Jumper’s Knee

Patellar tendonitis, commonly referred to as ‘Jumper’s Knee’, is a breakdown of the soft-tissue structure connecting the knee cap (patella) to the shin bone. We see this condition quite frequently in the clinic, and it tends to affect people participating in any activity involving repetitive squatting movements, or repeated jumping. This would include volleyball and basketball players, gardeners, and runners just to name a few.

Excessive physical stress can cause micro-tears in the fibers comprising a tendon. The body recognizes this and sends inflammation to the tendon to start the healing process. Special cells start to lay down new tissue (a form of scar tissue) and clean up damaged tissue. Pain, swelling, redness, heat, and loss of function are common signs associated with this inflammatory process. When inflammation occurs in the tendon connecting the knee cap to the shin bone, we call it patellar tendonitis. Your physiotherapist can help you rehabilitate from this injury in many ways.

In the early phases (acute phase) of injury the inflammation in the tendon needs to be resolved. Icing the injured tendon for 10 minutes at a time several times a day will help this process in the first few days of aggravation. The proper use of a patellar strap can also help in decreasing the inflammation. A patellar strap is a piece of neoprene or tubing that is attached just below the knee cap directly on the patellar tendon. It helps to decrease or redirect the forces traveling through the tendon, therefore limiting the amount of inflammation created during the day. Also, your physiotherapist may use modalities in the clinic such as ultrasound, cold laser, and interferential current that may help to speed up removal of the inflammation.

After about 5-7 days, the tissue enters a new phase of healing called the sub-acute phase. New tissue starts getting laid down. This new tissue your body has put down on the injured tendon needs to be re-modeled so it is aligned along the lines of stress and has appropriate length. This can be accomplished with a physiotherapy technique called deep transverse friction massage along with appropriate stretching exercises for the quadriceps muscle group in the front of your thigh.

Along side tissue remodeling and stretching, the new tissue also needs to be strengthened in a controlled environment. Drop squats are exercise of choice for these types of tendonitis. This involves a progressive squatting program of speed and load. Parameters provided by your physiotherapist are vital for success.

Other strategies your physiotherapist may employ include analyzing the alignment of your whole lower extremity, and screening the biomechanics of surrounding joints (hip and ankle), muscles and ligaments. There are often secondary instigators of patellar tendonitis such as excessively tight quadriceps muscles that increase the potential for the patellar tendon to break down, or poor arch control in the foot that can increase the angle of force through the knee and respective patellar tendon. Your physiotherapist may also revise factors such as your training progression, or modify the way you perform certain activities such as squatting in the garden.

Depending on the severity of the patellar tendonitis, in about 4-6 weeks you’ll be jumping for joy and back doing the activities you love once again.

A Pain in the Achilles →

Sun City Physiotherapy Locations

Kevin Bos, B.Sc.PT, FCAMPT, Dip Manips, Sports Cert, CGIMS

Kevin Bos is a co-owner of Sun City Physiotherapy and has been working as a physiotherapist for over 17 yrs. He graduated from the University of British Columbia in 1996 with a Bachelors of Science in Physical Therapy and worked for several years in the Fraser Valley before moving to the Okanagan.

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Iliopsoas Bursitis

Hips and Knees

Iliopsoas Bursitis

It’s a pain that no one wants to experience. It lives in the front of your hip and groin, and can radiate down the inside of the thigh to the knee. The hip and groin pain is noticeable with certain hip motions and activities. It’s called Iliopsoas bursitis, and you might have it.

Iliopspas bursitis is an inflammatory condition that involves the muscle and busra in the hip/groin region. It is often the result of repetitive hip flexion (bending) in activities such as running, dancing, track and field and gymnastics. People report having pain in the front of the hip and groin region that often radiates down the front or inner thigh all the way to the knee. Occasionally, a snapping or clicking is heard that may or may not be painful. The pain is made worse with extending the hip back, crossing the leg in front of the body, and twisting the leg inwards. Bringing the knee up to the chest can often produce a pinching sensation in the hip or groin.

The Iliopsoas bursa is the largest bursa of the 160 bursae found in the human body. A bursa is a fluid-filled sac that lies between a muscle and bony prominence. It is designed to reduce the friction and provide cushioning for the muscle as it glides over the bony prominence. Inflammation of the Iliopsoas bursa results when the overlying hip flexor muscle produces excessive pressure or friction on the bursa during movement. This increase in friction is often a result of tight hip flexors combined with repeated hip flexion, poor mechanics, or even direct trauma.

The amount of repeated hip flexion during running, dancing, gymnastics, and field events makes this a familiar condition for these athletes but it is also common among the recreational athlete too. What I tend to see, clinically with the recreational athlete who presents with Iliopsoas bursitis, is someone who typically has a seated job (desk job, driver, etc.) They spend the majority of their day in a seated position, which is the ideal position to promote hip flexor tightness (not to mention hamstring and calf tightness). Then, with their tight hip flexors, they go for a run or a long hike. The whole time the tight hip flexor is gliding over the underlying Iliopsoas bursa, creating excessive friction and inflammation. The end result in both cases is the same. Pain, decreased hip motion, decreased activity tolerance, and often tenderness to touch.

Treatment for Iliopsoas bursitis includes stopping the irritating activity, decreasing the inflammation with ice, using anti-inflammatory medication as directed, and seeing your Physiotherapist for assessment and treatment. Your Physiotherapist will determine the cause of the irritation to the bursa, rule out other possible diagnosis, and administer additional inflammatory reduction therapy (ultrasound and electrical stimulation). They will begin stretching exercises as soon as possible, and then appropriate strengthening exercises to minimize reoccurrence. If your injury was a result of improper mechanics, your Physiotherapist will also be able to help you identify and correct those factors.

Robina Palmer, B.Sc.PT, CAFCI, Vestibular Therapist

Robina Palmer is a registered Physiotherapist and co-owner of Sun City Physiotherapy.

Robina is a graduate of University of British Columbia’s School of Rehabilitation Medicine. She has practiced in sports and orthopaedic rehabilitation in various clinical settings throughout the United States and Canada.

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