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Leg Knee Pain

Injury Prevention

Knee Exercises

Dr. Larry W. McDaniel Ed.D. Allie Winkle, Allen Jackson, MS. Laura
Gaudet PHD discuss the common knee problem Patellar


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Patellar Tendinopathy commonly known as "Jumper's Knee" is caused by the

over use of the Patellar Tendon. This injury frequently affects athletes
involved in jumping sports which is included in a group of activities that are
classified as high impact sports. High impact sports are physical activity that
place above normal force on joints, bones, tendons, and ligaments. These
high impact sports include basketball, dance, volleyball, soccer, football, track
and field (distance running, high- and long-jump), mountain climbing, figure
skating, tennis and skiing. Other people who may suffer from Patellar
Tendinopathy include military recruits. This group is training in activities that
strain the knee which makes them more likely to develop Patellar
Tendinopathy. The overall occurrence of Patellar Tendinopathy among
sporting athletes has been estimated at 15% with a higher prevalence of
about 50% in elite jumping athletes such as volleyball and basketball players.

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The key warning sign of "Jumper's

Knee" is a shooting pain just below
the Patella, commonly known as the
kneecap, when walking, working out,
or performing daily activities. The
overuse of the Patellar Tendon
represents approximately 15% of all
soft-tissue injuries in athletes (Peers,
. When Patellar Tendon
overuse occurs inflammation of the
Patellar Tendon gradually become
more painful. In a survey that was
strategies, one-third of the athletes
with Patellar Tendinopathy were
unable to practice or participate in
their sport for six months (Peers,
2005). Tendon overload occurs when
"forces of 3 to 8% strain are applied to the tendon which causes
microtrauma", a small injury to connective tissue that may include micro
tearing of muscle fibers (Peers, 2005)
The forces applied when landing to the knee joint, Patellar Tendon, and other
knee tendons may be greater than nine times the participates body weight
(Donohue, 2008) . There are various ways to avoid knee pain which involve
strengthening the muscles that surround the knee; the Gluteus Maximus,
Quadriceps, and Hamstring muscles. By increasing the strength of the

muscles of the knee joint the load placed on the knee joint will be reduced.
This also includes the forces on the Patellar Tendon. In addition to
participating in strengthening activities, a conditioning plan that integrates
routine trunk and lower-limb stretching, plyometric training to increase
endurance may assist in reduction of excessive stress on the Patellar Tendon.
Risk factors that contribute to the injury of the Patellar Tendon are inflexibility
of the Quadriceps and Hamstring muscles, inappropriate overload of quantity
and intensity of training, hardness of the playing surface, and limited evidence
of inherited biomechanical risk factors (Vulpiani, 2007)
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As stated previously Patellar Tendinopathy, the over usage of the Patellar
Tendon, occurs mainly in athletes that participate in jumping and high impact
sports. Patellar Tendinopathy may occur when there is rapid acceleration and
deceleration, jumping, or landing from a jump. The sports that are affected
cause inflammation in the knee joint specifically in the Patellar Tendon. High
impact sports involve both feet leaving the ground simultaneously and other
quick movements. Track and field events such as running or sprinting, tennis,
skiing, soccer, and football are high impact sports that place pressure on the
knee joint and the Patellar Tendon.
In company with these common sports among athletes there is another sport
that affects the Patellar Tendon greater in male athletes than in female
athletes this sport is dancing. Males experience more repetitive jumps in
dancing than females (Mattingly, 2005) . Patellar Tendinopathy may occur in
males between the ages of fourteen and sixteen who experience a sudden
growth spurt which is characterized by the bones of the leg out growing the
tendons and muscles of the leg. The unexpected athletes affected by Patellar
Tendinopathy are military recruits during high impact training.
The most common warning signs of knee inflammation are pain, aching, and
swelling generated in the location of the Patellar Tendon. These symptoms
may be found on the lower side of the patella on the front of the knee, during
walking, jumping, and exercising. Inflammation that occurs during Patellar
Tendinopathy may be found in several areas. These areas include the top of
the Patellar Tendon, the bottom of the kneecap, the bottom of the Patellar
Tendon, and the top of the Tibia. The inflammation is caused by over use of
the joint without a sufficient amount of rest (Donohue, 2008) .

The stages of inflammation are classified according to symptoms using a scale

from zero to five with five indicating the most pain. These stages may assist
those suffering from Patellar Tendinopathy to determine the severity the
injury and the amount of activity that can be endured Stage one is minimal
worry, pain only after activity all that is needed is rest. Stage two is little
worry, pain before and after activity rest may be needed. Stage one and two
may responded well to conservative intervention involving therapeutic
exercise, ice, ultrasound, cross-friction massage, and rest (Klucinec, 2001) .
Stage three more worry, pain during activity and less able to perform at
satisfactory level. When in stage three prolonged level of rest, and limited
number of activity sessions are advised (Klucinec, 2001) . Stage four
increased worry, pain during activity, not able to perform at satisfactory level.
In stage four farther treatments may be advised. Stage five very concerned,
pain during daily activity. In stage five surgical treatments may be
recommended. At Patellar Tendinopathy's worst, there will be pain while
sitting or at rest.
Classification of Jumper's Knee According to Symptoms
Stage 0 - No pain

Stage 1 - Pain only after intense sport activity; no undue functional

Stage 2 - Pain at the beginning and after sport activity; still able to
perform at a satisfactory level
Stage 3 - Pain during sport activity; increasing difficulty in performing at
a satisfactory level
Stage 4 - Pain during sport activity; unable to participate in sport at a
satisfactory level
Stage 5 - Pain during daily activity; unable to participate in sport at any
Rehabilitation exercises are recommended to reduce knee pain caused by
Patellar Tendinopathy. These exercises consist of strengthening, stretching,
and plyometric training. Strengthening the Quadriceps, Hamstrings, and
Gluteus Maximus muscles may assist in reducing knee pain and the damaging
effects of Patellar Tendinopathy. As the muscles above increase in strength,
the tendon experiences less stress (Kongsgaard, 2007) . The tendon will be
able to avoid being overused if the muscles around it have the strength to
reduce the stress on the tendon. Stretching the muscles around the tendon
will increase flexibility in the joint to improve range of motion and the ability
of the joint to move smoothly through the motion. Stretching on a daily bases
before and after workouts may reduce stiffness in the joints and remove lactic
acid from the muscles. Plyometric training may improve muscle endurance. By
improving the muscles' endurance these muscles will be able to endure
increased stress for longer periods of time without resorting to a tendon for
more support which may overload the tendon and cause injuries. Below are
some tips avoiding knee pain.

Adequate warm-up prior to running or jumping (Dressendorfer, 1995)

Stretching program to maintain quadriceps and hamstring flexibility
(Dressendorfer, 2007) - Example: hamstring and quadriceps stretches
Strengthening techniques - Example: Half-squats and lunges can help
strengthen (Delaney, 1995)
Correct any biomechanical errors in jumping technique (Dressendorfer,
Avoid repetitive jumping on a hard floor (Mattingly, 2005) .
Unavoidable risk factors that contribute to Patellar Tendinopathy are
inflexibility of the Quadriceps and Hamstring muscles, strength of the Gluteus
Maximus, Hamstring, and Quadriceps muscles, inappropriate overload of
quantity and intensity of training, hardness of the playing surface, and limited
evidence of inherited biomechanical risk factors (Vulpiani, 2007)

Patellar Tendinopathy, commonly known as "Jumper's Knee" is the overuse of
the Patellar Tendon. The over usage of the knee is frequently found in athletes
that are involved in jumping sports. These sports include volleyball,
basketball, dance, figure skating, and many more. Any high impact activities
involving the lower body affect "Jumper's Knee".
Some examples of high impact activities are sprinting, jumping jacks, and
jumping rope. However, the wide range of patients affected by Patellar
Tendinopathy is not only found in sports. The pain of Patellar Tendinopathy
may affect fourteen to sixteen year old males going through a growth spurt. It
also affects military recruits during basic training participating in high impact
activities as part of their fitness preparation. Before symptoms occur relating
to Patellar Tendinopathy, there are ways to avoid knee pain and injury.
Knowing how to avoid knee pain may protect the patient from injury.
Common symptoms related to "Jumper's Knee" include pain, aching, and
swelling on the lower side of the anterior surface of the Patella. Other
symptoms include weakness and cramping of the knee joint. There are
common home remedies to treat "Jumper's Knee" such as ice, rest, and antiinflammatory medicine. Advil or Motrin may be used only in the early stages
of injury If the injury symptoms are left untreated the result may be knee
surgery. A patient returning to participation in physical activities should apply
heat to the knee for 10 or 15 minutes before starting an activity. Following
activity apply ice for 10 or 15 minutes (Dr. Donohue, 2008) . Conservative
treatments heal and keep Patellar Tendinopathy at bay for more than 90% of
cases (Vulpiani, 2007)
Awareness of the warning signs and stages may assist in the process of
avoiding damage to the Patellar Tendon. Athletes, coaches, and athletic
trainer's knowledge of the five stages, warning signs, and risk factors, may
assist doctors in the process of diagnosing and treating the injury more
effectively. The ability to diagnose the treatment as early as possible assists
doctors in the process of returning patients to physical activities.

1. De VILLERS, R. e al. (2001) Patellar-Tendon Imaging: Jumper's Knee.
Academic Search Premier. EBSCO Host. Karl E. Mundt, Madison, SD. 28
Jan. 2009
2. DELANEY, L. (1995) Giving Injuries the Ice. April & May. EBSCO
MegaFILE. EBSCO Host. Karl E. Mundt, Madison, SD. 28 Jan. 2009
3. DePALMA, M. et al. (2004) Patellar Tendinosis: Acute Patellar Tendon
Rupture and Jumper's Knee. Apr. 2004. Academic Search Premier.
EBSCO Host. Karl E. Mundt, Madison, SD. 28 Jan. 2009
4. DONOHUE (2008) Basketball Season is Here and so is Jumper's Knee.
13 Dec. 2008. Spartanburg Herald Journal. Proquest. Karl E. Mundt,
Madison, SD. 26 Jan. 2009
5. DRESSENDORFER, R. and ALPER, B. (2007) Patellar Tendinopathy. Apr.
2007. Academic Search Premier. EBSCO Host. Karl E. Mundt, Madison,
SD. 28 Jan. 2009
6. FERRETTI, M.D. et al. ( 2002) Patellar Tendonosis. Dec. 2002. Academic
Search Premier. EBSCO Host. Karl E. Mundt, Madison, SD. 26 Jan. 2009
7. KLUCINEC, B. (2001) Recalcitrant Infrapatellar Tendinitis and Surgical
Outcome in Collegiate Basketball Player: A Case Report. 2001. Journal
of Athletic Training. Proquest. Karl E. Mundt Library, Madison, SD. 26
Jan. 2009
8. KONGSGAARD, M. et al. (2007) Region Specific Patellar Tendon
Hypertrophy in Humans Following Resistance Training. Oct. 2007.
Academic Search Premier. EBSCO Host. Karl E. Mundt, Madison, SD. 26
Jan. 2009
9. MATTINGLY, K. (2009) Knee to Know. Aug. and Sept. 2005. EBSCO
MegaFILE. EBSCO Host. 28 Jan. 2009
10. PEERS, H.E. (2005) Patellar Tendinopathy in Athletes: Current
Diagnostic and Therapeutic Recommendations. Academic Search
Premier. EBSCO Host. Karl E. Mundt, Madison, SD. 26 Jan. 2009
11. VULPIANI, M. et al. (2007) Jumper's Knee Treatment with
Extracorporeal Shock Wave Therapy: A Long-term Follow-up
Observational Study. 2007. Journal of Sports Medicine and Physical
Fitness. Proquest. Karl E. Mundt, Madison, SD. 26 Jan. 2009

If you quote information from this page in your work then the reference for
this page is:
McDANIEL, L. et al. (2009) Findings Related to Patellar Tendinopathy
[WWW] Available from:
https://www.brianmac.co.uk/articles/article059.htm [Accessed

Larry W. McDaniel Ed.D. is an Associate Professor of Exercise Science at
Dakota State University Madison, SD. USA. Dr. McDaniel was a First Team AllAmerican football player (USA Football), a Hall of Fame Athlete, and Hall of
Fame Wrestling Coach.
Allen Jackson, M. Ed. is an Assistant Professor of Physical Education and
Health at Chadron State College in Chadron, Nebraska (USA) who is well
known for his presentations and publications at international conferences
focusing on Leadership, Curriculum, and Health.
Laura Gaudet, Ph.D. is a Professor and Chair of the Department of
Counselling, Psychology and Social Work at Chadron State College, Chadron
Allie Winkle Dakota State University is an outstanding student of Exercise

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