Friday, February 24, 2012

Patellar Tendonitis/Tendinosis or Jumper’s Knee

The patellar tendon links the kneecap (patella) to your shin bone (tibia). The quadriceps muscle and the quadriceps tendon allow your knee to extend.

Tendonitis refers to inflammation of a tendon. Tendonitis in the knee is commonly caused by activities that shorten the quadriceps, and that transfer force directly to the tendons of the knee. This force causes friction and inflammation of the tendons, making it difficult and painful to run, walk, or perform any weight-bearing motion.

Tendonitis of the knee is common in ball players, runners, cyclists and triathletes. It is also common in the elderly, or in extremely inactive individuals. Untreated tendonitis can eventually lead to tearing and rupture of the tendon.

Traditionally, tendonitis/tendinosis is treated by icing during the acute stages of the injury, reducing physical activities, and by the consumption of non-steroidal anti-inflammatory drugs (NSAIDs). These are short-term treatments that should only be applied during the acute stages of the injury. Most of these treatments are limited in their effects, and they provide only symptomatic relief – they act to reduce inflammation – but do not address the underlying biomechanical problems that caused tendonitis/tendonosis.

In addition, the long-term consumption of non-steroidal anti- inflammatory medications has several detrimental side-effects including gastrointestinal problems, ulcerations, and internal bleeding.

Treating Patellar Tendonitis with Soft Tissue  Therapy

Patellar Tendonitis, or Jumper’s Knee, usually responds extremely well to Soft Tissue Theapy (ART, Graston, Register Massage Therapy, Fascial Manipulation). The pain caused by Patellar Tendonitis is usually felt between your kneecap (patella) and its attachment point on your shin bone (tibial tuberosity of your tibia). Essentially, the entire knee capsule must be evaluated and any restrictions that are found need to be removed.

It is equally important to remove any restrictions in the quadriceps muscle since muscle fibers from the quadriceps combine at the knee to form the patellar tendon.

In addition to removing adhesions and restrictions, you should also address the following key factors to obtain a full resolution of this condition:
  • Strengthen Your Knee’s Kinetic Chain – It is important to perform exercise routines that strengthen and support all the elements of the knee’s kinetic chain even when that exercise does not appear to directly affect knee function.
  • Address Muscle Imbalances –The muscles that form the quadriceps femoris group can be incredibly strong. This strength has to be counter-balanced by an equivalently strong hamstring. When there is a large imbalance in strength between these two muscle groups, increased force is placed on the patellar tendon which attaches to the knee. Muscle imbalances in the hips and core also affect these structures, and need to be addressed for long-term resolution of the knee injury.
  • Reduce Obesity – Research has shown that carrying an extra 10 to 20 lbs of weight will greatly increase the stress on the patellar tendon. Weight management can be an important factor in resolving this condition.
  • Manage Your Training Intensity – It is important to pay attention to the onset of your patellar tendonitis. If you find that the condition occurs suddenly after an increase in training intensity, then you should be careful and restrict your increases to 5%-10% per week. Any increases above this level increases the probability of another injury.
  • Get Enough Rest – It always amazes me that people are so unwilling to give their body sufficient time to heal. Rest is a critical component of the healing cycle, so give your body enough time to heal between your workouts.
  • Wear Proper Footware – Good footwear is essential to the healing process, especially if you already have gait imbalances (over-pronation or supination).
By combining Soft Tissue treatments (ARTGraston, Register Massage Therapy, Fascial Manipulation)  with exercise, and by following the above recommendations, you can usually expect substantial functional improvements in your ability to perform your daily living tasks (climbing stairs, sleeping, running, and jumping) as well as a reduction in your pain.

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1 comment:

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