by Jeff Kittmer RMT
Athletes who participate in sports that require repetitive jumping or decelerating quickly from high speeds, commonly experience knee pain. In Recovery from Jumper’s Knee Episode 1, we discussed what Jumper’s knee (Patellar Tendinopathy) is, its causes, and ways to relieve its pain during rehabilitation.
Now, we will explore therapeutic exercises that will become integral tools in the healing of your patella tendinopathy. In order to do this, we need to create mobility, stability, and strength endurance around the knee. To be effective in healing Jumper’s knee, it is essential to know what exercises to do and when. An athlete should start as soon as pain allows, and gradually progress in intensity over the next 6 months or more.
Think of this 6-month period as 3 stages or phases. Stage one spans the first 3 months and the goal is to increase mobility, stability, and endurance. Stage two spans from 3 months to 6 months and the goal is to increase power, speed and endurance. Stage three spans from 6 months and onward and during that time it is important to focus on specific sports rehab for an individual’s sport. This is simply a guideline and should be adjusted based on the severity of an athlete’s symptoms, level of chronic injury, and caliber of competition.
When rehabilitating Jumper’s Knee, the focus is on stretching and strengthening key areas to bring the structures back into balance. Stretching the quadricep and hip flexors are particularly important in relieving the strain placed on the patellar tendon. During the stretches, lengthen the muscle until you feel a pain free pulling sensation.
While standing, bend the knee on the affected side and hold the foot. You can hold onto something for balance, or you can try holding your ear with the opposite arm. Try and keep the knees together and pull the leg straight back to prevent the leg from twisting. Be sure to maintain a neutral pelvic to prevent the lower back from arching into extension.
In the early acute stage, the stretch should be held for 10 seconds pain free. As the pain and inflammation declines the stretch can be held longer for up to 30 seconds. Repeat 3 times and stretch 3 times a day.
Hip Flexor Stretch
This stretch aims to lengthen the psoas and rectus femoris muscle. Place your knee on the floor with the other foot forward with the knee bent. Place something soft beneath the painful knee for paddling, such as a yoga mat, foam block, or folded towel to protect it. Tuck the tailbone to activate your core to level the pelvic. Shift your hips forward until you feel a pain free stretch in the upper hip and the front of the thigh.
Hold the stretch for 10 – 30 seconds. Repeat 3 times and stretch at least 3 times a day
If your knee is particularly painful, then you will want to start with isometric or static contractions of the quadriceps. Strengthening the calves is also important and can be done without irritating the patellar tendon. The application of cold therapy or ice after the exercises can assist in avoiding pain and tendon inflammation.
Isometric Leg Extensions
Lay on a flat surface and place a Trigger Point Grid Foam Roller under your knee. Contract the quadriceps, hold for a few seconds and then relax. Start with holding the contraction for 5 seconds, initially with 3 sets of 8 repetitions. Eventually building up to hold the contraction for 10 seconds; with 4 sets of 12 repetitions. If it is painful during, after, or the next day; reduce the time that the contraction is held.
Resistance strengthening is the next stage after isometric exercises. As long as pain levels allow.
Isotonic Leg Extensions
This exercise can be done with the RockBand Flex (starting with the light weight RockBand) to assist with strengthening and retraining movement patterns. Then working your way up to the medium / heavy weight RockBand for stronger resistance depending on pain levels.
Attach the RockBand Flex to the leg of an exercise bench or massage table as an anchor. Then place your foot through one of the loops on the band that offers an appropriate amount of tension. Slowly straighten the leg with a slight external rotation, to target the vastus medialis (inner quadricep). Start with 3 sets of 10 repetitions of light resistance concentrating on the last degrees of motion. Be sure to do an equal number of reps on the “good leg” as the one you are rehabilitating. Once you have progressed and things become easy, increase the number of repetitions, sets and resistance.
This is one of the more important exercises for Jumper’s Knee to work up to. The goal is to load the tendon and muscle eccentrically. Place the heels on either end of a foam roll or a slant board to reduce the contribution of the calves and increase the load on the quadriceps. Hold onto a dowel or a weight bar across your shoulders to help maintain proper alignment while squatting. Start with a double leg squat, squatting very slowly and then rising up quickly. Favour the “good” leg to aid on the upward movement when rising up. Eventually you will want to work towards a single leg eccentric squat with a double leg ascent to standing.
Start with 3 sets of 10 repetitions each day and gradually increase to 3 sets of 15 before increasing the weight or load. If pain is experienced during or the day after, dial back on the reps and load; apply ice to help to reduce the pain and inflammation.
Functional Plyometric Exercise
This exercise is reserved for the later stages of an athlete’s rehabilitation. Specifically, when they are starting to return to sports specific training. The explosive nature of the step back – step forward exercise mimics the start and stop demands of sport. Start by standing on a step with both feet, step back onto one foot bending the knee (eccentric contraction). Then in one movement, step forward back onto the step with the other foot, pushing off with the back leg.
Now that you have some tools to aid in the recovery of Jumper’s Knee. Remember, it is important to listen to the body’s pain signals when determining whether to increase an exercise’s intensity. If there is pain during or after the exercise, a reduction of repetitions or weight is required. Whether you are an amateur or pro athlete, knee pain should be assessed by your favourite massage, physio, or athletic therapist.
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