In this article I will share the lessons I learned from working with many athletes/people who had anterior knee pain just below or even on the knee cap (also called jumpers knee).
Obviously, I have my diagnostic pathways, which would lead me to different conclusions depending on the individual. Like with all dysfunctions and diseases there is not a single root cause attached to any disease. For any given person, there can be different causes as to WHY she/he has anterior knee pain.
Any doctor/specialist talking about THE pill, or THE program, or THE treatment for ANY condition, does deeply enough appreciate the variety of individuality of the human organism.
What mostly DOES NOT work in my experience :
- (JUST) RESTING
Of course the pain can subside when you are resting. You are also not bothered by a flat tire of your car, when you have the car parked in the garage. But as soon as you take the car out for a ride again, you will feel the flat tire again. The same is true for most all orthopaedic issues. Rest will of course take pain away. The measure of true healing is, if the pain is gone while doing intense activity. If the pain always comes back when activity levels go up, then the root cause is NOT fixed.
There are VERY few cases where jumpers knee developed solely because of too sharp of a increase in activity levels. For example when basketball professionals come out of the summer break and start into training camp with intense jump workouts. Or when I was working in physical therapy in the United States we had some cross country runners with insanely high training volumes. But one thing you will notice, if it is solely an issue of training volume, is that the problem mostly develops mostly on both sides and is unresponsive to other lifestyle changes/interventions.
2. Eccentric Exercise
While eccentric exercise is valuable in other chronic tendinopathies (tendon aggravations) I have found it to be not very beneficial in Jumpers Knee. As Jumpers Knee is an inflammatory condition, the pain will reside for a while, when you exercise, because the pain sensitivity reduces, fluid transfer increases, and tissue temperature increase with movement. That is why the pain is worst in the morning or after long periods of inactivity. But in general, I haven’t found unspecific general exercise (including eccentric exercise) to be very beneficial for anterior knee pain.
3. Working on the knee directly
Unless there was DIRECT trauma to the knee in form of an accident or a surgery, direct manipulation or injection of the knee will most likely not improve the situation long-term. Have never seen it. When the knee pain is very manifested, say it has been there for over a year, then working directly on the tendon can become a supplemental treatment necessary to remove scar tissue.
In contrast here are my top three interventions I end up doing with patients, because my diagnostic flow led me there :
- The foot. I usually do some form of manual therapy on the foot, but if you do not have access to a therapists who can mobilise and re-balance your foot, a good way to start is to change your footwear. For MOST it is using more flexible shoes. I have had good success with the New Balance Minimus in many athletes. If you can twist the shoe like a wet towel, then it is a flexible shoe. Also, just reducing the heel height can be important lifestyle change. We make between 2.000 to 20.000 steps EVERY DAY. You can imagine that any imbalance in the feet/shoe complex, will have an effect on the knee. Especially if you had a foot/ankle trauma in the last years, starting treatment on the foot is something you should really consider. Just taking a tennis ball and massaging the bottom of the feet takes the edge off for many patients with knee pain.
- The gut. Inflammation in the small intestine will shut off muscles in the hip, which can have a very negative effect on the knee. I have had many athletes respond really well to lifestyle changes that lead to less inflammation of the small intestine. For many people gluten (and other glutenous substances) found in all grains can be aggravating. For a smaller percentage it can be dairy products, for an even smaller percentage it can be soy, and for a substantially smaller percentage it can be many other foods. An elimination diet trial of 21-days, where you completely reduce consumption of grains, dairy, sugar, and soy to ZERO can be worth a try. In my diagnostic pathway I find that around half of all people with orthopaedic issues have some form of negative reaction to grains, dairy, sugar and/or soy.
- The hip. If the above two approaches did not prove fruitful, then craniosacral therapy, especially for re-balancing the hip, can do wonders. I purposely put “treatment of the hip” BELOW treating the foot and the gut, because problems in the foot and the gut, will kick the hip/sacrum out of position again after a while, so make sure foot and gut is taken care of BEFORE working on the hip.
Of course there are MAAANY other modalities that can work you, but I found most other effective strategies work by either balancing the foot, the gut, and/or the hip.
May the FLOW be with you all!!
Gerrit Keferstein is a Medical Doctor specialised in Performance & Functional Medicine. He is most known for his work on the optimisation of recovery and adaptation in elite athletes.