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Patella tendonitis, often known as “jumpers knee”, commonly affects athletes and participants in sports with the high physical demands of running and jumping. The condition develops as a result of overuse but can also be exacerbated by poor physical form during landings, exercising on an already inflamed or injured joint or more biomechanical problems specific to the athlete. These might include a loose kneecap, for example, or the natural overpronation (rolling inwards) of the foot. The inflammation of the patellar tendon causes degeneration over time, as well as significant stiffness and swelling. It can be made especially difficult to treat, as substantial rest is required to avoid making the condition worse or causing it to become chronic. Many athletes continue to train and participate in their discipline while suffering from patella tendonitis because they do not consider the pain to be too debilitating. However, the condition of the tendon can rapidly degenerate as a result and become increasingly difficult to treat. The rest period must then become longer, and the strength training and physical rehabilitation programme must be more extensive to regain full and effective function of the knee. In chronic or severely painful cases, surgical intervention may be necessary.
The American Journal of Sports Medicine recently published a study that found the highest rates of jumpers knee to be amongst athletes in volleyball, track and field and basketball — although footballers were also commonly affected. The particularly high occurrence in volleyball players (up to as much as 45% of cases) suggests that the specific action of jumping in the game may be more responsible than simply repetitive strain on the knee and surrounding ligaments.
Jumpers knee is accompanied by pain over the lower pole of the kneecap. This refers to the front of the kneecap, often towards the bottom. Fluid retention and swelling can cause the affected area to look thick or bloated. There is also likely to be tenderness to the touch and sometimes discomfort with the contraction of the quadriceps or thigh muscles. The action of jumping and landing is likely to cause the most damage and discomfort due to the jarring and pressure that it places upon the affected joint. Over-compensating on one side in an effort to relieve the pressure of jumpers knee can also result in further strain on other joints such as the hips and ankles and the unaffected side. The severity of the condition is usually graded from one to four by the patients themselves. A grade-one injury might only be mild discomfort after engaging in exercise, but a grade four would mean constant pain and limited function. Patella tendonitis commonly refers to an inflammation of the tendon, whereas patella tendinopathy usually refers to the degeneration of the tendon due to over-use. Both patella tendonitis and patella tendinopathy can become serious and chronic without treatment, however, and are commonly linked.
It is very common for athletes to continue training when they experience the initial discomfort or swelling of jumpers knee. They are often accustomed to some form of discomfort and often place an emphasis on completing training or building resistance. However, continuing to exercise on a severely inflamed joint can rapidly make the condition become chronic and easily aggravated. As the damage worsens, the treatment required will necessarily become more problematic and time-consuming too. What could have been a short few weeks of rest can quickly expand to months if athletes are not as disciplined with their rest and recovery as they are with their exercise. Ways to worsen the injury would be to continue to train and to fail to warm up and warm down correctly. This prevents the joints and tendons from being properly prepared for training. Engaging in sports that require jumping and rapid changes of direction can also be severely damaging. Incorrect training practices such as poor posture or form when exercising can place unnecessary strain on the joints and ligaments. There can also be weakness or poor functioning in the surrounding structures of the knee or thigh muscles that means other tendons are not adequately supported.
Keyhole surgery may be necessary if the condition of patella tendonitis has become chronic or severely painful. The choice of treatment will also vary depending on the level of activity that the athlete intends to return to. Athletes or sufferers who wish to return to a high level of intensive exercise may need more extensive treatment to regain full function for performance. Those who wish to achieve a stable and comfortable function of the tendon but do not intend to return to high-intensity exercise may be able to focus more on a rest and a gentle strengthening programme over a longer period of time. Surgery may not be required at all.
In all cases, rest will be the most important aspect of treatment. As the injury has arisen from over-use, it is essential that the weakened tendon and compromised structure of the knee are not placed under any additional strain. Failing to rest when the inflammation and discomfort are in their early stages can be what causes serious damage that requires surgical correction.
Professional advice and physiotherapy programmes are likely to incorporate eccentric exercises into their strengthening routine during recovery. These should be performed under the guidance of a professional so that discomfort levels can be safely monitored. Keeping the quadriceps and surrounding muscles supple and strong will help the knee to stay stable and able to cope with the demands of sport. It is also important to identify any potential problems with form, posture and biomechanics that may need to be corrected. Insoles can be used to prevent “rolling” of the foot so that no additional strain is placed on the knees and hips. This also makes a more stable base to land upon correctly if the athlete is still engaged in sports that require jumping. An overly tight iliotibial band or loose kneecap should also be addressed with professional attention and strength training.
With a combination of rest, raised awareness of the earliest signs of the condition, and adequate strength, flexibility and support with a brace, jumpers knee can be both prevented and treated.