Knee Pain: Patellar Tendinopathy, or Jumper’s Knee: A fourfold treatment strategy

Who gets patellar tendinopathy?

You have ongoing pain in the front of your knee. You play a sport that requires quick changes of direction and repetitive jumping—volleyball and basketball come to mind, as do soccer and dancing. Runners can develop it too, as I found out for myself when I was 30 years old. And so can weightlifters who do a lot of squatting. 

What is it?

It is an overuse injury that develops as a result of repeated micro traumas to the patellar (knee cap) tendon from activities demanding constant acceleration, deceleration, jumping and landing, or running, especially downhill. These activities involve repeated eccentric contraction of the quadriceps. Its onset is gradual, and due to repeated micro trauma, the tendon becomes inflamed.

It can occur in two places

  1. At the tendon’s attachment on the inferior aspect of the patella, which is the most common site.
  2. At the tendon’s attachment on the superior aspect of the patella.

How does it respond to acupuncture?

The condition responds well, especially if it is not chronic, as is often the case with younger athletes. In chronic cases, which are more frequently seen among older athletes, the course of therapy usually takes longer because degenerative changes will have occurred in the tendon from repeated wear, tear and repair of the tendon. Collagen fibers will be disorganized due to the deposition of scar tissue and the tensile strength of the tendon may be compromised.

The condition occurs more frequently in athletes who have uneven pelvic alignment and imbalances between opposing muscle groups as well as excessive foot pronation. Pelvic imbalances can be addressed with a combination of acupuncture and myofascial release. With excessive foot pronation due to flat feet, the athlete should consider foot orthotics.The treatment time will generally be from 4-6 weeks for acute cases. In chronic cases, the treatment time can last from 6-12 weeks. (1) 

My strategy for treatment is fourfold.

  1. Activation of energy flow through the meridians that traverse the knee. This is a classical approach based on concepts of Oriental medicine which in itself will help reduce pain and promote healing.
  2. Treatment of local areas around the patella to target specific areas and further enhance healing and pain reduction.
  3. Release of trigger points in overly tight muscles to improve balance in opposing muscle groups, particularly the quadriceps.
  4. 4) Myofascial therapy, particularly PNF, or proprioceptive neuromuscular facilitation (quite a mouthful, I know), to further relax tight muscles like the quadriceps that contribute to excessive pulling on the tendon. A technique that is very valuable for chronic patellar tendinopathy is called multidirectional friction eccentric contraction therapy (also quite a mouthful). We do this on the tendon itself. The multidirectional friction helps to break down disorganized collagen fibers in scar tissue. The eccentric contraction helps the scar tissue to reform in a more organized fashion.

(1) Matt Callison, L.Ac., Sports Medicine Acupuncture, San Diego, CA. Acusport Education, 2019, pp 853-857

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