Mike Nicholls, B.Sc., M.D., C.F.P.C., Diploma Sport Medicine

 

Dear Doctor:
When I am jumping, kicking, or running, my knee hurts. A friend mentioned a term called “jumper’s knee” or “patella tendonitis”. What is this and how is the best way to treat it?

Of all overuse sport injuries anterior knee pain, or patellar femoral pain, is one of the most common. Patellofemoral or anterior knee pain is only a symptom and can be caused or contributed to by a variety of problems such as trauma, leg alignment or length abnormalities, foot problems, patellar tracking problems, patellar subluxation, vastus medialis tendonitis, quadriceps tendonitis, iliotibial band (ITB) tendonitis, or patellar tendonitis, to name a few.

Patellar tendonitis or jumper’s knee is pain anywhere between the lower end of the patella (knee cap) and the attachment of the patellar tendon with the lower leg bone (tibia). Most commonly painful areas are at the lower end of the patella and near the attachment at the tibia (tibial tubercle). It is thought that the pain is a result of inflammation and microscopic tears in the patellar tendon. Factors that seem common to this injury are certain at-risk sports (jumping and running) and the practice of training at one sport “year-round”.

Taking a careful history is the most important step towards making the diagnosis of jumpers knee. In most cases the pain has been of gradually onset, was not the result of an injury, is worse during or immediately after activity, and particularly worse with activities such as running, stair climbing or jumping. A multitude of intrinsic factors (being “knock-knee-ed”, flat-footed, obese or inflexible) and extrinsic factors (hill-running, excess shoe-wear, running on uneven terrain, or excessive activity) can precipitate or predispose to developing jumper’s knee. The patient will often have been able to continue activities for up to several months while experiencing pain. A careful physical examination is also extremely important in ruling out other causes of knee pain both serious and benign. For example, many serious hip problems in adolescents can initially present as knee pain.

In a growing adolescent, jumpers knee can refer to Osgood-Schlatter’s disease, or inflammation at the growth plate (apophysis) of the tibial tubercle. This is not a disease in the true sense but is inflammation that resolves usually once growing is completed. It is common between the ages of 8 – 13 in females and 10 – 15 in males. It can result in a prominent lump or bony nodule below the patella that becomes permanent and is only a problem for people who work on their knees (brick or carpet layers). Casting or surgical treatment is used only as a last resort.

Successful rehabilitation involves first making the correct diagnosis and identifying any precipitating factors. Rest, ice, proper warm-ups, avoidance of aggravating activities or actions, and anti-inflammatories can all be used initially. Once pain free, attention is directed to correcting flexibility or strength deficiencies. Modified activities that do not cause pain can allow an athlete to maintain a level of fitness without compromising injury recovery. Physiotherapy can be integral in identifying muscle imbalances, flexibility problems or training deficiencies and is an important part of recovery by teaching rehabilitation and maintenance exercises. Some athletes benefit from the use of patellar taping, orthotics or a patellar tendon brace depending upon associated precipitating factors. As the athlete progresses, sport specific exercises and a graduated return to practice is allowed.

Complications include the development of chronic pain, tibial tubercle avulsions, patellar stress fractures and patellar tendon ruptures, but thankfully these are rare.

Although rarely a serious problem, patellar tendonitis can be an extremely frustrating and challenging problem for the athlete, coach and medical staff. If taken lightly symptoms can persist for many months and occasionally many years. Early aggressive therapy is best. With a conscientious effort from the athlete and guidance of the medical team it can also be a very gratifying problem to overcome and prevent. Don’t let Jumper’s Knee keep you grounded!