“When I land from a jump my patellar tendon hurts.”  This sentence just about sums up what is required to diagnose “Jumpers Knee”.  I’m not complaining as I love simplicity.  But I also enjoy finding the cause of WHY the knee hurts when someone jumps which is why you won’t catch me applying ultrasound to someone’s patellar tendon.  If you do this please consider dedicating your time to assessing WHY the body is creating a pain signal while absorbing the impact from a jump.

 

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A 16 year old dancer came to see me with bilateral jumpers knee (not Osgood Schlatters as the tibial tubersoty was not affected).  Her pain was only aggravated by climbing stairs and of course jumping. In a case like this I’m thinking the quads are either overworking or under working.  During my physical exam it was clear they were overworking.

 


It turns out the facet joints in her low back were compensating for her ability to laterally flex and extend her low back/trunk.  Do the lumbar erectors and quadratus lumborums have to fire optimally if the spinal facet joints are going to do all the work?  It’s like that annoying kid in class who always answers questions and after a while you apathetically stop raising your hand.

 

 

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Note the uncanny resemblance of “that kid” and the lumbar spine facet joints…

 

Point being if the facet joints provide the lumbar spine with the stability it requires then the surrounding musculature do not have to work as hard to stabilize the spine.  They get apathetic and lazy like you used to when that kid wouldn’t stop raising their hand every 5 damn minutes.

 

Now if this pattern continues would the quadriceps take on an increased load during the landing of a jump if the lumbar musculature is not firing efficiently?  Think about the ground reaction force one must absorb and dissipate during the landing of a jump. I used NKT® to confirm my suspicions.

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Force = mass * acceleration  <- PHYSICS!

 

After releasing tension from the lumbar facet joints via Chiropractic manipulation this incredible athlete was able to extend and flex her spine to the left against resistance with much greater ease.  Unfortunately this pattern did not help her to flex the trunk to the right with a clean neural lock.  Further examination revealed a dysfunction within the right patellar tendon mechanoreceptors which were associated with her ability to flex the trunk to the right.

 

After these issues were cleared there was immediate pain relief during jumping and stair climbing.  The discomfort was not 100% gone but she needs to do her homework and there is always a possibility of additional underlying dysfunctions.  Please understand that releasing tension from the low back and right patellar tendon was not enough in this case, nor was strengthening the lumbar musculature.  It was the sequence of events that allowed her nervous system to adapt to this efficient pattern of movement.

 

Next time you see someone with Jumpers Knee, ask WHY the patellar tendon is so angry.  Stretching the quads might be part of the answer but don’t stop there. The underlying cause lies within the patient and how they move.

 

Ask lots of questions and assess. Never stop asking “WHY?”.

 

UPDATE:  After 5 sessions consisting of manual therapy and exercise progressions this patient is now pain free and can resume dance activity.  I should mention that she had previously seen Physiotherapy consisting of cookie cutter hip strengthen exercises and ultrasound for over a year before coming to see me.  

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