If you are feeling knee pain on top of the kneecap, then this one is for you, you may be suffering from jumper’s knee.
Patellar tendonitis / jumper’s knee is a very dynamic condition as it’s not easy to pinpoint and isolate the problem so we need to look at the hips, knee and entire leg as a whole. The pain on the kneecap is simply the symptom, but your tightness, lack of strength and recovery all contribute to this.
How your body works
Your body isn’t just simply a mechanical structure or machine that pushes and pulls. Your body is an intricate collection of connective tissues that all work together and push and pull on each other in various ways and various degrees. So simply pinpointing the issue to your knee doesn’t tell us the whole story. The pain on the knee is merely the symptom. You’d most likely have to use your bum to fix your knee.
What is Patellar Tendonitis?
Patellar tendonitis / patellar tendinopathy is more commonly known as “Jumper’s knee” as this condition is mainly found in under active adults in jumping / repetitive impact activities like basketball, volleyball and football / soccer. The research done indicates that most active adults who engage in functional own body weight training typically indoor and at home usually suffer from this. There are cases of runners and CrossFit athletes experiencing this as well as repetitive concentric to eccentric powerful knee flexion to knee extension forces may lead to this condition.
How can you pinpoint the pain?
It is a localized pain on top and just below the kneecap / patella. The pain can occur suddenly, or it may build up over a period.
The patella tendon and quad tendons are tremendously strong. They can withstand forces of 10-15 times your body weight. It is largely thanks to these tendons that wrap over the knee and attach to the shin bone that generate the torque necessary for lifting, jumping and running.
The stiffening and hardening of these connective tissues due to adaptations in the program is all normal and to be expected through regular participation. So far you are all good. The problem occurs during a phase of de-conditioning. De-conditioning is a break in training when your muscle size decreases, strength decreases, and the tendons are no longer accustomed to the heavy / repetitive resistance you place on them.
Patellar tendonitis is mainly caused by unexpected tension overuse. I want to focus on the ‘unexpected’ part of overuse as we discussed in blog part 1 of the knee series, as this is a common occurrence. Yet we find jumper’s knee among athletes who have had a very disciplined routine for years. It’s not just beginner or intermediate athletes who suffer from this condition. The clue is in gradually building up the training program after a long break. The body and joints cannot always perform to the extent of what the mind or ego wants to perform at.
Do I really have Patellar tendonitis?
I have included 2 easy tests to check if you have patellar tendinitis. You can try these where you are sitting and reading this right now. These tests are safe, and nothing can go wrong. I’ve asked Coach Marnus to join us in this demonstration. You’ll have to ask a friend to assist you in this one, life is always easier when you have good friends.
If you are experiencing the same pain specific to the same area when you are active, then this indicates a confirmed case of patellar tendonitis.
Test 1: Bent Knee Test
Test 2: Crossfriction Test
You’ll need another friend for the second test, its easy to follow. You can use the same friend as in the 1st test, but if they did a horrible job at it, it’s safe to say you need a new knee buddy 🙂
The main causes Patellar Tendonitis?
As mentioned before – when you take some time off your training , you’ll go from a conditioned state to a more de-conditioned state. If you could squat 100kg before you took a break from regular squatting – your muscles, tendons and entire knee system cannot squat the same 50kg on a regular basis if you haven’t been incorporating that into your training on a regular basis. That’s just the way things are.
Yet, that is what people do. After a break in training they jump in where they left off with the same 50kg. Others who are more cautious may drop 10% off that 50kg yet that still is not enough of a drop if you have been de-conditioned. A weight closer to 70% of your 1RM would be a good start. Or similarly a weight where you can perform 10 reps with relative ease is a good start to get back into things safely.
There is no / limited clear visible swelling with patellar tendonitis but the dull and aching pain on top, below and above the knee is very clear and can build up over time and become very serious. I’ve met individuals who have lived through this pain for up to 12 months. At that stage matters have progressed considerably and will need hands on professional help.
Early treatment
If you have only been feeling this pain for a few days or so then simply de-loading / removing the stimulus that causes the pain along with some conservative treatments should fix the problem.
Lessen the load, lessen the reps. Tendons provide particularly good load feedback. They communicate very well. Tendons become irritated because of too much / repetitive load or too heavy load. If you are experiencing a pain indication of 4/5 out of 10 as an example, you can apply ice, rest the area or lessen the activity and load. If the pain is less than 4/5 out of 10 about 24 hours after training, then your approach is working.
De-loading the weights and reps is a short term solution, but to fix this in the long run we have to incorporate easy to follow exercises to correct the relationship between the ankles, knees and hips and their surrounding fibers and muscles.
Corrective exercises
If you’ve been experiencing this pain for a number of weeks, then simply rubbing and icing won’t do and corrective exercises are needed. We are especially going to focus on hip rotator strength and VMO strength for knee stabilization.
You’ll also most likely have to adapt the way you train by focusing on correct form and driving your knees out over your toes when performing squats. If pushing your knees outwards isn’t something you’ve seen, you may want to start there as it is the only correct way to squat and protect those knees and ensure you strengthen the correct areas in the hips and knees, especially the gluteus / bum muscles. Driving the toes outwards will activate your glutes more and you definitely want to incorporate the largest and strongest muscle in the body when performing squats to support adequate hip and pelvis movement. You are especially focusing on the VMO / vastus medialis obliques that is responsible for knee stability and the gluteus medius responsible for hip rotation and stability during most lower body movements in sports.
Here are some very handy additional exercises you can perform to focus on the VMO and hip rotators. These exercises focus mainly on isometric strengthening so we are eliminating the quick flexion to extension movement in the knee.
- Reverse wall sits – to strengthen the entire knee complex and focus on the VMO. Complete multiple sets to accumulate 220 seconds in total, this is usually about 5 sets of 45 seconds.
- Standing side raises – focus on lifting the leg as high as possible as to activate deep into the side glute. Complete 20 reps of each leg for 3 sets.
- Stability Bulgarian split squats at 3 seconds decent. We are lowering slowly. 3 second decent on a 90-degree flexion is ideal for corrective knee exercises. You are lowering deep enough to mimic a half squat position; this is the ideal position to target the VMO. Place most of your weight on the front leg and minimal weight on the back leg. Complete 2 sets of 10 reps per leg
- Single leg raises – Again, we are focusing on the half squat depth as to activate the VMO and incorporating all the structures in and around the knees while the hips and gluteus are stabilizing the position. Complete 10 reps per leg and complete 2 sets.
In part 3 we are examining the pain on the outside of the knee. ITBS / Iliotibial band syndrome is no joke and unfortunately most individuals are going about the wrong way to correct it. If you have been foam rolling the side of your knee I’ll explain why this worsens the condition and why ITB issues originate at the hips.
Click here if you are frustrated with repetitive knee issues and are keen to join our tried and tested 12-week Body Transformation and rehab program.
Hannes puts the ‘personal’ back in personal training with dance moves to keep people entertained and a very hands on approach via conducting rehabilitation, sports specific conditioning and functional wellness training. He hosts wellness talks, seminars and writes exercise science courses and workshops. Hannes has qualified well over 1000 new and upcoming trainers and coaches through accredited course providers.
