Getting better from knee injuries depends on figuring out the problem. It’s important to match the injury to the treatment. Finding out what is stressing the area, causing pain, should be done by a trained therapist before starting rehab. This article is looking at if the tendon is the source of the trouble and how we approach it’s healing.
Jumper’s knee is often seen in people who do lots of jumping (ie. basketball, volleyball, racquet sport, ultimate frisbee). Pain is felt just below the knee cap, partly on the bone and partly on the tendon. Runner’s knee is pain felt around, under or on the sides of the knee cap. Tendon pain is located on the tendon between the knee cap and the shin bone. Often this is called tendonitis, which is used as a bit of a catch all phrase. In the end, what we do for both of them is similar.
How your whole leg moves, not just the knee, is often a cause of the problem and should be checked out during the initial session. Looking at just the knee can’t always explain why the tendon is becoming overloaded and injured as the knee just a piece of this puzzle. How the rest of the body moves around the knee can be the rest of the puzzle. These movement problems should be fixed at the same time as doing exercises to get the tendon to heal. Also, this could also be something simple such as doing too much in a short period of time, a change in shoes, or other stresses in life that are adding to the problem.
Tendons are made up mostly of collagen tissues which adapt differently than muscle and so need to be treated differently when injured. Often, people choose to play through the pain in hopes the pain will go away on it’s own. The result is an abnormal tendon, which has too many nerve endings and too much blood supply in the area. This means normal activities cause stress and pain on the area.
The treatment to remedy this problem is to stress the tendon with the right amount and kind of exercise. This stimulates the tendon cells to become stronger, and gradually it heals and becomes normal.
Exercise to Fix the Problem
The best place to start is isometrics (holding a position while flexing the quad muscle without moving). This has been shown to help decrease pain and adds starts to load to the tendon that needs to get stronger. While you are doing this, you should also be reducing any extra load you are putting on the tendon. You will need to modify what and how much you are doing that is using the knee. For a short period of time, doing less stairs, running, etc is best until the tendon has had the chance to heal. When the tendon is ready, you can restart higher intensity activities to slowly build up your tolerance.
Next we want to progress to heavy and slow exercises. The body responds to this by building up the area and making it stronger. You want to progressively increase how heavy you make the exercise, and also gradually increase the speed of the movement when you can. Start with simple exercises that just use the knee then move on to more functional exercises that use the whole body.
Because the body is continually healing, these exercises need to be done on a regular basis. Studies have shown that doing the exercises twice a day is sufficient, but if you wanted to do more, it doesn’t hurt.
So how do you know if you are healing or causing a new injury? A good rule used with success is to do the exercise until it becomes uncomfortable but not painful. So on a scale of 1 through 10, 2-4 on 10 is OK, any more is too much and would be a good time to stop. Also, if you feel the discomfort for longer than 20 minutes after you have exercised, that’s another sign you did too much. Likewise, if there is no discomfort at all, you are not doing enough and probably will not be getting the body to respond and heal itself.
At this point, we guide you to start to build your power and reactive type exercises. But only once you have enough strength to tolerate this! These are things like running and jumping. Being gradual is important to make sure we don’t step back with our progress!
Don’t expect quick results, however, you should progressively be able to move more and more weight. It is important to do these exercises each day to ensure continually stimulation. Less than that and the tendon will take longer to heal.
Finally we’d get you back to the sport you want to get back to. Again, progressively doing the things that were previously painful, letting the body build up tolerance in order so you can do them fully.
Progress is usually measured in weeks and months with these things, depending on how long you’ve left it before getting treatment. So you definitely need to be patient and stick with the exercises for a good while.
These same guidelines also apply to other body parts like the Achilles tendon, tennis elbow, golfers elbow or the rotator cuff, we’d just change the exercises to load the tendon that’s affected.
Have you had this type of injury before, what’s worked for you? Let us know if you have questions in the comments below!
Sharma, P., and N. Maffulli. “Biology of tendon injury: healing, modeling and remodeling.” Journal of musculoskeletal and neuronal interactions 6.2 (2006): 181.
Wilson, John J., and Thomas M. Best. “Common overuse tendon problems: a review and recommendations for treatment.” Am Fam Physician 72.5 (2005): 811-818.
Dimitrios, Stasinopoulos, Manias Pantelis, and Stasinopoulou Kalliopi. “Comparing the effects of eccentric training with eccentric training and static stretching exercises in the treatment of patellar tendinopathy. A controlled clinical trial.” Clinical rehabilitation 26.5 (2012): 423-430.
Robyn Edge is the therapist leading the charge of Movement Lab. She has an extensive background in her own athletic pursuits, and injuries, as well as an extensive background in functional rehab, functional training and injury prevention. Employing modalities such as acupuncture, myofascial cupping, and active release, she manages pain and promotes healing in addition to her active style of practice.