Patellar tendinitis (or tendonitis) or more recently called Patellar tendonopathy (or tendinopathy) is what is commonly known as “jumper’s knee” and is the patellar tendon injury that nearly every freerunner or traceur has experienced at one point or another. It is that niggling pain at the front of the knee underneath the knee cap (patellar) that does not stop you doing anything, but aches day and night, and just will not go away. As the name “jumper’s knee” suggests it is a general knee overuse injury that is common to those participating in jumping sports, usually onto hard ground, such as in basketball or volley ball, although rugby and football players repeatedly playing on hard ground also experience this injury. With our discipline commonly being practised in the urban environment, there is no harder surface to land on, and hence jumper’s knee has become prevalent within the community.
The Injury Explained
In patellar tendinosis, it is the patellar tendon that causes the pain and irritation. To understand why, it is worth explaining what its anatomical role is during normal function. The patellar tendon connects the quadriceps muscle group of the front of the upper leg across the kneecap (known as the patella, a “sesamoid” or floating bone) to the bone of the lower leg (the tibia). The patellar tendon is part of the structures that allow the knee to straighten (’extensor mechanism’ of the knee) and provides strength for this action. The patellar tendon, like other tendons connects muscle to bone (ligaments attach bone to bone) and is made of tough string-like bands, which are surrounded by a vascular tissue lining that provides nutrition (blood and energy) to the tendon. Some anatomists believe the patella tendon should be classified as a ligament as it connects the patella (bone) to the tibia (bone), however, as it attaches the quadriceps via the patella, and due to the vascularity it should continue to be classified as a tendon.
The Knee
Injury Causes
The injury causes the tendon and the tissues that surround it to become inflamed and irritated. Generally this is due to overuse, as discussed above, usually from jumping activities. However, in some cases patellar tendonitis develops after sustaining an acute injury to the tendon (such as an impact), and not allowing sufficient time for the tendon to heal. As stated above, the most common form is the overuse injury and usually occurs because those suffering are taking part in jumping sports. This obviously fits directly with Freerun/Parkour.
Other Reasons For The Injury
- Increase in the frequency of training.
- Increase in the intensity of training.
- Change from one technique/training method to another.
- Repetitive training on a considerably hard surface.
- Bad technique/mechanics during training.
- Genetic abnormalities of the knee joint.
- Lack of strength of the quadriceps muscles.
Good Tendon Fibres On The Left With Bad Fibres On The Right
Symptoms
Pain is felt directly over the patellar tendon, which runs down the front of the knee to the top of the shin. Visual swelling is not always seen in the area, but pain is felt by placing pressure directly on the tendon’s anatomical position. Another common symptom is pain with activities, specifically jumping or running, and in fact kneeling, which is not good for the practitioner, as jumping and running are the main tools of our trade. Lastly it may seem to “squeak” or “creek” due to stiffness; this is known as creptis and is very a common symptom.
What Should I Do?
Important that you raise this chronic (ongoing) injury with a qualified medical professional as soon as possible. Your GP is the best bet. Additionally you need to stop all activities that cause you pain or discomfort. This unfortunately includes running and jumping. However, let your body be your guide, if an activity causes pain, don’t do it. Overall, rest is the most import aspect of patellar tendonopathy recovery, but it is very important to remain active in practice as well as rehabilitation, this means continuing to perform general fitness and upper body exercises. Basically, anything that is pain free. Any rehabilitation should be designed to decrease the symptoms, strengthen the muscles of the quadriceps and improve hamstring and quadriceps flexibility.
If Symptoms Persist
If rest alone does not clear the injury then the following may/may not be used: 1) X-rays can be performed to confirm there is no problem with the bones around the knee. 2) A rehabilitation programme, usually prescribed by a physiotherapist or a sports therapy professional. 3) A MRI is used in patients with very chronic patellar tendonitis as a way of identifying areas of degenerative tendon. This occurs when the knee is used when pain is present but ignored for long periods of time. 4) Icing the area (see previous article on injury management) is an important treatment. The ice will control the inflammation, decrease swelling and help flood the area with blood and nutrients, encouraging healing. Minimizing inflammation and swelling allows the tendon to return to its usual state and perform its usual function. 5) Stretching the quadriceps, hamstring, and calf muscles prior to activity is very important while waiting for recovery, but also when recovered and normal activity is resumed. A good stretching habit, even when injury has subsided, will help prevent a recurrence. 6) Surgery is a last option, but is very rare and only used on occasions when patients have persistent patellar tendonitis symptoms despite all treatments mentioned above and below.
Rehabilitation Program Should Include:
- Rest
- Non-impact aerobic training (cycling/swimming).
- Flexibility training for quadriceps and hamstring muscle groups.
- Use of non-steroidal anti-inflammatory medications (Ibuprofen)
- Use of therapeutic modalities: Ultrasound, Electric Muscle Stimulation.
- Cryotherapy (ice massage or ice packs).
- Specific strengthening exercises such as: eccentric leg press and decline eccentric squats.
- Slow return to impact aerobic training and prior sport.
Genu Valgum Condition
Risk Factor - Will You Be Affected?
Jumper’s knee occurs in as many as 20% of jumping skeletally mature athletes (i.e. not children whose are still growing). An interesting fact is that another knee injury affecting footballers, the ACL (anterior cruciate ligament) rupture occurs more prevalently in females than males. This may be due to the fact that females, as a normal part of their development in puberty, often become somewhat knock-kneed (genu valgum) as their pelvis begins to widen. Could this also be true for Patellar Tendonopathies? In terms of bilateral tendonopathy, (both knees) males and females are equally affected, and for unilateral tendonopathy (one knee), the male-to-female ratio is 2:1, meaning it does not seem to follow the same pattern as that of ACL injuries in females. Therefore, males and females are just as likely to be affected. Furthermore, other studies have shown that the following could make an individual more at risk to patella tendonopathy; larger body weight, bow leggedness (genu varum), knock knees (genu valgum) and unequal limb-lengths (one leg longer than the other, even if by less than 1cm). However, as stated, these only “could” make an individual more at risk, whereas the only biomechanical impairment actually linked to jumper’s knee is poor quadriceps and hamstring flexibility, so it is very important to include a flexibility and stretching routine into your training.
Genu Varum Condition
Conclusion
If you think you might have Patellar Tendonopathy seek medical advice as soon as possible. Do not do what most of us want to, and carry on training through the injury, and through the pain hoping it will go away. In the long run it will take longer to completely heal, and you will open yourself up to other injuries in the meantime. It is important to follow medical advice, rest and stick to a well structured rehab programme. Additionally, once the tendonopathy occurs it is important to recognize the reason for the original injury, whether it is rapid increase in jumping, or a strength imbalance (the two most likely causes for a practitioner of our discipline/s) so it can be avoided in the future and rehabilitated effectively. Lastly, a word of warning: if a patella tendonopathy goes unchecked, the tendon will form scar tissue in the irritated area, resulting in a career of fighting off the tendinitis whenever there is an increase in volume or intensity of the training sessions. If left unchecked, it could ruin your enjoyment of Freerun/Parkour forever.
More About The Author - Sean Lerwill
Sean is a Royal Marines Commando Physical Training Instructor (PTI) with numerous sports, exercise and fitness qualifications under his belt including; REPs (Register of Exercise Professionals) Advanced Instructor Level 3 (Fitness Manager and Personal Trainer), British Weight Lifting Association (BWLA) Coach, Kettle Bell Instructor, and SAQ (Speed Agility Quickness) diploma. He also has a BSc honours degree in Molecular Genetics from King’s College London. His personal sporting background includes athletics (running), cross country, triathlons, football, rugby and martial arts.
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my knees creek but their is no pain is this a problem?
it’s only been in the last few weeks and as i attempt squats or pistol squats they make a crack sound, any help?
Hey kriskris, that is a condition called… creptis, or something, I think. I know what you mean, I have them too. It is usually not harmful, but a symptom of something that is, such as this jumpers knee. If you feel it, it probably means youve been running and/or jumping too much or with improper form.
can u warm up the knees in any way?
kriskris i have the same problem you have but i have it for about 6 months i know it is because the big jumps . the sound of my cracking knees is skarry and i started some conditioning stuff .hope its gona help.( sorry for the english if its bad)
Creaking or cracking in any joint is the sign of excess fluid on the joint…this is not nessisarily a problem…but i would recommend getting it checked out as long term joint abuse can lead to dammage! most people who train hard for any sport end up with creaking this or acheing that the best thing you can do is minimise it by resting things when they are bad and getting every things check out!
My knees crack once in a while, but the pain feels like its in the core of my knee, and only comes after like sitting with my knees up for a long time. I don’t do any parkour yet though. I suspect it happens because I fell and hit the insides of my knees on ice a lot when I was young. Now, whenever I hit the insides of my knees on something hard (ie: a metal pole) it hurts a lot. I really hope it isn’t something serious or something that could impede the ability to do parkour/free running. Any advice, comments, wtvr is greatly welcome.