Jumper's Knee, or Patellar Tendinopathy, is a condition that many athletes and active individuals face—especially those in high-intensity sports like basketball and volleyball, where jumping and quick direction changes are key. But the good news is, with the right approach, you can get back to doing what you love.
Our treatment focuses on restoring balance and mobility through manual therapy and functional exercises, with a special focus on Motion-Specific Release (MSR). The key to success? Early, accurate diagnosis combined with targeted therapies that address the root biomechanical imbalances.
Our Success Rate is Over 90%
Our 90% success rate in treating Jumper's Knee underscores the effectiveness of our multimodal, interdisciplinary approach, focusing on pain relief and improved function.
Article Index
Jumper's Knee Anatomy and Biomechanics
The patellar tendon connects your kneecap (patella) to the shinbone (tibial tuberosity) and is essential for lower limb movement. Made of strong, parallel collagen fibers, it's designed to handle the intense loads from jumping and rapid movements. However, repeated strain can lead to microtrauma, causing a condition known as Jumper’s Knee, or patellar tendinopathy.
Biomechanically, the patellar tendon transfers force from your quadriceps to your tibia, allowing knee extension. During jumping, particularly when landing, the tendon faces high demands. If your muscles and tendon can’t absorb and spread these forces, the stress leads to changes in the tendon, affecting knee movement. Left untreated, this can result in a cycle of pain and re-injury.
Clinical Presentation
Recognizing the signs and symptoms of Patellar Tendinopathy is key to diagnosis and effective treatment planning. Here are the common indicators clinicians should watch for:
Localized Anterior Knee Pain
Description: Pain just below the kneecap (patella) is a hallmark sign.
Why It Matters: This specific pain helps differentiate Patellar Tendinopathy from other conditions like osteoarthritis or meniscal injuries.
Pain During Tendon-Loading Activities
Description: Pain worsens with activities like squatting, lunging, or jumping.
Why It Matters: Increased pain during these movements indicates the severity of the tendinopathy and its impact on function, helping guide treatment strategies.
Presence of Crepitus
Description: A crackling or grating sensation often felt during movement, common in chronic cases.
Why It Matters: Crepitus may signal significant tendon damage and should be further evaluated with imaging to assess the level of tissue degeneration.
Diagnosis
A comprehensive diagnostic evaluation for Patellar Tendinopathy necessitates a multi-faceted approach that blends a detailed patient history with focused orthopedic tests. Here are examples of orthopedic, neurological, and vascular examinations that we commonly perform on our patients:
Knee Examination
This video guide provides an in-depth look at orthopedic testing techniques tailored for knee examination. These tests are crucial for diagnosing conditions like Patellar Tendinopathy or Jumper's Knee. Tune in to learn how these methods can accurately pinpoint the cause of knee pain and guide effective treatment strategies.
Lower Limb Neuro Examination
The lower limb neurological examination assesses the motor and sensory neurons supplying the lower limbs to detect any nervous system impairment. This examination is used both as a screening and investigative tool.
Peripheral Vascular Examination
The peripheral vascular examination is a physical exam that evaluates the circulatory system outside the heart and lungs. This exam is important in diagnosing and managing peripheral vascular diseases such as arterial occlusion, aneurysms, and venous insufficiency.
Specialized Orthopedic Tests for Patellar Tendinopathy:
Single-Leg Decline Squat: Instruct the patient to stand on a declined surface (10-25 degrees) with one leg. Ask them to perform a single-leg squat while observing for pain or instability. Pain during this test can indicate patellar tendinopathy.
Resisted Isometric Knee Extension: With the patient seated and knee flexed to 90 degrees, apply a resistive force against their lower leg as they try to extend their knee. Pain or weakness may indicate a compromised patellar tendon.
Functional Limitations Assessment: Evaluate the patient’s ability to complete tasks that load the patellar tendon, like squatting or jumping. Note any limitations in range of motion, strength, or performance.
Imaging
Imaging modalities such as ultrasonography and MRI are pivotal for enhancing diagnostic accuracy and understanding the nuances of Patellar Tendinopathy. Each imaging method has distinct features that it brings to light:
Ultrasonography: This imaging technique primarily evaluates tendon morphology and echogenicity. In cases of Patellar Tendinopathy, you might observe hypoechoic regions representing areas of tissue degeneration or small tears. Additionally, it may reveal a thickening of the patellar tendon.
MRI: An MRI is particularly useful for visualizing intrasubstance tears and the severity of the condition. Within the scan, you would see changes in the signal intensity within the tendon substance, which may point to degeneration or tears. The severity can be gauged by the extent of these changes, including any involvement of surrounding structures.
By employing these imaging techniques judiciously, practitioners can achieve a more comprehensive understanding of Patellar Tendinopathy's clinical picture, thereby guiding the treatment strategy more effectively.
Differential Diagnosis
While the primary focus is on diagnosing Patellar Tendinopathy, it's essential to rule out other conditions that could manifest with similar symptoms. Here are some differential diagnoses, along with brief explanations:
Quadriceps Tendinopathy: This condition involves pain and degenerative changes in the quadriceps tendon, often seen in athletes involved in jumping sports, similar to patellar tendinopathy.
Patellofemoral Pain Syndrome: Characterized by diffuse anterior knee pain originating from the patellofemoral joint, this condition is often aggravated by activities like squatting and climbing stairs.
Sinding-Larsen-Johansson Syndrome: A traction apophysitis at the inferior pole of the patella, commonly affecting adolescents and young athletes. It is similar to Osgood-Schlatter disease but occurs at a different site.
Distinguishing between these conditions and Patellar Tendinopathy often requires advanced imaging or metabolic profiling to achieve diagnostic accuracy.
Manual Therapy
In the subsequent videos, we demonstrate several effective Motion-Specific Release procedures for addressing ligament injuries, including Patellar Tendinopathy of the knee. These procedures highlight the practical application of manual therapy procedures in promoting recovery and optimal function.
Knee Release Protocol - Motion Specific Release
In the accompanying video, Dr. Abelson demonstrates an effective knee release protocol using Motion Specific Release (MSR) procedures. These procedures address the localized area of pain and the broader kinetic chain, contributing to a more comprehensive treatment approach. It is essential to recognize that each instance of knee pain should be assessed and managed as a unique dysfunction tailored to the individual patient. In some cases, the treatment may focus on local structures, while in other instances, it may involve addressing a more extensive kinetic chain to achieve optimal results.
Increasing Knee Joint Mobility - 4 Point MSR Knee protocol
This video demonstrates Effective Motion-Specific Release knee mobility procedures, which effectively address the body's entire kinetic chain. The complicated structure of the knee joint includes the femur, tibia, and patella, as well as a large number of muscles and ligaments.
Fascial Expansion: The MSR Knee Pain Protocol
Utilizing fascial expansions in knee pain management merges contemporary insights into fascia, kinetic chain relationships, and acupuncture principles. This approach effectively treats Jumper's Knee (Patellar Tendinopathy) by improving joint function and reducing discomfort. The MSR protocol's focus on fascial health and biomechanics helps alleviate Jumper's Knee symptoms and enhance mobility, offering a holistic treatment that addresses underlying causes and promotes tissue repair.
Treatment Frequency
The frequency of treatment depends on the severity of the ligament injury, ranging from mild to severe (post-surgical). Here's a breakdown:
Grade 1 Tear (Mild)
Frequency: 2 sessions/week for 1-2 weeks
Total: 3-6 appointments, transitioning to home exercises and self-care.
Grade 2 Tear (Moderate)
Frequency: Weekly to bi-weekly for 2-4 weeks
Total: 3-8 appointments, tapering as symptoms improve.
Grade 3 Tear (Severe/Post-Surgery)
Frequency: Intensive therapy begins post-op, gradually advancing through pain management, strength training, and sport-specific exercises until a full return to activity.
Functional Exercise Programs
Functional exercises are key to Patellar Tendinopathy recovery, helping to strengthen the tendon and improve mobility. A phased approach ensures progress while minimizing the risk of re-injury.
Phases of Transition:
Isometric to Concentric/Eccentric Training
When to Transition:
Pain level reduced to 3 or less (out of 10).
Isometric exercises completed without sharp pain.
Improved tendon stability during clinical evaluation.
Concentric/Eccentric to Plyometric Training
When to Transition:
Pain-free concentric/eccentric exercises with good form.
Strength near pre-injury levels.
Functional tests (e.g., single-leg hops) completed without pain.
Plyometric exercises are the final step, reintroducing dynamic movements under healthcare supervision.
Now, let's explore the specific exercises we recommend!
Specific Exercises
Isometric Exercises: Pain Modulation Phase
Isometric exercises are particularly effective for initial pain modulation. By applying tension without actual movement, they allow for muscle engagement without stressing the affected tendon. This can be a crucial first step in the rehabilitation process.
Static Quadriceps Hold
Instructions: Sit on the floor with your legs extended. Tighten your quadriceps while pressing the back of your knee into the floor.
Sets & Repetitions: 4 sets of 10-second holds.
Isometric Wall-Sit
Instructions: Stand with your back against a wall. Slide down into a squat position and hold.
Sets & Repetitions: 3 sets of 20-30 second holds.
Concentric and Eccentric Training: Active Strengthening Phase
The next phase involves concentric and eccentric training once pain modulation is achieved through isometric exercises. Concentric movements strengthen the muscle while shortening it, and eccentric movements do so while lengthening it. This phase aims for a more dynamic strengthening of the muscle-tendon unit.
Bilateral Squats
Instructions: Start in a standing position. Perform a squat by lowering your hips back and down while lifting your chest.
Concentric Phase: Rise back up to a standing position.
Eccentric Phase: Lower yourself back down slowly, taking twice the time to rise up.
Sets & Repetitions: 4 sets of 8-12 reps.
Leg Press Machine
Instructions: Sit in the leg press machine. Place your feet hip-width apart on the platform.
Concentric Phase: Extend your legs to push the weight up.
Eccentric Phase: Lower the weight back down in a slow and controlled manner.
Sets & Repetitions: 3 sets of 10-15 reps.
Plyometric Training: Advanced Training Phase
Plyometric exercises introduce controlled impact forces to further challenge the tendon and supporting musculature. Designed for those in the advanced stages of rehabilitation, these exercises aim to restore the tendon's ability to handle dynamic, high-impact activities safely.
Box Jumps
Instructions: Stand in front of a box or a sturdy platform. Jump up onto the box, landing softly with knees slightly bent.
Sets & Repetitions: 3 sets of 8 reps.
Depth Jumps
Instructions: Stand on a platform. Step off, then immediately jump vertically as high as you can.
Sets & Repetitions**: 3 sets of 6 reps.
By incorporating a three-phase approach that includes isometric exercises, concentric and eccentric training, and plyometric activities, practitioners can offer a holistic and scientifically-grounded regimen for managing Patellar Tendinopathy.
Why Choose Our Approach for Jumper's Knee Treatment
Our approach to treating Jumper's Knee (Patellar Tendinopathy) has a proven success rate of over 90% in reducing pain and restoring knee function. Here’s why our method stands out:
Established Expertise: Developed by Dr. Brian Abelson, our Motion-Specific Release (MSR) technique is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients. You're in expert hands.
Comprehensive Assessments: We perform thorough evaluations to identify all contributing factors, including biomechanical imbalances and overuse patterns, ensuring that we address the root causes of your condition.
Targeted MSR Techniques: Our advanced MSR procedures focus on releasing fascial restrictions and improving tendon flexibility, promoting healing while reducing the risk of recurrence.
Custom Exercise Programs: We design individualized exercise regimens that strengthen the patellar tendon and improve knee mobility, helping you return to your sport or activity stronger than ever.
Logical, Evidence-Based Approach: Combining manual therapy, functional exercises, and support strategies, our method ensures a balanced, long-term solution to Jumper's Knee.
Choose our proven, patient-centered approach for lasting relief and recovery from Jumper’s Knee. Take the first step towards your recovery with confidence!
References
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409-416.
Lian, Ø., Engebretsen, L., & Bahr, R. (2005). Prevalence of jumper's knee among elite athletes from different sports: A cross-sectional study. The American Journal of Sports Medicine, 33(4), 561-567.
Visnes, H., & Bahr, R. (2007). The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes. British Journal of Sports Medicine, 41(4), 217-223.
Kongsgaard, M., Kovanen, V., & Aagaard, P. (2009). Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scandinavian Journal of Medicine & Science in Sports, 19(6), 790-802.
Malliaras, P., Cook, J. L., Purdam, C. R., & Rio, E. (2015). Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. The Journal of Orthopaedic and Sports Physical Therapy, 45(11), 887-898.
Scott, A., & Backman, L. J. (2018). Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nature Reviews Rheumatology, 14(12), 721-730. (Focuses on biologics and their application to tendinopathies).
Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277-1283.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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