Jumpers knee

[noor afendi]

How to differentiate between Jumpers knee and Osgood Schlatter's disease?
Patient is young female who c/o pain at tibial tubercle when do kneeling or when the site is touching to hard surface.
Does not produced pain when resist knee extension or flexion.
Able to run fast with no c/o pain after the activities.
What are the possible treatment and reconditioning?
Thank you.

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[physiobob]

For memory jumpers knee is more at the apex of the patella (i.e. proximal patella tendon/"ligament" attachment). Osgood Schlatters is at the distal attachment. The mechanisms, age, clinical history might well be similar.

Can you give us more info on the patient: age, activity level, biomechanics/lower limb alignment? Attached is an image showing the site of a jumpers knee issue

thanks

[physiofixme]

Jumper's knee is a tendinopathy of the patellar tendon. The onset is typically following a period of jumping type activity e.g volleyball, netball. Pain is still distal around the inferior pole of the patella but the pain is clasically reproduced by jumping. Osgood Schlatter's is obviously very similar in presentation but often any sport or activity will aggravate it not just jumping. I'd look for biomechanical abnormalities too ie subtalar pronation etc. I think the key differentiating factors will be the age of the patient and the activity that aggravated the knee pain.

[flyer]

Hello everybody, my doctor told me that I may have Jumper's knee and I would really like to heal it by the end of February because my basketball season will start then. I already made a treatment plan for myself and was wondering if anybody can confirm that this plan would work, what order i should do it in, or anything like that.

-rubbing Traumeel Gel on it every morning and night
-jogging in the pool 15 minutes each day
-icing it for 10 minutes, resting it for 10 minutes, then icing again for 10 minutes after physical activity
-wearing a knee brace during physical activity

If it helps...I'm 16 years old and haven't reduced the amount of basketball I play, I only reduce how often i jump; I heavily rely on my jumping and I suppose the pain came from over training. The pain is only there upon landing when I jump and when I am warming up, after warm up most of the pain goes away. If I run very fast or sprint some of the pain comes back, but it doesn't pain as much as when I land after jumping

any advice would be greatly appreciated, thanks

[physiofixme]

Yep you are on the right track. I would add to your treatment plan:

Quads stretches...hold for 30 seconds and repeat 2-3 times on each leg daily. (I don't have access to a picture of this right now but could put one up later)

Quads strengthening exercises....in particular squats as this is an eccentric exercise. Eccentric exercises have been proven to be the most efficient way of strengthening tendons following a tendinopathy (which is what is going on in your case). Squats can aggravate your pain however so you need to make sure your squats are pain free. Taping for jumper's knee would help to reduce pain with squatting so that you can continue strengthening. Ultimately you want to be doing single leg squats (again i'll try to add some photos later)

Start doing two leg squats in sets of 10 ie 3 sets of 10 every second day without any weight to start. you can then add weight after 5-7 days of this. Weight can be added by a barbell over shoulders or dumbells in hands. Or if at home put a back pack on with books in it. After 2-3 weeks you can start doing single leg squats....initially without weight and then add weight after another week. This should all be painfree.

You may need someone to show you how to tape for jumper's knee as it is a little tricky to describe.

[physiofixme]

I've tried to upload some exercises for you and have given you a couple of options. For the single leg exercises you can either do squats or step downs off a box or step.

[physiobob]

Your home made program is not addressing the causes of your problem, only the symptoms. Your sports physio should assess you from the ground up. What brought on the condition, at 16 it is unlikely to be Osgood Schlatter's. That said you need to discuss factors such as diet ++, footwear +, technique +, amount and type of training +++

There are also some useful taping methods to reduce the pain and load on the insertion to keep you doing something while it is healing. You need though to think of this like you would a fracture and that this fracture is not healing well. It needs active rest (minimal loading) You need to work on your glutes, calves etc both concentrically and eccentrically to perfect your mobility on the court without overloading the small hinge that is the knee joint. You cannot do this alone.

[flyer]

Thank you physiobob and physiofixme

physiobob can you explain what concentric and eccentric exercises are?

also...I'm not an expert like you or the other physiotherapists on this forum and am not definitely not saying you're wrong, but I am almost certain that my knee problems are due to over training and I don't really understand how working on my calves, quads, glutes, or hamstrings will help because working on them was the problem.

here is some of the training I did if it helps, I did all heavy weights...and now i regret it
Deep Squats w/ barbell 3 sets of 5
deadlifts w/ barbell 2 sets of 5
lunges w/ barbell 3 sets of 6
calf raises on machine 3 sets of 8
and lots of explosive plyometrics training

i did the weights twice a week and plyometrics twice a week...that pattern continued for all of July and August, I started experiencing some problems in September and kept quiet about it because i thought it wouldn't be a problem, but that was a mistake and now it's pretty bad

if you can help me out, that'd be appreciated, thank you

[physiobob]

Exactly you are doing the wrong training or too much training. You have answered perhaps your own question. Back Off!!. Look for exercises that work on hip extension and stability without excessive patella loading.

Calf raises on the machine are more likely to be training gastrocnemius and you need to work soleus eccentrically not create an overactive gastrocs.

Right now:

Deep Squats: NO
DeadLifts: NO
Lunges: NO
calf raises on machine 3 sets of 8: NO unless working eccentrically with a bent knee
Lots of explosive plyometrics training: NO NO NO

All your exercises are designed to overload the knee joint and all should be stopped right now. Work on stability training on a ball, do more balance work. Do hip 'kick back' type exercises with a machine or resistance tubing of some sort. Whatever you do stop overloading the small hinge joint that is your knee!!!!

Working on the right areas in the right, sports specific way will mean they will do some work in the functional activity and therefore the patellofemoral joint will so less. Hence the training load on that joint will be less. And as this is an over training issue then this is what you need to do. It is NOT weak as a joint, it is OVER WORKED and is behaving normally to being over-worked. Therefore you do not need to 'strengthen it ' specifically. Hope this makes sense to you.

[fris]

I am 22 years old and was told today that I have osgood schlatters, I thought I would be too old. I have pain in both legs, particularly when bending, playing sport and over the tibial tuberosities to palpation. Having looked at Jumper's knees it seems that the pain is typically more proximaly and onset usually begins with pain after exercise. My pain has beem most definitely during exercise and is very localised to the tuberosities. So...
Is it possible to only get osgood schlatters disease at 22?
Does it make a difference to treatment/prognosis if it is jumpers knee rather than osgood schlatters.
Thanks

[physiofixme]

You are right in that the onset of Osgood Schlatters tends to be around age 10-12 years in girls. Osgood-Schlatters is a self limiting condition and usually gets better regardless of what action you take. HOWEVER..... Jumper's knee is not!! If you are suffering from Jumper's knee as opposed to Osgood Schlatters then you will need a considerable period of treatment and rehabilitation before your symptoms disappear. Treatment and rehabilitation for Jumper's knee (see advice below) won't do you any harm if you are suffering from Osgood-Schlatters.

[251733]

my experiance with jumper's knee:

no jumping no running no dancing until recovery

How to recover??? bicycle and again bicycle few hours a week.

Why? no scientific explaintion just experiance.

[oddscwodd]

Jumpers knee wrecks your life. Injury 15th april 2008.

As an exercise addict I got diagnosed with a Patellar tendon lesion on the tibial tuberosity. My mistake was to ignore it. As an athlete you get used to the niggles and aches of your body and normally you can tell which are sort of okay.

JUMPERS KNEE IS NOT!

After three weeks of struggling to exercise got to the point where I could not sleep or put weight on my leg. I could not physically touch my knee.

Stopped leg exercises and walking.

Got a great Physio to help me.
Physio taught me how to tape my knee. Learn this. It instantly stopped me limping.

I am not a physio so I will not even atempt to teach it.

Iced three times a day. For twenty mins.

Took anti inflammitory medication not for pain but to reduce swelling.

Got these from the doctor so that i didn't have to take every four hours. One tablet a day. Go see your GP. and get anti inflammitory gel to rub on as well. (If they will let you).

Found heating the area was a bad thing. Just made it worse after a couple of days gave that up.

Cortisone injections did nothing.

As soon as I could tense my quads without pain from tendon did sets of twenty of these when I remembered. Just sitting down or stood up. Pulling knee cap up and relaxing. Ten or 15 times a day.

Stretching hurt it so did not do that.

After a TWO MONTHS got on exercise bike at lowest resistance. Ten seconds cycle, ten seconds rest for 20 mins. Sounds pathetic I know but it is what I had to do. ICE straight after all exercise. At this point quad had wasted away and my knee would give way underneath me if not careful. Could not physically run or go up or down stairs.

ICE

Started walking forcing myself to walk properly with no limp. After two weeks could go up stairs (concentric contraction of quad) but could not walk down stairs (eccentric contraction of quad). Able to do two 20 min cycling sessions a day. Non stop low resistance.

ICE

4 weeks ago started quad extentions and knee control exercises on a half swiss ball or balance board.

Resistance too much on bike two weeks ago so got shin splints so reduced that.

This week. Quad exercises! half squats. Now able to control walk upstairs and down. Been able to run and hop with no significant pain (but not pushing it)

Future. Went to the consultant. Said looking at the MRI that it could take 3 weeks to 3 years to heal. Other problems will hopefully work themselves out.

Moral of story. Do not mess about with any tendinopathy. I managed to train my upper body into submission as well with golfers elbow.

Also after your quad has wasted it puts all your biomechanics out. This means that lots of secondary problems occur. These make recovery much harder.

Have posted myself on other forums about disparities in advice. Under periosteal lesiion if anyone is interested.

Lastly. It takes a long time to heal so nip it in the bud if you can

[emeraldphysio]

Re: Jumpers knee

I too am an exercise addict. Last February 2008 I started to get anterior knee pain, especially on ascending and decending stairs. It became so tender to even touch. It felt as if there was more involved than the patellar tendon (i.e fat pad)

I attended an orthopaedic consultant who x rayed my knee, saying it was jumpers knee and to rest, cease aggravating activities, stretch, ice and continue with eccentric exercises.

I did that for 4-5 weeks and still no let up on pain. If anything it got worse! I went back to the consultant and told him not only had I ceased playing sport but not it was affecting my job. So he gave me a cortizone injectinon into the area around the tendon. Initially it was very sore but improved to such a level that it was painfree for 4-5 weeks. I was able to return jogging up 70%. Then it got worse again. I continued with eccentrics and ice during this period. I went back to the consultant who told me to again put up with it.!

I sought a 2nd opinion, a sports physician who took am MRI. He told me there was a slight tear in the patellar tendon and he told me to cease all eccentrics, everything for 6 weeks. I rested for 8 weeks and at time if I stand for long periods or sit for long periods my knee (front and back will get very sore) and I will end up limping! So after all this rest it just seems to be the same and on occasion worse.

I've been told it maybe due to a high patella, tight hamstrings etc, anyone who assesses my hamstrings, hip flexors, quads etc say they are flexible! Antiinflammatorys seem to give me good relief as do painkillers, but I can't keep taking them for the rest of my life. I'm very active and play alot of sports. I've rested this for what seems like an eternity and there is no improvement. I'd be obliged if anyone has any interesting ideas. Thanks

[oddscwodd]

Rest it Rest it Rest it. Even walking on it if it is a tear can be a bad thing. Everyone told me to exercise my patellar tendon to re abilitate it. It just got worse. You really need to rest it. Using anti inflammatories is good but be careful because it can mask you injuring it further. Get an exercise bike if you need to exercise. Get it on lowest resistance and start just keeping the knee mobile.

If it is a tear and you are not getting joy in twelve weeks go back to your consultant. You may need surgery. Or you might need a complete leg brace to stop any knee flexion to allow it to heal.

Both of these are last resort.

If your not careful you will lose a functional quad. This will mess up your biomechanics. This will mean lots of secondary problems.

So rest it. exercise the quad at first by contracting the muscle then relaxing it. Find a really good sports physio.