Jumper’s knee - patellar tendinitis

Do you feel pain when you jump? After you are done running, your knee hurts even when you rest? Do you feel pain even during the pressure? In the following article we will try to explain you the problematics of the „jumper’s knee” in detail and offer you possible options of therapy.

IMG 2217 fill 308x205JUMPER’S KNEE

The area where the tendon of the quadriceps (extensors/flexors of the knee) is attached on the shinbone (tibia), is very prone to various disabilities and injuries, because there is a great pressure in this area. If the attachment of the quadriceps muscle is overloaded, the pain is very often manifested in the area of the attachment of this muscles to the shinbone - directly beneath the patella. Overloading in this area restricts proper blood circulation along with the flow of the lymph, which supply the muscles and other tissues with oxygen and nutrients, but on the way back they cannot take the metabolites and waste which were naturally produced in the body. Blood and lymph therefore cleanse the body. If the tendon is overloaded for a long period of time, the attachment is being surrounded by harmful substances, which are gradually accumulating, and it can result in inflammation. „Jumper’s knee” is then manifesting as a pain in the area of the quadriceps tendon attachment directly under the patella. In case the knee joint was already injured before, the tendon could have taken a minor injury as well as other surrounding soft tissues of the knee. The differing pressure on the soft tissues in this area could have enlarged the range of the injury and problems as well.

Factors that are affecting the formation of „jumper’s knee”:

  • Long term overloading of the legs (running - especially into the hill, hard landing, long distance walking,...).
  • Muscle imbalance especially in the area of the feet.
  • Previous injuries of the legs, microtrauma of the patellar tendon, injury of the knee joint.
  • Incorrect walking or running stereotype.

Diagnosis

First manifestation is a pain in the area of the attachment, on touch, during a peaceful regime as well as during activity. If the calcium ions started to be stored and the tendon starts to calcify, it will be visible on the X-ray image. Another option is examination with the ultrasound, which can precisely reveal not only the areas where the tendon is affected by the inflammatory process, but also smaller injuries or parts of the tendon transforming to bone.

Conservative treatment

In drugstore you can get all kinds of ointments and gels which can for a certain time lower the pain, but their side effects often harm the body, as it is in case with corticosteroids (hormonal drugs). The doctor will offer you cortisone injection, which also contains corticoids, which will impair the tendon even more, and it will become more prone to injury. It is ideal to use ice compression in acute phase.

Temporary relief can be achieved also by standard rehabilitation procedure such as magnetotherapy, laser, electric stimulation or classic stretching. These physical therapeutic procedures and their effects do not bring solution for the source of the pain. The same way, stretching will become especially in acute phase problematic and it will only evoke pain. It is therefore ideal to include it into preventive treatment and regeneration.

Surgery

If you decide for operative treatment, you can expect invasive intervention during which surgeon will cut part of the attachment of the tendon below the patella, and then he will drill into the attachment in order to stimulate the repairing process. After the operation you will have the knee at least 4 weeks in a firm orthosis. You will be gradually able to walk without crutches, and after 6 weeks you will be able to slowly get back to the original physical shape. Sport or any other demanding physical activity will be possible after 3-4 months.

RECOMMENDED TREATMENT PROCESS

In acute phase, it is optional to limit the physical activity, or at least decrease the intensity, and focus more on the slow stretching of the leg muscles, especially the muscles of the front thighs. We recommend to consult with a professional what is ideal sport and everyday shoe. For a softer rebound and impact, shoe with a soft outsole or insole is better.

Focus on the sufficient relaxation and regenerative phase of your training. In acute phase use cold compress after the physical activity (warmth could only further support development of the inflammation) and do a thorough stretching. Relaxing massage or baths are also optional alternatives. You can massage the muscles yourself at home by using various massage tools, and apply compressions as well (not warm in acute phase).

Application of the the shockwave therapy

Nowadays the most effective treatment of the jumper’s knee is the treatment with shockwave. It is modern, non-invasive method, the so called ESWT - Extracorporeal shockwave therapy. There are two different methods used in the therapy.

  • Radial shock wave therapy - very strong shock waves, which are produced in the machine, and they get deep into the tissue thanks to the headpiece. This type of shock wave has the biggest effect on the skin and muscles, the waves then spread to the sides.
  • Focused shock wave therapy - unlike radial shock wave, focused shock wave has much higher effect, it is able to get beneath the surface and affect specific areas which are sources of pain or inflammation.

The main effect of the shock wave is the stimulation of blood circulation and lymph in the given area, as well as activation of the immunity system, which helps the healing process. Blood and lymph bring into the place of application not only oxygen and enzymes, which treat the inflammation, but also vitamins etc. they also take away the metabolites, various waste substances and calcium ions, which cause calcification. Natural repairing process is therefore accelerated 3-4 times faster, and there is a reason why you feel relief from pain directly after the first application. Because of the position of the tendon, it is recommended in case of jumper’s knee to combine application of radial and focused shockwave therapy.

Extensive clinical studies prove that the shock wave therapy is successful in 95%. According to our own experience from the clinical experience it is necessary to apply focused shockwave approximately 3-4 times in 7-10 days interval. The successfulness of the treatment depends on the parameters of the machine, (each producer differs), on the number of the shockwaves and therefore also on the energy applied into the problematic area, it depends on the chosen headpiece, and last but not least also on the experience of the therapist and his ability to include into the treatment process the surrounding structures, which have a functional relation with the damage of the knee.

What does the therapy look like at FYZIOklinika?

During application of the focused shockwave therapy, we always treat the soft tissues in the affected knee area with the radial shockwave therapy. For intensive deep massage, which will support the relaxing effect, we use massage headpiece V-Actor. After that we apply kinesio tape (elastic cotton band) which releases the pressure on the skin layers. It also stimulates the blood circulation, and it supports the effect of the shock wave even several days after the therapy.



Author:
 Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

Source: practical experience in diagnostics and therapy with the use of focused shockwave therapy, FYZIOklinika

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