This is a tendinopathy of the patellar tendon - The tendon starts to degenerate because the strain taken through the tendon is greater than what the tendon can stand. this can occur in two ways - either because the tendon is overloaded in the plane it usually works - eg when you land from a high jump (basket ballers beware) or because you stress then tendon in a direction it was never designed to be stressed in - eg when the knee collapses inwards as you land when you run - this places a lateral stress on the tendon.
Symptoms are pain under the knee cap - typically in the fiorst few steps of a run and then after you have cooled down. this slowly gets worse and can, lead to sleepless nights and grumpy runners
Signs are fairly diagnostic -
pain worse when going down stairs, "Cinema sign" pain when sitting for long periods with a bent knee. and tenderness when you get your fingers under the lower pole of the patella (push the knee cap to your feet with the heel of your hand when the knee is relaxed and the leg straight. then get your fingers p under the lower border of the knee cap and push - OUCH
Cause - reaching for the ground as you run - so running down hill, and landing with a straight knee - especially if your impact point is ahead of your body
First aid - A patellar strap will make it feel more comfortable (Cho-Pat or similar). Icing can reduce pain but both these actually delay healing so should never be thought of as long term fixes.
this will not go away if you continue to run as you always do. You need to make a change - Either stop your knee collapsing inwards by bolstering the strength of the Quadriceps (see later) or wearing shoes with more stability. Or reduce the impact forces - learn to run so that you land with a bent knee under your centre of gravity. Learn to stop reaching for the ground and stop collapsing your coere (for me I was only able to do this when I leanred pose running www.posetech.com - but your experience may be different - look at www.chirunning.com)
To strengthen Quadriceps the exercise I find most successful is as follows
First
Sit with your foot up on a stool - straight out in front of you. Put your forefinger and third finger of the hand on the same side up under the lower border of the patella - to wither side of the tender bit. Push your knee backwards and tense the quad - you will feel the tendon tense between your finger tips. Then relax tense relax for about 20 reps.
Secondly
place thumb at top pole of patella - and third finger at bottom pole - push knee back and feel the tendon tighten - and relax - you may get some craching popping and feel tenderness under your third finger tip. Tense relax 20 reps
Then use a theraband or a stretch cord - sit with it around your ankle. knee bent 90#* under you and theraband coming from behind - striaghten the knee against the resitance of the cord and slowly release by bending the knee again. all the time put pressure on your patellar tendon 20 reps - then get up and do 10 deep swuats (although do not start these till the pain starts to subside (if you do this 3X a day the pain will be gone in 3 days and you can start the quats then - I would not run till the squats become pain free (less than a week)
Running is the problem though - If you land with a straight knee - you will be back to square one within a few days of starting - you need to learn to land on a bent knee on the Ball of your ffot - ie underneath you
Do this and your PT will become a thing of the past.
Your Physio will talk about eccentric strengthening and will suggest you do one legged squats where you lower yourself on an incline board on the bad leg and lift yourself up with the good leg - but should also warn you that doing this exercise may well make things worse before they get better. The other commonly advised exercise is wall sitting - but in my experience this just makes things worse so I never advise it now.
Good luck, this is a horrid slow burner type injury - but it can be made better without hindering your running too much.
Patellar Tendinitis
 |
SummaryTendinopathy of the patellar tendon - runners knee, jumpers kneeThis article is owned by cabletow |