Knee pain - again
What exactly is “jumper’s knee” and why isn’t it called “weightlifter’s knee” or “hockey knee”? We open SIB this month with an authoritative and practical account of the pathology which usually gets diagnosed as “patellar tendinitis” but which is more likely in most cases to be “patellar tendinosis”.
Dr Rod Jaques, the new medical director of the English Institute of Sport, explains: “It is thought that the first symptoms of patellar pain correlate with fluid or oedema in the patellar tendon, often close to the lower pole of the patella. Very little inflammation if any occurs and studies show degenerative changes in the tendon rather than any clear inflammatory process. This syndrome of degenerative change in the patellar tendon is called ‘patellar tendinosis’.
Patellar tendinosis is an occupational hazard for anyone involved in sports that subject the lower patella area to direct loading, rapid deceleration or high traction forces – which covers the main jumping sports but also, for instance, weightlifting and hockey (played on Astroturf, the traction forces can be extreme).
Usually there will be distinct tenderness at a particular spot below the kneecap, and possibly thickening in more severe cases. There may also be swelling behind the kneecap and some quadriceps muscle wasting. Authoritative diagnosis is best done, Jaques says, with ultrasound rather than MRI or X-ray.
Patella tendinosis is another of those sporting injuries that we still don’t have definitive scientific explanations for. Jaques favours mechanical impingement of the back of the patellar tendon, but stresses that there may be other, indeed multiple causative factors. Things to look out for include:
*weak quads relative to hamstrings
*very poor mobility of the lumbar spineJaques shares his preferred rehab technique with SIB readers, based on strict self-management of pain by clients, thorough assessment of hip mobility, and muscle strength and control from hip to leg, and a simple but powerful programme of eccentric exercises.
“The key to the rationale behind eccentric drills is that they are the best way of promoting tendon remodelling: the regrowth and reordering of collagen tissue in place of the fluid-filled degenerative tissue typical of tendinosis.”
For details of Rod Jaques’s rehab programme, read the new SIB.