How to get rid of Patellar Tendonitis (Jumper's Knee)

Triathlon Forum
1

I was diagnose with Patellar Tendonitis also known Jumper’s Knee. I started noticing the symptoms around July 2012 and let it progress for 4 months to the point I was feeling pain during my runs and during squatting activities. For the past 3 months, I’ve stopped doing activities that did not aggravate it. I’ve iced it almost everyday and took Ibuprofen when needed. I’ve only been biking and running 1 mile a day. During that 3 month period, I went to PT for one month where they had me do lower extremity exercises and ASYTM treatments which helped. Today, I feel no pain during my runs or during squatting activities. I am at the point where I want to increase my running volume; however, I’m worried it might return again. When I palpate (message) over my petalla I feel a dull pain like there is still something there. I do not feel this dull pain in my other knee.

Strange part about this is I’ve been a runner for 12 years and I have never had this injury before until I started doing triathlons this past summer.

If any of you have had this injury, what did you do to get rid of it completely. Do I need surgery? Are there different treatment I should try.

2

surgery is always a ‘last resort’. Sounds like you’re good to go to bring back the running slowly and carefully.

3

Get checked out on the bike. Have someone take a smart phone and video you from the front. Good chance that its from the start of cycling since you mentioned thats when it started. If your knee is whipping in on the pedal stroke then you could be stressing the patella.

Strengthen your hips and knees. Eccentric strengthening and control is impt for getting rid of the bitch that pat ten is. Hopefully you can get it sorted out. Start small and build up. even a one mile to three mile jump is still a 200% increase…that can be a lot in a healing process.

4

First have you had your bike professionally fit? An incorrect fit could lead to anterior knee pain. Secondly, are you currently doing eccentric strength exercises during your Physical Therapy sessions?

5

If you havent already, buy a decline board and do your eccentric decline single leg squats religiously 3 x each day and it will eventually go away. The dull ache will likely remain. If it gets sharper, double your daily squat sets. Keep after it hard. This worked for me and I got through it.

http://runningwritings.blogspot.com/2011/09/injury-series-tendon-remodeling-part-ii.html?m=1

6

Find the source of your pain. Tight hips, unstable hips, tight ankle, unstable ankle, bike fit, etc. are all possibilities, but we’re just blindly throwing darts at a dart board and hoping we hit the bullz-eye. While there have been some good N=1 suggestions that’s what they are, N=1. No two people are the same and neither are two injuries. Find a professional who can intelligently determine the reason for YOUR knee pain and come up with a plan to fix the issue.

7

Find the source of your pain. Tight hips, unstable hips, tight ankle, unstable ankle, bike fit, etc. are all possibilities, but we’re just blindly throwing darts at a dart board and hoping we hit the bullz-eye. While there have been some good N=1 suggestions that’s what they are, N=1. No two people are the same and neither are two injuries. Find a professional who can intelligently determine the reason for YOUR knee pain and come up with a plan to fix the issue.

^^^Yes. Find a recommended ART practitioner in your area and make an appointment.

My son, a year round swimmer in high school who does a lot of dry land training, had been experiencing flare ups for over a year. In early December it got much worse. The school set him up with an orthopedic surgeon and PT. The PT has ben quite helpful, identifying the causative issues and prescribing the exercises to get better. After 5 weeks of slow and steady improvement we also sought out an ART practitioner and she seems to have had a significant impact on his rate of improvement.

David K.

8

Had it for 2 years but then it went away after religious IT band stretching. Mine was caused by bad running form and too many miles on crappy shoes. Any sign of soreness the shoes get replaced and I stretch and roll my IT band all the time. Every so often it might be slightly sore after a high mileage week but nothing like before.

I would just slowly ramp up the running miles and see what happens. A friend of mine had platelet therapy to help hers recover.

Good luck.

9

I had problems with this for a long time before I fixed it.

i did lots of leg extensions focusing on the last 3-40% of the movement, this strengthening the inner part of the upper leg.

easy to do, very effective. once you get that under control, SQUAT!!!

10

A foam roller has been the biggest help for me.

In August I was running only about 10 miles a week and my knee pain was so bad I couldn’t finish 3 mile runs. I rested it for a few weeks to do a sprint in mid September. The pain wasn’t gone, but I was nervous to push it on the run.

After seeing a physical therapist, I started rolling my ITBs before and after each run. I ran a 15k in November with no pain, and now I’ve been averaging 40 miles/week and ramping up for a marathon.

I think there are multiple causes for this type of knee pain. For me, it wasn’t form but tight ITBs. Once I addressed that, I started feeling better almost immediately. Although its felt fine, I also take advil after a long run just to help any potential swelling.

11

I had a history of fairly severe Patellar Tendonitis. The best results I saw came from doing Eccentric Exercises. I woudl highly recomend them. Here are two links showing how to do them. I did them 2-3 times a day, starting with no weight and gradually adding and increasing weight.

http://eccentric-exercises.blogspot.com/2007/12/my-eccentric-exercise-protocol.html
http://www.sportsinjurybulletin.com/archive/patellar-tendon.html

12

I was in the same boat and it always came back. I had surgery (i also ended up tearing a meniscus after years of tendonitis) And they did a platelet therapy where they take my blood and spin out the (white?) blood cells and then inject those white blood cells back into the affected areas of the knee to help it heal. PT didn’t help me at all, and long periods of resting my knee helped for awhile but it always came back, and each time it did it was worse than before. My damage was pretty bad, in college the basketball trainer was giving my cortisone injections once a month, and i had no idea what kinda damage i was doing until it was to late.While i still have some pain there, i had to give up basketball and much jumping, my 35"vertical is history. I can run and bike pretty much pain free, only time it will ever really bother me is after a ride where i stood up in the pedals more than usual. My advice would be to try the distance, if it doesn’t work out find a doctor that can do the platelet thereapy and do that, and if that doesnt work get the surgery and be done with it. Recovery for me was 4 weeks non weight bearing 6-8 weeks before i was walking ok 10-12 before i was doing any type of real exercising. However the meniscus part of the surgery is what caused the longer recovery.

13

Patellar tendinopathy is the new name for chronic jumper’s knee because by 4 months (as in your case) the condition is mainly non-inflammatory (i.e., not an “itis”) and unresponsive to anti-inflammatory therapies. So, don’t rely on ibuprofen, etc. or astym for pain control. Rather, eccentric exercise training on a 25 degree decline board (as was mentioned above) is the standard of nonoperative care. The persisting dull pain may be due to the presence of a large fat pad below the patella or new blood vessels that are characteristic of this condition. You could have an MRI (only if your mind is open for arthroscopic surgery) to check on whether your infrapatellar fat pad is large and you might consider injections with a drug called polidocanol that scleroses the neovessels. Athletic patients of mine who did not benefit fully from eccentric training had good outcomes with these procedures.

This condition is common in jumping sports such as volleyball, basketball, track&field, but uncommon in runners unless they run down hills hard a lot. If your knee pain is related to cycling, it is less likely from patellar tendinopathy and more likely from patellofemoral stress syndrome, which could be corrected by a proper bike fit.

14

I have only been doing walking lunges but not eccentric squads. I will give them a try.

15

I have had a bike fit (FIST tri fit) so my riding style should be pretty good. During PT I did have unstable ankle stability but its much better now after doing stability exercises. Some of the previous injuries I’ve had in my career are achilles tendonitis, tendonitis around the ankle in general, and Osgood slaughters when I was in my late teens. I do have tight IT bands and tightness in the legs but what runner doesn’t right. I will try some of the advise on this forum and I’ll let you know how it goes.

16

I have had a bike fit (FIST tri fit) so my riding style should be pretty good. During PT I did have unstable ankle stability but its much better now after doing stability exercises. Some of the previous injuries I’ve had in my career are achilles tendonitis, tendonitis around the ankle in general, and Osgood slaughters when I was in my late teens. I do have tight IT bands and tightness in the legs but what runner doesn’t right. I will try some of the advise on this forum and I’ll let you know how it goes.

Must admit that I am fishing here, but your history of Osgood-Schlatter’s raised my curiousity to ask: 1) Did the O-S resolve by itself or were you treated for it? 2) Do you have “excessive” flexibility in your ankles, knees, or other joints? 3) Long fingers? 4) Osteoarthritis in your knees?

17

The O-S resolved itself. I have excessive flexibility in my ankles. I can barely touch my toes stretching so my hamstrings are a little tight. I do have long fingers (not sure what that has to do with anything…lol). I don’t believe I have osteoarthritis in my knees; however, last summer when I started riding I believe I was showing symptoms of patellofemoral syndrome in my “good” knee but it went away after my leg muscles got stronger. I am 25 years old. Runner for 12 years and serious biker for 1 year.

18

My concern with those questions is that you might be at risk for early osteoarthritis. However, you seem to be on the right track (with the advice of your PT) for rehab and prevention. Your PT will know better, but comprehensive balance training may be necessary to stabilize your “loose” ankles. As others have suggested, continue to strengthen your quads with eccentric exercises (try a decline board) and a lower-extremity stretching program could be helpful, too.

The dull pain that you feel under your patella might not go away if the cause is space-occupying tissue like a large fat pad or neovessels. Maybe you can live with it?

19

Sorry to hear about your problem, I hope to recover soon.

Patellar tendonitis is relatively common cause of pain in the inferior patellar region in athletes. It is common with frequent jumping and studies have shown it may be associated with stiff ankle movement and ankle sprains.

Our medical orthopedic team use a new method for patellar tendonitis treatment without surgery, steroid or physiotherapy … this method is “Stem cell therapy”

Stem cell therapy is an amazing strategy in treatment which depends on regenerative medicine to produce a new healthy instead of diseased inflamed tendon.

Contact us for free consult at

http://stem.md/

20

How does “Jumpers Knee” differ, if at all, from “Runners Knee”??

I have the latter, was diagnosed by Ortho last fall w/ patellar tendonitis. X-Rays were negative. No MRI done.

Came on at the finish of a half mary last Sept, which otherwise went great. Crossed the line, and immediately felt stabbing pain in my L knee.
Had never had any issues whatsoever like that prior. (that knee had meniscus scoped a decade ago, been fine since)
It was a borderline pancake-flat race, not sure why I’d have this issue there, vs a normal training run - it’s hilly where I live.

After getting the OK from the doc, I resumed training for NYC (f’n Sandy, grrrr), and worked around it as best I could.
Took 2+ weeks off from running after that race (due to calf “heart attack” that hit during Harrisburg mary at mile 18 - ugh.), and ran very minimally/sporadically for the next few months.

Had a recurrence of the calf issue, and the knee was bothering me more, so I stopped running again, this time for 5 weeks.
Was doing a lot of downhill skiing, and got tired of it bothering me while doing that. It worked - I had decreasing problems each week, and near the end it was hardly bothering me at all. Thankfully biking isn’t affected by the knee (or calf), so I was able to keep riding.

Upon resuming, the calf has been ok , and the knee went from pretty good initially, to more acutely and chronically painful thereafter.

Short of flying to Germany to spend time w/ Kobe Bryant’s “doctor”, what are the other options??
(besides surgery - I’d like to avoid that, if at all possible)
I’ll defintely try the decline board squats, and foam rolling the ITBs for starters.