Jumper’s Knee
Have you ever felt pain in the front of your knee, right below the knee cap? It tends to feel fine at rest, but is worse with jumping, cutting, or running, and then aches after? Maybe even hurts going down stairs or doing movements like squats or lunges when it’s really sore? If this sounds like you, it could potentially be jumper’s knee, otherwise known as patellar tendinopathy (tendinitis).
I’ve been there. For 2 years of competitive basketball and 5 years of recreational basketball, I struggled with knee pain that would limit my play and affect my daily life in the days after it was really aggravated. My story goes like this: Junior year of high school basketball, my knees started to get sore after playing. It really wasn’t all that bad, and I could play through it with no hiccups. Quickly, though, it got worse and worse. After sitting all day at school, we would suit up for practice and begin shooting around to warm up. Things would typically feel okay then, but once we started our full court layup lines, I’d inevitably take one jump a little too hard and flare up my knee to the point of limping. It would hurt the rest of practice, but I’d push through the pain and it would generally feel a little better by the end. However, the rest of that night and the next morning would be rough. Going down stairs was limp-worthy, but then later on, throughout the day as I’d move around they’d loosen up and start to feel a little better, just not fully. Then I’d have practice again and repeat this entire painful process until by the end of the season, my knees felt shot. I didn’t know there was anything I could do about it other than “make it through the season”. Fortunately, I’m happy to say, I still play basketball and don’t have knee pain during or after games (even though I do have far more gray hair), and it is not something that just has to be “dealt with”.
So, what is patellar tendinopathy? In short, it is a chronic overload of stress to the tendon right below the knee cap that causes it to weaken, and often becomes painful. The tendon’s role is to transmit force when muscles contract. They are essentially the “springs” of the human body, and when they are used as springs (like when jumping), they are stressed. In normal situations, this is a good thing, as this stress causes them to adapt and get stronger. However, if the stress is too much or too frequent with too little recovery, they can become overloaded, and eventually weaken. Now, unfortunately, when this weakening happens at certain parts of the tendon, it doesn’t typically heal. This is why resting alone is not recommended for this condition. If you do rest, you will most likely feel better until you return to jumping, cutting, and running, when people often have their symptoms return, just as I did year after year when basketball season would roll around.
So if I shouldn’t rest, but it hurts to play, what should I do? What you need to do is condition the tendon similar to how you condition yourself to be fit for your activity that is causing your pain. To get more fit, you exercise, rest, exercise again, rest, and repeat. This allows your body to recover between the exercise sessions, get stronger and overall more fit. Tendons respond in a similar way. Using the tendons like springs (like when jumping or running) is the hardest job for them to perform, while doing slow things where there is no spring effect is much easier on them. Generally, this “tendon conditioning” can start with loading the tendon with exercises where you hold still (isometrics). The Double Leg Decline Wall Squat Isometric is a great exercise to do just this. There will often be some discomfort with doing any of these. This is okay, so long as the discomfort is about a 3/10 or less, and it doesn’t hurt more the next day. That would be an appropriate stress where it can still recover.
“So, what is patellar tendinopathy? In short, it is a chronic overload of stress to the tendon right below the knee cap that causes it to weaken, and often become painful. The tendon’s role is to transmit force when muscles contract. They are essentially the “springs” of the human body, and when they are used as springs( like when jumping), they are stressed”
Now, we just did something slow for a while, but you still want to jump, which is fast. “How do I get from not moving to jumping?” Great question. We need to slowly add in speed and force. The next step is commonly taking similar movements from isometric to now adding motion to them, such as in doing a Double Leg Decline Wall Squat with a 3 second descent and 3 second ascent. This will allow heavy loading while also moving slowly.
“Wait, I still haven’t done any jumping yet, how am I supposed to play basketball?” Well, we need to start jumping!
“But, how?” We will tend to start with jumps that are both low intensity and jumps that aren’t overly hard on making the tendon “spring”. Things like Double Leg Pogo Jumps (or jumping rope) are a great low intensity jump that does use the spring effect, but is much less intense than, say, a Depth Jump. We can use exercises like this to “condition” the tendons to tolerate this stress and gradually build strength over time. There are other jumping options we can use to take the “spring” out of the jump. Exercises like Seated Box Jumps and Depth Drops are great choices to break up the jump and take away the “spring” stress while still moving fast. Progressing all of these is very much an art and taken at each individual’s speed, as everyone recovers and responds differently. We keep progressing these (while still doing the earlier loading) over time until the tendon is conditioned enough to play your sport. Often, working with a physical therapist to help guide you each step of the way will be the best route to get you back on the court and/or stay on the court, pain free.
For bonus information in video format, the guys at E3 rehab did an excellent job putting together an informative video with explanations and demonstrations as well which you can find HERE.