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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Core Stability

Physio Articles

Core Stability

One of the most common reasons people require physiotherapy is for low back pain. Treating low back pain usually centers on the common goals of decreasing pain, increasing range of motion and improving function. For the majority of low back injuries a core stability exercise program is beneficial for improving function and returning to activities of daily living, work and sports. Core stability exercises are a common and often successful treatment in physiotherapy for recovering from an injury, preventing a further injury, improving general health and optimizing athletic performance.

So what exactly is core stability?

We have three different systems that aid in the stabilization of our spine. One is the passive system which includes non-contractile tissues such as bones and ligaments. The second is the active system which includes contractile tissues such as muscles and tendons. This active system of muscles that attach to the spine and pelvis is necessary for stabilizing the spine and producing motion. The third is the motor control system. This can be thought of as our ability to turn on and off the required muscles to the correct degree at the appropriate time.

What causes someone to have poor core stability?

A lack of stability is often seen when one of the above three systems is affected. This could include factors such as: an injury to the tissue itself, insufficient muscle endurance, muscle imbalance or poor motor control. In fact, in many people with low back pain it is common to see atrophy of the spine stabilization muscles, poor muscle endurance, a muscle imbalance or delayed activation of the stabilization muscles. Physiotherapy focuses primarily on motor re-learning, or learning to activate the correct muscles at the appropriate time, and improving the endurance of these muscles.

What exercises should I be doing to improve core stability?

It is important to begin by understanding what exercises to avoid, exercises that may be doing you more harm than good. We determine the quality of a core stability exercise not only by how well it turns on the correct muscles but also by the amount of stress it puts through the spine, known as compression and shear forces. For example, while a sit up may be a great exercise to strengthen the core, specifically the rectus abdominis muscle, it requires excessive bending (or flexion) of the low back and results in a high compression force on the spine. Repeated bending of the back and high compression forces on the spine is a common mechanism of injury for tissue damage to the vertebral disc. This would make it a poor choice when designing a core stability program. It would also be unwise to do this exercise alone, as it will most likely result in a muscle imbalance which could potentially lead to injury. It is advisable to start a core stability program with exercises that keep the spine in a neutral position and avoiding excessive bending and twisting. Common exercises that I often teach to improve core stability include a front plank, a side plank and a squat. Along with other exercises, these three challenge different muscle groups and have lower compression and shear forces through the spine which minimizes the risk of injury.

When designing a core stability exercise program it is important to focus on improving motor control and muscle endurance rather than trying to improve muscle strength at higher loads. It would also be beneficial to include a cardiovascular exercise, such as walking, to your program. The exercises you include should be comfortable and should not cause any low back pain. One exercise program is not appropriate for everyone. Exercises should consider your training goals (injury rehabilitation, injury prevention, general health or improving athletic performance) and your past medical history (including general health and specific history of low back injury).

Shin Splints by Sun City Physiotherapy

Sports

With the start of a new year, you may have made New Year resolutions to start running, or to take your running to the next level by completing your first marathon or half marathon. There are many factors to consider when you start to run or train for longer races. One major consideration is to avoid injuries. Shin splints are a common injury that physiotherapists see in clinic.

Shin splints are an umbrella term used to describe pain and discomfort in either the front or back portion of your shin. It usually presents in the lower 1/3 of the leg in the muscles around the tibia (shin bone). It typically has a dull ache but can be sharp and severe pain. Shin splints often start at the beginning of the workout, it may or may not disappear during the workout, and then returns after you finish your workout. Patients may also complain of soreness to touch and swelling.

Shin splints are often associated with running injuries, especially for long distance runners, novice runners, overzealous fitness fanatics, and for those just increasing hill training. You may also see it with dancers, tennis players, basketball players, or high divers, but it is not exclusive to these athletes.

Some of the major causes of shin splints include: changes in running surface and terrain, changes in training regimes, poor foot or ankle biomechanics, poor running mechanics, muscle imbalances, being overweight, or unconditioned athletes doing too much, too fast.

Typically your healthcare professional will want to rule out several conditions with the most serious being stress fractures and compartment syndrome. Once a diagnosis is made, treatment usually starts out conservatively with ice, ultrasound, and interferential current to control pain and swelling. Your doctor may also try to control inflammation with the use of some medications. There will be discussions about activity modifications such as no hill running. There may be other treatments to try such as taping or orthotics, and your physiotherapist may focus on some stretching and strengthening exercises. If conservative treatment does not appear to be helping, aggressive treatment may be considered. This may include a cessation of activity altogether, immobilization, or in some cases, surgery.

Recovery from this injury can be long and frustrating and it can really impede your goals – whether that includes getting back in shape or completing your first marathon. So remember to progress your training at a reasonable rate and make changes in your routine slowly. Happy running!

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.

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Sun City Physiotherapy Locations

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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