Jump Up and Jump Around
WOW! I can’t believe there are so many issues in and around the knee.
Here is a small confession at the end of last year when I was planning this month’s injury report I thought I was going to run out of ideas to write about. Boy was I wrong. Enough of the confession and on with Injury Report.
This week I am going to tackle a knee injury that plagues more people that suspected. This injury affects athlete that frequently jump, or anyone for that matter who jumps a lot. This knee injury is known as jumper’s knee, or in the medical pretense: patellar tendonitis.
Jumper’s knee is caused by too much stress on the tendon that connects the quadriceps muscles to the tibial tuberosity (the pointy part of the shin bone just under the knee). This is usually an indicator that there is compensation usually in the ankle. WebMD breaks down the symptoms into 4 categories:
- Stage 1: Pain only after activity, without functional impairment
- Stage 2: Pain during and after, although the patient is still able to perform satisfactorily in his or her sport
- Stage 3: Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level
- Stage 4: Complete tendon tear requiring surgical repair
Now obviously we do not want to be even at Stage 1, and in a little while I am going to give you guys just a little taste of what is required to get these knees nice and strong. But first I would like to try to explain just one possibility of why people get jumper’s knee.
As stated earlier jumper’s knee will give you an indicator that there is something wrong with the ankle. So, a simple range of motion assessment of the ankle will give you an indicator of a problem. Make sure you test for:
- Subtalar eversion
- Subtalar inversion,
- Abduction, and
If, for some reason, there is equal or near equal range of motion then move up to the actual knee itself and test for:
- Internal Rotation, and
- External Rotation
There should be some movement with the last two. If there is still nothing wrong, equal range in both legs, then move to the hip and test the hip in different positions, which I will be getting in the weeks to come.
Once you have completed the ROM test for the legs and found something wrong, go back to it and just do an isometric hold on it in the direction that it is weak. This is hard for me to explain on paper, it is much easier to show how it’s done.
The pressure on the tendon should ease off because now we are strengthening the muscle that is not firing properly so the quadriceps can now “take a load off” so to speak. And the pain should go away; for a time.
This isn’t the end of. Not by a long shot. Next you, as the trainer, must prescribe an exercise routine that will help the muscle(s) that are supporting the knee become stronger and become more efficient in distributing, and managing the load placed on it. This can only be done by: first, knowing what muscle is not firing, and second, knowing in what position the joint should be in for it to shut off. Again, this is all answered in the ROM testing description stated above.
Let’s say, for arguments sake, the hamstring complex (it is a complex of muscles) is not responding to load properly. Below, is a great hamstring workout that is sure to stress the hammy’s and make sure they understand what to do when they are called upon to shine!
- Squats. Most people would argue that squats are for the entire legs and I am not going to argue with them they are correct. But you can play around with the squat to put more emphasis on a certain part of the leg complex. For example, to put more stress on the hamstrings simply place the bar across your upper back, sit down as far back as you can, make sure your legs are as tight as you can get them. Better yet, use a smith machine, then use your butt to lift yourself up.
- Prone Leg Curls. When I see people doing this in the gym I almost cry with the amount of mass they are using. You really don’t need that much, trust me 20 to 45 lbs. is all you really need, unless you have hamstrings the size of your chest! When you do this movement position of your legs is everything. Make sure you lift your knees off the pad so your lower back and trunk are anchoring your hips. Then do the curl from that position in space. Trust me 20 lbs. will feel like 100.
- Lying Down Hip Thrusts. Very simple movement to do and more importantly very safe. Lie down on your back with both knees bent and your feet on the ground (this is the beginners position). Tighten up both legs as tight as you can get them and push your feet straight into the ground, this should lift your butt off the ground. When you are comfortable in doing 3 sets of 10 repetitions straighten out one leg and repeat.
There! There are three exercises that you can do right now on your own to get those hammy’s nice and tight. Mind you the knee joint is a very complex joint that has a multitude of muscles that cross it and that the exercises will bring a little bit more stability to that joint it’s not the holy grail of knee exercises. The holy grail of knee exercises is the one that will help you diminish the pain that you are going through with jumper’s knee, safely.