for shoes may also reduce the problems.
  4. Corticosteroid injections and NSAIDs are often recommended (Source).

However, I read many bad things about injections, because they weaken the tissue over time. As such, they significantly increase the probability of a partial or a full rupture, at some point in time.

On the website of UMC Utrecht , I read that quite often, a mix is recommended:

  • Alternative / dosed sports load below the pain threshold to maintain the basic condition.
  • Intensive exercise therapy for the patellar tendon (eccentric exercises).
  • Optimizing the static.
  • Improve trunk, knee and ankle stability through exercise therapy.
  • Supportive measures such as patella strap, ice massage after load, etc.
  • Stretches hamstrings and quadriceps if there are muscle shortenings.

4. Any alternative treatments?

Well, there seem to be some alternative treatments like:

  • a) PRP : Platelet-rich plasma therapy. This practice involves injecting the site of the injury with the patient’s own platelet-rich plasma in an effort to accelerate healing.
  • b) Dry needling : a needle without a syringe is inserted into the affected area and moved, with the guidance of an arthroscopic camera, in an effort to break up or destroy degenerative structures within the knee that may be contributing to injury.
  • c) Hyperthermia thermotherapy : this process involves using both a heating source and a cooling source to raise the temperature of internally damaged tissues (in this case the patellar tendon) while allowing the surface level tissues to stay cool.
  • d) Shockwave treatment : this procedure, also known as ECSW, involves sending electric impulses into the muscle tissue surrounding the patella to deliver force to damaged tissues. The force from the electric waves can help to do away with damaged or torn soft tissues. (source)

But I found little evidence as to what extent these alternatives are effective, or not.

5. Can this injury be handled by means of surgery?

Jumper’s Knee is apparently an injury to take seriously. After some time, the acute injury can become chronic:

Continuing to exert the patellar tendon after experiencing the initial signs of jumper’s knee (mild inflammation and swelling) can cause the acute injury to become a chronic condition. With this in mind, athletes who find that the initial symptoms of jumper’s knee are not easing with a few days rest should seek out medical evaluation to determine the best ways to prevent further injury ( Source )

If nothing really helps, surgery can be considered.

This seems to be the last kind of treatment to be considered, because it is invasive and above all, because recovery after surgery takes a long time:

If all measures fail over a period of six months, surgical treatment can be opted for. All the inflammatory tissue is cut from the tendon through an incision at the front of the knee. This operation itself does not take that long and is not that drastic, but it is a long rehabilitation. After the operation, a brace is applied that keeps the leg stretched for 2 weeks. Afterwards, the brace is progressively loosened so that you can bend completely again, about 6 weeks after the operation. The first month should also be done with two crutches and then another 2 weeks with 1 crutch. The reason for this slow rehabilitation is the risk of otherwise tearing the tendon, which is weakened by cutting out tissue. ( source ).

In this scenario, you should assume a recovery period that lasts for quite some months.

6. Let’s get started.

In conclusion, before trying exotic treatments, I will go for exercises first!

For example, I found some lunge variants that could do the trick: https://youtu.be/oqqnmOJD3XA

Of course, if readers have any advise, many thanks in advance!

With kind regards,

Peter

P.S. version in Dutch? : Link: Jumper’s Knee – Marathon Running Blog

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