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Knee pain due to a jumpers knee
Information about the patellar tendon injury.
General
Cause
Symptoms
Exam
Treatment
What is a jumpers knee?
At the front of the knee are two tendons: the quadriceps tendon and patellar tendon. These tendons connect the quadriceps to the lower leg through the kneecap. Tightening the quadriceps muscles allows the knee to stretch.
A tendon is composed of collagen and is relatively poorly perfused. This allows the tendon to handle large tensile forces and store elastic energy during running, jumping and other forms of movement. The downside is that a tendon takes longer to recover after damage or overuse.
Tendinopaty is divided into three stages:
Tendinitis:
The tendon can become inflamed due to overuse with sports. Another cause is that the quality of the tendon decreases over the years. With minor strain/sport, the tendon can become overloaded. Sharp pain at the level of the tendon insertion is characteristic.
Tendon dysrepair:
When the tendon is not given enough rest and time to recover, the quality of the tendon can deteriorate. Small blood, and nerve vessels grow in the tendon and the ultrasound usually shows fluid. The ingrowth of the nerve vessels makes the tendon painful.
Degenerative tendon:
The tendon quality is greatly reduced due to long-term overuse from sports or aging tissue (age related, or after cast immobilization). The tendon is markedly thickened and very painful when loaded and touched.
How does a jumpers knee occur?
The two main causes of tendon complaints are overuse due to sports or decline in tendon quality due to the natural aging process. The complaints arise from a continuously high sports load (disturbed work-rest ratio) or a one-time severe exertion in the case of a degenerative tendon.
Knee tendon complaints occur primarily in basketball players, soccer players and practitioners of other explosive sports. The complaints usually occur when the frequency and/or intensity of training increases.
The reason why your teammate does not suffer and you do is difficult to explain. The cause for tendonitis is multifactorial.
- Running pattern (foot placement).
- Distorted alignment of the knee relative to the hip.
- Rigid landing technique
- Reduced strength around the hip and core stability.
- Reduced strength of the leg musculature.
- Stretching of the foot (flat feet or mobility of the big toe)
- Shoes
- Surface on which sports are played.
- Labor rest ratio.
- Intensity (height of jump) and volume (amount of jumps).
What are the symptoms and complaints in a jumpers knee?
Pain symptoms usually develop gradually. The first pain symptoms are felt after exercise. The pain is very characteristic and can be pinpointed with one finger. Localized swelling may be present. There is no fluid in the knee. The knee can extend and flex normally without resistance. The tendon may be stiff in the morning, which recedes as soon as you get moving. Climbing stairs, squatting and other activities with force on the knee may provoke the pain.
Tendonitis can be divided into 4 stages according to the Blazina classification;
Stage 1: Tendon pain after (sports) activity, which disappears after a rest period.
Stage 2: Tendon complaints at the start of the (sports) activity, which disappear during the warm up. After the (sports) activity, the symptoms return and disappear only after a longer rest period.
Stage 3: Tendon complaints at the start, during and after (sports) activity. Often there are also complaints during normal daily activities. Complaints disappear only after prolonged periods of rest.
Stage 4: Continuous tendon complaints, even at rest and normal daily activities. The symptoms also do not disappear after prolonged periods of rest.
How can you examine if you have a jumpers knee?
The examination at the general practitioner and physical therapist consists of an interview and physical examination. The location of the pain is most typical of a tendon complaint. The conversation should clarify the severity and cause of the symptoms. During the physical examination, on the one hand, the diagnosis is confirmed, but also possible causes for the complaint are examined. These findings lead to a treatment plan, which may be confirmed by ultrasound. Orthopedically, knee tendon complaints are operated on in exceptional cases.
What can you do about a jumpers knee?
An important part of treatment is teaching the client to deal with labor : rest relationships.
Rehabilitation can be roughly divided into four phases:
- Reducing pain.
- Build load capacity of the tendon.
- Functional exercise therapy.
- Sports-specific training.
Fase 1: Adjusting the ratio of labor to rest. Possibly anti-inflammatories or pain medication (ibuprofen, diclofenac or paracetamol) An isometric exercise program. This involves holding a knee angle, such as (for example, wall sits). Because of the continuous tension of the quadriceps, tension is required of the tendon. There is a pain-relieving effect from this.
Fase 2: By targeting the tendon with training forms, the tensile strength of the tendon can be increased. The emphasis here is slow and heavy training.
Fase 3: De training wordt uitgebreid met functionele en gerichte oefeningen. Hierbij gaat het om de stabiliteit, coördinatie en de gehele beweegketen optimaliseren.
Fase 4: Sportspecifieke oefeningen gericht op remmen, versnellen, springen wenden en keren als de sport deze vaardigheden vereist.
Een andere opbouw is:
- Isometrische oefentherapie
- Krachttraining
- Functionele training
- Snelheidstraining
- Plyometrie
- Return to sport/performance
Tips:
Matige pijn aan de kniepees is niet erg en kan weinig kwaad. Pijn die tijdens of na het sporten toeneemt is natuurlijk niet prettig. Het is in dat geval van belang om de belasting naar beneden bij te stellen. Herstel kan lang uitblijven en daarom is het niet gek om 1 tot 2 maanden de sportbelasting te reduceren. Sprint, spring en deelname aan partij of wedstrijden wordt afgeraden. Een alternatieve sport is een optie, of verkort te totale trainingstijden en frequentie per week. Het is altijd van belang om voorzichtig in beweging te blijven en fit te blijven. Een zorgverlener (fysiotherapeut, sportarts en/of huisarts) kan hier eventueel bij coachen.
