Everyday in the clinic, I meet men and women of all ages who are struggling to achieve their fitness goals, not for a lack of effort, but because there knees simply won’t cooperate. Whether you are someone just starting out on your fitness journey post-quarantine, or a seasoned veteran who has decades of lifting experience, chances are you’ve suffered with knee pain that has hindered your progress or kept you away from training entirely. How many people do you see in the gym everyday who rely on KT tape, knee braces, or daily icing, just to make it through their workouts? Maybe you are one of these people and you’ve tried just about everything to get your pain under control, but still are not seeing any results. Let’s take a deeper look at why we see so many athletes develop debilitating knee pain, and what steps you can begin to take to get out of pain fast!
Many of the cases of knee pain that we see at GO PT have a similar presentation:
1. Dull and sometimes sharp pain just below the knee cap;
2. Pain began as a minor annoyance that would ease once the person warmed up, however, progressively worsened to the point of pain during and after workouts;
3. The patient has had some kind of change to their training regimen in the past 3 months, whether that be volume, intensity, new movements, or new setting;
4. They have tried rest, however, the pain unfortunately persists. If a few, or all these scenarios apply to your own knee pain, you may be suffering from “Jumper’s knee”, or more accurately, patellar tendinopathy.
Patellar tendinopathy is a painful condition involving the patellar tendon (although technically a ligament) that attaches from the bottom of your kneecap to your shin bone. This condition is quite common in athletes who participate in running, jumping, squatting, lunging, and weight- lifting. Firstly, it is important to distinguish the difference between tendinitis, as the name suggests, a painfully inflamed tendon that has undergone too much stress, or tendinopathy, a chronic and degenerative condition of the tendon which results in pain and weakening of its structural integrity. How can you determine which of these two pathologies you are dealing with? If your pain has been present for 2 or more months, has progressively worsened, and has not responded to a break from activity, you are dealing with tendinopathy.
Secondly, we have to consider that symptoms often show up at the knee as a result of poor mobility or strength in other parts of the kinetic chain – mainly the hip and ankle. For instance, if your hip is not providing enough stability, the knee will often collapse inwards during squatting and lunging movements, creating undo stress on the patellar tendon. Similarly, if we lack ankle mobility needed for jumping & landing mechanics, we see a tendency of the arch to collapse, the knee caving inwards, resulting again in painful symptoms occurring at the knee. These are only 2 examples, however, there are numerous factors taking place at various points of the kinetic chain, which ultimately affect the health of your knees and ability to make progress in training. All that being said, some individuals possess excellent mobility and strength in the hips, knees, and ankles, and still find themselves developing painful knees with loaded movements. If this is the case, we must take a step back and analyze what has changed in loading volume and/or intensity. With quarantine coming to a close and more athletes getting back into consistent training, we find that it’s common for people to progress too quickly before the body is able to adapt. The patellar tendon undergoes huge amounts of stress and load during movements such as squatting, lunging, and jumping. Just like our muscles, the patellar tendon must be loaded in a controlled and progressive manner to adapt positively and become stronger. Too much repetitive stress too soon can cause the tendon to weaken and become painful.
For the early stages of rehabbing from patellar tendinopathy, start with the following exercises which focus on decreasing pain and provide controlled loading to the tendon:
1. Active Release Therapy for the Quads
2. Reverse Nordic Curl
3. Decline Step Downs
Next, we want to begin to focus on creating more mobility and stability through the hips and ankles:
1. Calf Raises for Ankle Mobility
2. Hip Airplanes
3. Single-leg Step Downs
Finally, we need to build a more robust knee and patellar tendon so that the pain stays away for good!
1. Bulgarian Split Squats
2. Spanish Squats
3. Banded Goblet Squats
For these exercises, spend 2-3 weeks at each level of the rehab process, focusing on slow tempo and perfect form for each exercise. For the mobility exercises, spend 1-2 minutes actively performing the exercise. For all other exercises, start with 2-3 sets of 15 reps at slow and controlled tempo. With each subsequent week, see if you can decrease the reps and increase the load as you would with any strength training program. Always use pain as an indicator. If you are able to complete 15 slow and controlled reps with minimal (think 0-3/10) pain, then you are OK to progress with load/resistance.
I hope you all find this article helpful in combatting patellar tendinopathy so that you can get back to training pain free! As always, feel free to shoot an email to Brett@groundtooverheadphysicaltherapy.com if you have any questions related to knee pain or the structure of this rehabilitation plan. Tune back in next month for a blog post detailing another common condition that we treat here at GO PT!
Dr. Brett Rolison