Every athlete has experienced pain in the knees at some point. The stress of
repetitive motion in running or cycling, sprinting up and down a basketball court,
football field or back and forth on a tennis court puts a lot of wear and tear on one
of the bodies biggest joints. A little soreness from time to time is normal, but
sever pain could mean the onset of jumper’s knee or patella tendinitis.
The patellar tendon connects the kneecap (patella) to the shinbone (tibia). Its
very important job is to help your muscles extend your knee to say, kick a ball,
run hill intervals or jump in the air for a rebound.
Patellar tendinitis (or PT for short in case) commonly afflicts athletes who play
sports that involve frequent jumping like basketball or volleyball, hence the name
jumper’s knee. It is not limited to those types of athletes, however.
What A Pain In The Knee
If you are an athlete or very active, pain in your knees is not something you are
unfamiliar with. It possible you won’t even realize you have a problem until you
start engaging in physical activity. After an intense workout you might feel some
discomfort in the knee and not realize this is a common first symptom of PT.
Often times the pain from PT will subside after a few minutes of physical activity,
like during your warm up, so it’s not unusual for athletes to dismiss the pain and
continue doing the very thing that is causing it.
So the pain goes away a few minutes after you start your workout and if it returns
later, you will most likely write it off to being hardcore. This kind of neglect is the
worse thing you can do because you are only exacerbating the problem. If you
don’t take action, though, the pain can increase.
Besides pain, other early symptoms of jumper’s knee are swelling beneath the
kneecap and an unstable feeling in the joint. Left untreated, eventually patella
tendinitis will start to interfere with your daily activities and make climbing the
stairs or getting out of your Lazy Boy difficult.
It’s time to call your doctor and treat the symptoms of PT right away if you want
to avoid worse, more permanent damage to the tendon, surgery.
A Stress Mess
Your doctor will tell you that patella tendinitis is an overuse injury. The stress
inflicted on the patellar tendon from repetitive jumping, running, or bending your
knees in pursuit of personal glory causes tiny tears to develop in the tendon.
There are other risks factors that can lead to PT. If you have tight leg muscles,
which reduces flexibility in your quadriceps (quads) or hamstrings (hammies) you
increase the stress on the patellar tendon.
An injury unrelated to your knee could cause a muscle imbalance to occur. Say a
stress fracture in your ankle or hip pain, which alters your run gait or the way you
move in anyway. You can also become muscularly unbalanced if you are always
engaging activities that keep your muscles in one plane of motion like cycling or
running. The quads and calves may become overdeveloped leaving you with
weaker hammies or hip abductors. The resulting uneven pull on your tendons
can cause tendinitis.
When the imbalance starts to wear on the patellar tendon and those tiny tears
start to multiply inflammation and pain are the result.
Athletes and other really active types are usually their own worst enemy because
they are conditioned to “push through the pain.” However, being “hardcore” and
ignoring the painful warning signs your body screams at you can make the tears
in your tendon larger and larger until it can no longer perform its job and
suddenly your sleeping on the couch because your bedroom is on the second
Other symptoms of PT are pain before, during and after your workouts. Swelling,
the knee joint locking up, and instability. If taking a few days off from your more
strenuous workouts and RICE (rest, ice, compression and elevation) doesn’t
relieve the symptoms, then you have a problem.
Patellar tendinitis is just one stop away from the more sever pain train called
patellar tendinopathy, which is degeneration of the tendon, so get yourself to a
doctor right away.
Be A Boy/Girl Scout
You’ve heard the motto, “always be prepared, right? That is a good one to heed
before you see your doctor for debilitating knee pain.
Before you head to your appointment you can find some relief from your
symptoms with rest (duh) and ice. This will not fix the problem, if you just return
to the sports and activities that caused the problem too soon.
Your family doctor might do an exam and then refer you to a sports medicine
specialist and this is really the best way to go. These doctors have advanced
training in diagnosing and treating musculoskeletal problems.
Tell your doctor in great detail all the symptoms you are having, when the pain
first started, not just when you couldn’t make it up the stairs anymore. Have a list
of all your past sports injuries and medical conditions you have been diagnosed
with and all the medications, including supplements you are taking when you go
to your appointment.
Be sure to note any injuries you may have sustained to other parts of the body,
and not necessarily while doing something sporty. If you twisted your ankle trying
to avoid stepping on the cat or wrenched your back loading your daughter’s Girl
Scout Cookies into the back of the mini-van don’t keep it to yourself. These
seemingly unrelated injuries, might be related, after all, so don’t disregard them.
So what should you expect during your examination? Since pain from PT is
usually concentrated on the front of your knee, a little bit below your kneecap, the
doctor will probably start there. He/she will apply pressure to different areas of
the knee to determine your pain center and level and see if it is anywhere else
around the knee.
The next step is probably some imaging tests. An X-ray, will not show a patellar
tendon problem, but could reveal bone issues that might be contributing to it. An
ultrasound will use waves to create an image of your knee so that your physician
can see exactly if and where you have tears in your tendon. An MRI is rolling out
the big guns, but it will give you the most complete, detailed image of your knee
and tendon, revealing even the tiniest tears.
Jumpers knee has four categories or grades:
1. Grade one: The pain is only present after training or a workout. This is
when you stop engaging in strenuous physical activity, elevate the leg,
apply ice, and take it easy for a couple of days.
2. Grade two: Pain is experienced before and after strenuous activity but it
goes away after a warm up. Do all of the above, but more frequently.
3. Grade three: The pain is always present and starts to inhibit your
performance. At this point it is probably a good idea to seek medical
4. Grade four: The pain is present all the time and inhibits normal everyday
activities (stairs, standing after prolonged sitting) You are in trouble and on
your way to permanent damage that rest, pain relievers and ice can’t fix.
Good News and Bad News
The bad news is, you have patellar tendinitis. The good news is you only have
patellar tendinitis, not the more sever tendonopathy. The even better news is;
there are a lot of non-surgical, minimally invasive treatments that you can try that
will probably clear up the problem.
First, you can take a pain reliever and anti-inflammatory like ibuprofen (brand
names are Advil or Motrin). For longer-term relief try naproxen (Aleve).
Next, you need to do a variety of physical therapies to get rid of PT symptoms
and strengthen the knee since it and the tendon have weakened when
surrounding muscles attempted to compensate for your injury.
Stretching is key. You should already be stretching after intense workouts, but if
you haven’t now is the time to adopt a very good habit of doing so. Regular,
steady stretches will reduce muscle spasms, cramps, and lengthen leg muscles
that can become knotted and tight from constantly contracting during prolonged
strenuous physical activity.
Some standing stretches you can try are:
• Hamstring stretch – Place your foot on something flat, stable and only
hip high. Fully extend your knee and then bend slowly forward until you
feel a stretch in the back of your thigh and knee. Hold it for at least 20
• Quadricep Stretch – Hold on to something sturdy and stable for balance.
Then lean backwards slightly while bringing your foot up towards your
gluteus maximus (buttocks). Pull your foot as close to your glute as
possible keeping your knees together so that you feel the stretch in the
front of your thigh
• Calf Stretch – A foot or two away from a wall, lean into it placing your
hands or forearms against while keeping first one foot and then the other
flat so that you feel a stretch down the back of your calf
• IT Band (iliotibial band) – Since this band runs down the side of your leg
and is in direct contact with your knee it is important to stretch it. You can
use a foam roller to apply pressure and stretch it or do a standing stretch.
Cross your right foot over your left and shift you weight to the left foot Next
rock you hips gently back and forth until you feel a stretch down the side
of your leg. Switch legs.
There is a right way and a wrong way to stretch. Do not bounce during your
stretches. Ease into them and hold them for several seconds at just the point
where you feel tension and maybe slight discomfort. Before you begin the
stretches warm up your muscles with five minutes of light cardio such as a spin
bike or just marching in place.
Ice and compression can be especially beneficial in reducing inflammation and
pain. Putting an ice pack on the knee on a regular basis will reduce swelling and
increase the knee’s mobility. You can also try some kind of knee support like a
jumpers knee support strap (infrapatellar strap) that encircles the leg just below
the kneecap. This changes the angle of the tendon against the kneecap, thus
changing the distribution of the force away from the tendon, and directs it through
the strap instead.
Strengthening exercises are the next step in rehabilitating your knee. Muscular
imbalances may leave crucial leg muscles weak which will increase strain on the
patellar tendon. Eccentric stretches are muscle-tendon contractions such as
lowering your leg slowly while you extend your knee.
You can typically lower more weight than lift it, which is part of the concept
behind eccentric exercises. For example, it is easier to lower the dumbbells in a
squat. It is crucial to perform the exercises with proper form and under the
guidance of a trainer if you are not well versed in doing those kinds of exercises.
Good old fashion lunges, with lighter weights to start, that you can gradually add
to, also help rehabilitate your knee without putting added stress on the tendon.
Be sure to use good form and perform the movements slowly at first.
Some other really good strengthening exercises for PT are wall squats, and step
More Good News
For an athlete, being forced into a prolonged period of inactivity can feel like
torture. The good news is with PT you don’t necessarily have to cease and desist
from all training.
It is a good idea to stop doing whatever it was you were doing at the onset of the
knee pain and take a couple of days off. Use that time to apply frequent ice
packs to the injured area, wear a compression sleeve if you have it and do lots
and lots of stretching.
To keep up your cardiovascular fitness you can go swimming. This will work your
upper body and core, challenge your heart and lungs but not put any additional
stress on your injured knee. Only do free style flutter kicks, not breaststroke
swimming, though, because of the way it distends your knee.
You can also ride a stationary recumbent or upright bike, just be sure to position
the seat a little higher or farther back and keep the tension very light. You also
ride your regular bike outside, but may need to move your saddle higher and
always stay in an easy gear.
Of course if you feel any pain in your knee, stop exercising and take some more
What The Doctor Orders
If your symptoms persist or get worse despite rest, ice, stretching and
strengthening exercises, your doctor can help. He/she will probably start with the
least invasion procedures that will have minimal side effects.
One option for reducing inflammation and relieving PT pain is Inotophersis. A
corticosteroid is spread on the skin of your knee, especially just beneath it. Then
a device with a very low electrical charge is used to push the medication past the
skin into the inflamed tissue below.
A corticosteroid injection is using a syringe to administer a cortisone medication
to reduce inflammation directly into the affected area. This can rapidly reduce
joint pain and restore full function to your knee almost immediately. There is a
very low risk of allergic reaction, so discuss that with your doctor first, but
generally this treatment is quick, and has relatively few side effects. However
some patients report that the injections are painful. The injections can only be
repeated every three months because there is an increased risk of joint damage
if you do more than that.
Platelet-rich plasma injections have also been used to treat the symptoms of
persistent patellar tendinitis. The plasma is injected into people with PT in hopes
that it will promote new tissue formation and heal the damage tendon. RPR, as
it’s known, is a relatively new procedure but is showing great promise in using
cutting edge technology, and the body’s own natural ability to heal itself.
If the damage to the tendon is so bad that nothing has worked to relieve the pain
and returned your knee and you back to normal activities then it’s time to
consider surgery. It really is a last resort and is rarely need to treat anything but
the worst cases of patellar tendinitis which by the time surgery is being
considered it has become tendinopathy.
Those who can benefit from surgery have damaged or torn the tendon to the
point that has started to degenerate. Thanks to technology, surgery can be
minimally invasive and still get great results.
During surgery the doctor will attempt to repair the worst of the tears in the
tendon. If the tendon has ruptured and needs to be reattached this is done by
passing the tendon through holes drilled in the kneecap. Sometimes graft tissue
is necessary to ensure the tendon is the right length.
There is a new surgical procedure that is less invasive. Using ultrasound, doctors
can perform what is called longitudinal tenotomies (cutting the tendon), which will
stimulate a healing response in the uninjured part of the tendon. It’s generally
treated as an outpatient surgery, too.
As is the case with almost any surgery there are risks and complications that you
need to consider. The most common problem associated with patellar tendon
surgery is weakness and a loss of motion. Scar tissue can accumulate and
cause stiffness in the joint and some patients will never regain full range of
motion in the knee. Post-surgical physical therapy and rehabilitation are crucial in
keeping this from happening.
Infection has also been reported. Any time a wound is created in the body there
is risk of germs and bacteria getting into the tissue. The risk of infection is
particular high in patellar tendon repair surgery. Surgeons will make every effort
to minimize the risk by using sterile surgical techniques and give the patient a
dose of antibiotics to prevent infection. If a patient does develop a post-surgical
infection this can slow down the healing process.
Embolus or blood clots are also a serious risk of surgery for a damaged tendon.
Usually blood clots form in vessels that have been damaged by surgery,
obstructing them. However they can migrate to other areas of the body and a
prevent blood from reaching vital organs like the lungs, heart and brain.
Of course there is always a risk of a bad reaction to anesthesia. While this is rare
it is something you should discuss with your doctors before you undergo surgery
to repair your patellar tendon.
Perhaps the worst part about undergoing surgery for PT is the prolonged time ti
takes to recover, anywhere from six to nine months. You will not be able to bend
your knee for at least five or six weeks after surgery. After a couple of weeks you
may be able to stand on your leg but must absolutely not bend the recovering
After surgery it is critical that patients begin physical therapy and rehabilitation to
restore range of motion and strengthen the muscles. This will be prescribed by
your doctor after about six to eight weeks. It can be a pretty grueling process and
will require patience and diligence in following your physical therapists
instructions, applying ice to reduce swelling, using compression and elevating
your leg as much as possible.
If you stick to the post surgical recovery plan and intense physical therapy it is
possible to have a complete recovery.
To avoid the pain and misery of patellar tendinitis prevention is your best friend.
Do not play through or push past pain. As soon as you notice knee pain take a
break from whatever your doing, apply ice to the area and rest.
Keep all the muscles in your leg strong by conditioning and strengthening all the
different muscle groups. Strong thigh muscles are essential for avoiding tendon
damage. Regularly doing wall squats, one leg squats and other eccentric
exercises will also help prevent the onset of PT.
Improve your form. Whatever your sport of workout of choice, be sure you do it
with proper form. Wear well fitting shoes, learn how to lift weights properly, make
sure you are stretching correctly, not bouncing through the stretch, and always
warm your muscles up before you stretch them.
With a few lifestyle changes and vigilance when it comes to monitoring pain you
can avoid the pain of jumper’s knee and keep on keeping on.