treating patella tendonitis / jumpers knee

kike

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Jumper´s knee / patellar tendinopathy

If you´ve been diagnosed with jumpers knee then you´ll know about it, a pain that can go from anything to a light pain just below the kneecap right after training to a full blown crippler that makes sitting down on the bog for the morning routine absolute torture. If you´ve searched online than you´ll know that most of the treatments involve the RICE method (rest, ice, compression and elevation) and a good dose of ibuprofen, unfortunately this is only effective in the INITIAL stages of the injury and is useless for 95% of the people who have been dealing with it long enough to start worrying about looking for online help.

I have been dealing with injury since April 2016 had to pull out of RT just 5 days before starting and after an initial misdiagnosis that made it 10 times worse, 4 different Physios and a lot of spare time spent slaving over a laptop, I´m finally on the mend and with a decent level of knowledge to be shared but just so we´re clear. I AM NOT A DR.

I´m going to cover the basics of the injury because any online search should give a decent look at the anatomy and function of the patellar tendon and why the damage occurs.

The first step in treating this injury is understanding the difference between patellar tendonitis and patellar tendinosis, the treatments vary greatly as well as the rehab time and expectations

Patellar tendonitisis an inflammation of the tendon in response of to much stress and can be understood as a RSI (repetitive strain injury); training to hard for to long, a sudden increase in activity, inadequate foot wear... Or bad biomechanics that effect the knee function and lead to injury over a long time; Bad hip or ankle mobility or both, weak hips, ankles, core or all of them, tight thighs and calves... Generally the pain is only present after training and goes away within a few days, however if left untreated it will lead to tendinosis and then you will be Mega F*text deleted**text deleted*D for 3-12 months and not know what the hell is going on.

To treat tendinitis, use the RICE method for 2 weeks and then use steps 1 and 2 of the tendinosis treatment as a PREHAB method, you´ll most likely come back 5 times stronger and more efficient within a few weeks of working on the basics, it probably wouldn’t hurt to visit a Physio to get screened for the potential weaknesses by a pro.

Patellar tendinosis is a degeneration of the tendon structure caused from damage over a long period of time that has not been dealt with correctly. If you constantly exercise and don’t give the body enough rest and coupled with dodgy biomechanics, the damage to the tendon will be too much for the body to cope with and will eventually stop regenerating itself. Ibuprofen and ice won´t help at this point and can actually be detrimental to recovery.

Pain is present before and after training and in worse cases even during the activity, if not managed will eventually lead to the rupture of the tendon and to butcher knives of blood thirsty surgeons. The good news is that it is very manageable but it takes a long time and a lot of patience is required. Tendons take a minimum of 90 days to regenerate and mature the collagen fibres and these will regenerate in relation to the stress hat is placed upon them, so all rest and no play means that the tendon will never grow back strong.
 

kike

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He has a lot more material to look through and you can really work most of your body with his stuff although you look like a sadist most of the time. Investing in some mobility material will be really good for your general health as you can use it for your whole body and is great for recovering and will save you money in the long run by keeping most basic injuries at bay. I have a foam roller 20£, a cricket ball stolen, 2 ducked taped tennis balls found, voodoo bands (not sure how they work but they did help) 18£ and a mobility band which I borrowed. In all 38£ and really worth it.

-rehab step 2: core, glutes, hamstring and leg strength. Every other day for 2 weeks to allow for a strong mind muscle connection and allow the body to start adapting while doing the flexibility and mobility work every day

Your core is not just your abs and doing crunches will not work it. Your core is all the muscles that surround your belly and lower back, your arse and some could argue that upper back comes in to play. If you have weak and lengthened hamstrings, tight claves and weak peroneals coupled with a feeble core then you´ll be inefficient at running, doing push ups, climbing stairs... every athletic movement that you do and inefficient mechanics leads to injury as your knee has to make up for the saggy hips and rolling ankles. You have to address these weaknesses but you have to know why you´re training in regards to jumpers knee and to do it properly. Standard crunches offer very little in the way of core activation, involve to much of the hip flexors which tighten the hips and quads and hurts the knee and are a waste of time for everything except passing the RMFA.

The ideal thing to do is to work your core without overactivating those hip flexors that are already tight and over worked from your weak core

here are some great ideas to work with, choose 3 different exercises and do them for 3x15 each to start addressing those weaknesses.

You´re glutes are the biggest muscles in your body and are involved in EVERY movement you do, so it makes sense to have them strong and happy. There are1000s of exercises you can choose from; lateral hip raises, monster walks, hip pikes, side clams, glute bridges, glute thrust, blabla bla. Don’t over complicate it, pick 2 that you feel work for you, one that concentrates on hip abduction (kicking your leg out sideways) and one that focuses on hyper extension (your thighs kicking out behind you)so for example monsterwalks and reverse hypers and also do the Peterson step up. Do 3x20 of all three and really feel the burn to strengthen those glutes and start correcting the muscle imbalances.

The Peterson step up is great for addressing imbalances and focusing on cleaning up the knee joints movements and has a direct translation in to the next part of rehab.
don’t go past level 3. And really focus on keeping your knee in line with your 3rd and 5th toe and not going to far forward.

Your hamstrings will probably be weak from being stretched out all day due to the tight hip flexors and weak glutes but some basic work to get them strong again will also help the glutes recover proper function. Do 3x10 on the leg curl machine and 3x10 arabesques
 

kike

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Your leg strength involves your calves and peroneals. The calves are usually tight and thus weak, if some soft tissue and flexibility work has been involved before hand then they should have started loosening up by now and it´s time to strengthen them, think that the stronger the calves the more work they can take off the quads and in turn off the knees, and if the peroneals are strong then the ankle movement becomes more efficient and that means less pounding the road and more bouncing off. Try 3x15 of single leg calve raises and 3 x 20m heel walks.

-rehab step 3: specific eccentric loading of the tendon. 6 weeks to 3 months.

No one really knows why but eccentric exercises (the negative portion of the lift like going down slowly on a pull up) has a remodelling effect on tendons and helps the regeneration process. The single leg eccentric decline squat is the gold standard for jumpers knee rehab and although there is other evidence to suggest other rehab programmes, I´m only going to stick with what I have done. Also this is the exercise with which the Peterson step up has a direct relation to.

Perform 3x15 single leg eccentric squats on a slant board every day but don´t go all the way down to 90·,
if you don’t have a slant board handy you can DIY it by using anything that puts your foot at an angle, I used a step and a 20KG plate in one gym for a few weeks and it did the trick. You have to work on this and slowly add weight to the exercise, remember than pain on a 4/10 scale is acceptable both during the exercise and after a 24h period but if it´s less than all the better. Try adding 5kg a week as the tendon gets stronger until you´re working with around 35% of your body weight regularly, this should take about 6 weeks to 3 months depending on the damage of the tendon.

Carry on doing the stretches and the remaining strength work every other day to ensure that you are correcting the imbalances and also not falling back in to them.

-rehab step 4: HSR (heavy slow resistance training.) 6 weeks to 3 months.

Now that we have re-established some of the structure of the tendon, making it stronger and capable of handling load, we can now start to train with heavier weights and in a more sport specific way.

HSR training has been proven to provoke a better healing response than eccentric training over a 6 month period and has the added benefit of being more functional to athletes. The training model I used was slightly different from the following one but I designed my own one and this one was done by a pro. No need to do the single leg squats anymore and HSR is to be done every 2 days and slowly adding weight and reducing reps.

Here is a really good program written by DR. Jacob Harden:

Week 1:

• - Day 1 o Find best pain free 3 rep max followed by 65% x 3 x 12



• - Day 2 o Find best pain free 3 rep max followed by 70% x 3 x 10

 

kike

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• - Day 3 o Find best pain free 3 rep max followed by 75% x 3 x 8




Week 2:

• - Day 1 o Find best pain free 3 rep max followed by 70% x 4 x 12



• - Day 2 o Find best pain free 3 rep max followed by 75% x 3 x 10



• - Day 3 o Find best pain free 3 rep max followed by 80% x 4 x 8




Week 3:

• - Day 1 o Find best pain free 3 rep max followed by 67.5% x 4 x 12



• - Day 2 o Find best pain free 3 rep max followed by 72.5% x 3 x 10



• - Day 3 o Find best pain free 3 rep max followed by 77.5% x 4 x 8




Week 4:

• - Day 1 o Find best pain free 3 rep max followed by 72.5% x 4 x 12



• - Day 2 o Find best pain free 3 rep max followed by 77.5% x 3 x 10



• - Day 3 o Find best pain free 3 rep max followed by 82.5% x 4 x 8



Jacob R Harden, DC – Instagram: @dr.jacob.harden Monica L Wharton, DC – Instagram: @quaddoc
 

kike

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12 Week Heavy Slow Resistance (HSR) Training Progression For Patellar Tendinopathy

Month 2 - All training is written as weight x sets x reps. Percentages were based off of the daily rep max.

Week 5:

• - Day 1 o Find best pain free 2 rep max followed by 70% x 3 x 10



• - Day 2 o Find best pain free 2 rep max followed by 75% x 3 x 8



• - Day 3 o Find best pain free 2 rep max followed by 80% x 3 x 6




Week 6:

• - Day 1 o Find best pain free 2 rep max followed by 75% x 4 x 10



• - Day 2 o Find best pain free 2 rep max followed by 80% x 3 x 8



• - Day 3 o Find best pain free 2 rep max followed by 85% x 4 x 6




Week 7:

• - Day 1 o Find best pain free 2 rep max followed by 80% x 4 x 8



• - Day 2 o Find best pain free 2 rep max followed by 82.5% x 3 x 6



• - Day 3 o Find best pain free 2 rep max followed by 85% x 4 x 4




Week 8:

• - Day 1 o Find best pain free 2 rep max followed by 82.5% x 4 x 8



• - Day 2 o Find best pain free 2 rep max followed by 85% x 3 x 6



• - Day 3 o Find best pain free 2 rep max followed by 87.5% x 4 x 4



Jacob R Harden, DC – Instagram: @dr.jacob.harden Monica L Wharton, DC – Instagram: @quaddoc
 

kike

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12 Week Heavy Slow Resistance (HSR) Training Progression For Patellar Tendinopathy

Month 3 - All training is written as weight x sets x reps. Percentages were based off of the daily rep max. No rep max performed in Week 12 as we wanted to mitigate fatigue for an absolute pain free 1 rep max attempt.

Week 9:

• - Day 1 o Conservative 1 rep max followed by 80% x 3 x 5



• - Day 2 o Conservative 1 rep max followed by 85% x 3 x 3



• - Day 3 o Conservative 1 rep max followed by 90% x 3 x 1




Week 10:

• - Day 1 o Conservative 1 rep max followed by 82.5% x 4 x 5



• - Day 2 o Conservative 1 rep max followed by 87.5% x 3 x 3



• - Day 3 o Conservative 1 rep max followed by 92.5% x 5 x 1




Week 11:

• - Day 1 o Conservative 1 rep max followed by 80% x 4 x 5



• - Day 2 o Conservative 1 rep max followed by 90% x 4 x 2



• - Day 3 o Conservative 1 rep max followed by 95% x 4 x 1




Week 12:

• - Day 1 o 85% x 4 x 3 based off of Week 11, Day 3 rep max. No rep max performed in training.



• - Day 2 o 75% x 3 x 3 based off of Week 11, Day 3 rep max. No rep max performed in training.



• - Day 3 o Work up to pain free 1 rep max


If I would add anything it would be some single leg work like the single leg press to even out both sides and to make sure that not one side is stronger than the other, as well as all the other complementary work for the core, glutes, hams, calves...



............Return to running..............

It´s the main goal here due the fact that you won´t be much use in the RM if you can´t run.

After a few weeks of HSR training you should be able to start jogging, remember that it´s a long game and if it took you 3 months to build up to squatting your own bodyweight without pain then the same applies to running, and remember you need rest to recover so it´s a good
 

kike

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idea to train in 3 day cycles: day 1 train HSR method. Day 2 work on returning to running, day 3 we can train our upper body to allow the lower body full rest.

Start by combining short jogs with longer rest intervals, 1 minute running and 2 walking and then you can play around with the running and rest times.

-Week 1: 1 run 2 walk x 5 / week 2: 1 run 1 walk times x5 / week 3: 1 run 2 walk x 10 /week 4: 2 run 1 walk x 10... and so on, obviously this a conserved approach and anyone can get back in to it how they like and some will heal faster than others so it´s a case of testing, correcting and adapting .

Once you can run 20 min pain free at a comfortable pace then you´re practically there, slowly increase the speed and the time of your runs and start to add plyometric training to give the tendons the final boost. Single leg step up jumps and scissor jumps are what I started on, 3 x 6 with each leg and slowly progressed from there.

Remember to rest if you step up the intensity in a training session, remember to rest an extra day to give your body the chance to adapt.
 

A350-800

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this is a brilliant post not just for anyone with patella tendon issues but with other knee issues too. When I had it band issues the amount of misinformation and terrible advice from the general medical community and online running websites made the injury perpetuate and made dealing with it extremely stressful and long winded. A specialised post like this will be brilliant for anyone with a biomechanical knee injury in the future and your advice can be applied to many overuse injures around the body, thanks, especially all the rehab exercises and general strength program :) one thing I found frustrating when I had itb syndrome badly was not being able to do sit ups for fear of activating the overly tight hip flexors and TFL you mention in your post, I started a post on it a while back as I was frustrated with sit ups as they seem to do more damage than good haha :)
 
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kike

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thanks @A350-800 I wrote this because of the lack of info and know how frustrating i is to. I had to cut it short because I didnt want it to go on for to long but yes, this post can be used for a lot of lower body injuries because most come from the same place but just have a different result.
 

Hubb97

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Really appreciate you taking the time to post this. I can usually squat now without pain and have started working on the leg press machine also as well as doing eccentric squats with heels raised. To be honest running never really caused pain once I was fully warmed up but I could certainly feel it afterwards which was very frustrating. I'm currently trying to do slow intervals such as 1 minute jog 30 sec walk and seems to be going ok for now, can be a little sore when I'm on my feet all day though which is annoying. Will get there in the end!
 

kike

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@Hubb97 no worries mate, the reason I posted this was because of how frustrated I got. Lay off the running and stick to swimming or a static bike to keep your stamina up while you work on it, and the pain factor is a hard one to judge but I got to the point where I couldn´t walk and only got better a month ago so be patient and you´ll be sky high soon.
 

HoldFoldEm

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This is an old thread but been using it for recovering from Jumper’s knee and it’s helped loads!

Id suggest also listing which body part is tighter than the other and maintaining a consistent approach to stretching and working on mobility for these areas, I’ve seen a decent improvement in mobility in the last few weeks.
 
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