Some research on patellar tendonitis for basketball players

Knee tendonitis is a common ailment for basketball players due to the repetitive jumping and landing on a hard surface. Knee tendonitis, often called “jumper’s knee,” is most prevalent in sports characterized by high demands on speed and power for the leg extensors with the highest prevalence in volleyball and basketball [Lian, Engebretsen, & Bahr, 2005]. “In volleyball, a direct relationship exists between the number of training sessions (number of jumps) and the development of patellar tendinopathy” [Ferretti, 1986; Warden & Brunker, 2003]. This is one argument against year-round training for young children, and year-round competition for high-school players. With year-round play and training, the symptoms are likely to develop due to the repetitive stress to the tendon. 

The game is not going to change and become less stressful. Instead, players are becoming more and more powerful, meaning the potential for more stress due to the increased force and increased height of jumps. Interestingly, those who presented with symptoms of jumper’s knee outperformed a matched control group without symptoms on a series of jumping tests with the greatest difference being in power on a rebound jump [Lian, Engebretson, Ovrebo, & Bahr, 1996], suggesting that those who produce the most force and power are also the ones most at-risk for knee tendonitis. Therefore, beyond limiting exposures (which is not likely to happen in many cases, unfortunately) or reducing performance (what’s the point?), what else can players or coaches do to reduce the symptoms and pain associated with jumper’s knee?

A study by Witvrouw, Bellemans, Lysens, Danneels, and Cambier (2000) with 138 male and female physical education students found:

The only significant determining factor was muscular flexibility, with the patellar tendinitis patients being less flexible in the quadriceps and hamstring muscles (P < 0.05). The results of this study demonstrate that lower flexibility of the quadriceps and hamstring muscles may contribute to the development of patellar tendinitis in an athletic population.

Before I continue, rather than invest in an expensive foam roll to work on your mobility and flexibility and to attack your trigger points, invest $2 in a lacrosse ball. I have found much more success and more versatility with a lacrosse ball than a foam roller.

Here is a video of an exercise (starts at 1:14) that we have had some success implementing with a couple players who have some knee tendonitis issues. Below are some exercises for the hamstrings:

Here is another video with hamstring exercises using a band.

Beyond increasing flexibility, a rehabilitation program for knee tendonitis may look something like this from Rutland, O’Connell, Brismee, Sizer, Apte, and O’Connell (2010):

Initial treatment for patellar tendinopathy includes the following: absence from jumping, relative rest (absence of abuse), stretching of lower extremity musculature, deep transverse friction massage of the patellar tendon, eccentric quadriceps exercises, strengthening of hip and knee musculature, utilization of a patellar orthotic (if needed), and cryotherapy. Since patellar tendinosis is a chronic, non-acute condition, inflammation is absent. Thus, anti-inflammatory medications (NSAIDs) are seldom effective. Additionally, the use of cortisone injections may negatively affect tendon strength and may possibly result in tendon rupture.

The first suggestion is obvious: avoid the activity which causes the pain. Unfortunately, this means sitting out, which many players are loathe to do. However, as an overuse injury, it is hard to eliminate the symptoms without rest and avoidance. Stretching was covered above, and there are many other articles and videos on stretching.

Several studies have suggested eccentric training [Forhm, Saartok, Halvorsen, & Renstrom, 2007; Jonsson & Alfreson, 2005; Rutland et al., 2010; Stanish, Rubinovich, & Curwin, 1986]. An example of the eccentric loading would be:

Performing eccentric squats on a 25° decline board for 3 set of 15 repetitions twice daily….Using a decline board, more specifically targets the patellar tendon (25-30% higher patellar tendon forces) as compared to squats performed on flat surfaces which more likely targets the quadriceps muscle. This specificity of tendon training allows the patient to progress faster than on a squat on flat surface secondary to a better isolation of the knee extensor mechanism….A patient is ready to progress when they can easily complete the 3 sets of 15 repetitions of eccentric squats on a decline board pain-free (Rutland et al., 2010). 

The information is above is just a cursory glance at the research into knee tendonitis or tendinopathy. The prognosis generally is not great, especially for an athlete who refuses to take considerable time away from jumping-related activities (like sports participation). Therefore, the best cure is prevention.

Learning to jump and land properly; resting during the year; strengthening the muscles around the hip and knee; and maintaining flexibility and mobility at the ankle and hip are four things that every athlete can and should do to protect their knees from the wear and tear of basketball.

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