Jumpers Knee & Patellar Maltracking

Hi All,

Was hoping to get some more information as they physio i have been seeing is unable to really give me any answers apart from rest- Ive rested for three months and still the pain is present.

A few months ago i started getting pain in my left knee under the knee cap so i went to my physio who told me to stay off it, it subsided slightly and she told me i could return back to training and running and it flared up again immediately. She sent me for a x-ray and ultrasound and i got the following back

ULTRASOUND
there is a bony spurring at the interior pole of patella with heterogeneity and decreased echogenicity with hypervascularity at the adjacent proximal patellar tendon compatible with a chronic jumpers knee type patellar tendonitis and secondary trophic changes within the patellar. The distal tendon images normally. There is a small effusion within the suprapatellar pouch but not within the deep pretibial bursa or prepatella bursa.

RADIOGRAPHS
On the skyline projection, there is a mild degree of lateral patellar maltracking and tilt. Prominent bony spurring is seen at the inferior pole of patellar at the patellar tendon origin but not at the quadriceps expansion insertion. There are no features to suggest a more generalised enthesopathy.

With this being given to my physio and GP they suggested three to four months of rest. I have rested. During this time the pain has been frequent and frankly has not subsided.

Can anyone please give me any other ways in which to subside or explain to me further what the above means (frankly i don't understand it). I have been on antiamflamitories and constantly ice down if i do anything over the normal.

I have lost all muscle mass and cardio function since i have been resting, so i would like to be able to go back to running and weights training. Any help would be great.

Hi Kelli
It sounds like you will need a good manual (hands on) physiotherapist with rehab skills who can give you advice regarding a progressive eccentric loading programme of the knee to improve your tendon strength, whereby settling your patellar tendon pain.
Mobilisation of the patella may prove beneficial also as this can often become stiff, and glute/quads strengthening combined with proprioceptive (balance) rehab will also round out the program.
They should also be able to help you out with alternative gym/cardio options so you can begin to regain your fitness without compromising your knee symptoms. All the best. Mike

The eccentric strengthening already mentioned is the best way for quad tendon strengthening. However, you have increased fluid there and may need to stretch you quad tendon and have manual therapy to find the ideal position of the patella during activity. If that is successful then you can strengthen and retrain the muscles in the pain-free position. If the quad is tight it will pull on the patella ligament from the inferior patella pole to the area of the tibial tuberosity. The bone spur may be a problem. It is there and often forms with constant pull or contact as in the shoulder. If it is in an area of contact during movement there is a problem. A good therapist can try t position the patella and have you perform activities that produce your pain, such as deep squats or ascending/descending deep steps. If it abolishes your pain you have a good chance of rehabbing it.

I left out the key in the last sentence...If the therapist can reposition the forces/stress on your patella and then you can perform the normally pain producing activity, then you have a chance. Sorry about that