So, I spent the weekend before last watching March Madness.
By “spent the weekend watching” I mean that it was on at my cousin’s house
while I was there doing laundry for 2hrs, but thankfully it was enough to
inspire this week’s blog. Duke was playing San Diego State and there was a lot
of sprinting, cutting, and jumping happening. Obviously my chiropractic brain
started thinking about knee injuries. It actually made me think of one injury
in particular given the season we’re entering into. According to the calendar
at least, Spring is here and I’m seeing more and more runners logging their
miles through the streets of Boston now that the Earth has started to thaw
(fingers crossed). The overuse knee injury that plagues runners and jumpers
most commonly this time of year is Patellar Tendonitis, or Jumper’s knee. It
sneaks up on you, and can be surprisingly painful, so let’s take a second to
talk about the injury and some ways to treat it.
A lot of people who show up to the office with knee pain
caused by this injury are just confused. They haven’t tripped, they didn’t run
into anything, and they can’t really pinpoint when the pain started. All they
know is that their knee has been bothering them during their last few runs or
pick-up basketball games. The hardest thing for people to wrap their minds
around is that the pain associated with this injury is caused by a combination
of cranky muscles and tendons, and not some major tear or fracture. Patients
suffering from this injury present with stories so similar to one another that
sometimes it feels like déjà vu. They sit on my exam table, point to the front
of their knee right under the knee cap, and tell me they haven’t “done”
anything but it sure does hurt when they exercise. When I ask how it feels to
go up and down stairs they look at me like “How did you know?!” While I wish it
was because I am brilliant and can also read minds, the truth is that the
nature of this injury dictates what activities are painful, and stairs are
almost always one of them.
When we’re talking about the knee, there are a couple of
muscle groups to consider. Some of the muscles of the thigh/quad attach from
the pelvis to the femur/thigh bone, and others attach from the femur/thigh bone
to the shin bone. It is these muscles, the ones that cross over the knee on
their way to the shin, that create movement at the knee joint. When the muscles
of the quad contract, they extend the lower leg out straight. The opposite
happens when the muscles of the hamstring contract. This brings your heel
towards your buns. For now, let’s focus
on the muscles in the quad.
The main muscles of the quad are the rectus femoris and the
vastus lateralis, medialis, and intermedius. They are all responsible for
extending the knee and all play an important role in walking, jumping, running,
and squatting as a result. The rectus femoris is particularly important because
it attaches up into the hip and is important in swinging the leg forward while
walking/running. It also travels down to the knee where it surrounds the kneecap
before it turns into the patellar tendon and attaches to the shin bone. You can
imagine how a muscle that crosses not one but TWO major joints is probably both
very important and also under a lot of stress. This is especially true when it
comes to the point at which the muscle attaches to the shin bone below the knee.
Any overuse of the muscles (think runners with constant knee flexion and
extension through their stride, basketball players jumping AND running, etc)
can irritate that attachment point and cause tiny tears, inflammation, and weakness
in the tendon, resulting in knee pain. Any imbalance of the muscles of the
quads (or even the hamstrings/gluts for that matter) that affects how they work
can make things even worse. The muscles start contracting in ways they aren’t
meant to, and your body reacts with irritation and discomfort in that patellar
tendon right below the kneecap. Eventually, the biomechanics of your knee are
just “off” enough to cause that cranky, nagging
pain that you’re feeling.
So, how do we diagnose Patellar Tendonitis? Well, we rule
out the bigger/badder stuff first. We use orthopedic tests to figure out if
anything else can be causing your pain. Sometimes we take X-rays to make sure
the bones aren’t involved. The rest of our diagnosis comes from testing the
muscles for imbalances, assessing the joints of the knee for motion or lack
thereof, and figuring out where the tenderness/pain is coming from.
Now the important part: How do we fix it?
Rest: There isn’t an athlete on the planet that likes to be
told to rest, but sometimes it’s necessary to let things heal. Now, 2 weeks of
rest won’t fix the cause of the injury, but it will help with the pain and
inflammation.
Foam Rolling: I’m sure that you’ve seen someone at your gym
rolling around on one of these over-sized pool noodles. They’re great for
working through muscles that are so tight that stretching just isn’t going to
cut it. If you’re tight enough it might feel like torture, but it works to loosen
up both the muscle and the covering of the muscle that tends to develop
adhesions and scar tissue over time. This allows the muscle to work more
appropriately and takes stress off of that cranky insertion point we’ve been
talking about. To use it, put it on the floor and lower yourself onto the
roller so that your upper body is supported by your forearms in a plank
position, and your lower body is supported by the roller under your quads
(perpendicular to your body) with your feet off the ground. This probably WON’T
feel good. I’m sorry! The goal is for you to roll up and down your quads
15-20times in this position. If it’s too much pressure, feel free to put one
foot on the ground while you roll out the other leg to take some of the pressure
away.
Graston: If this isn’t the first blog of mine that you’ve
read, you’ve probably heard me talk about Graston. It’s that soft tissue
technique that looks like a medieval torture technique but is actually AWESOME
for soft tissue injuries. Your chiropractor can use it to break up adhesions in
the covering of the quad muscles or around the tendon just under the knee cap.
It hurts, but it’s a really effective way to get the muscles contracting the
right way, taking pressure off stressed out joints.
Muscle imbalances: Because there aren’t too many ways to
tackle this one yourself, you may want to consult with your chiropractor. You
may have thought that your chiro was just there to address your low back and
neck pain, but we can do knees and extremities too! We are able to figure out which
quad muscles are doing what, and target them accordingly. I’d love to tell you
there’s a magic formula for everyone’s Jumper’s knee, but I’d be lying to you. Sometimes
we need to put you through different squatting routines, practice proper
sit-to-stand technique, or add some strengthening/stretches exercises to your
gym routine. Proper function and biomechanics can make all the difference in
this kind of injury.
Adjustments: Sometimes the way the joints of the knee are
moving , or not, is the cause of the problem. If joints aren’t moving or
gliding the way they should be, the muscle attachments in that area can get
stressed, begin to work improperly, and create pain where that muscle inserts.
In this case, irritated quad muscles due to restricted knee joints can result
in inflammation just below the kneecap. The same is actually true for the low
back and pelvis as well. If joints aren’t moving properly in these areas, the
muscles that connect these areas into the legs get tight and irritated. If
these muscles go to the knee, you might have yourself some knee pain. Ask your
chiropractor to evaluate your spine and knees for good motion in the joints,
and address them with adjustments if necessary .
The moral of the story is that knees are sensitive, and even
if you haven’t sustained a major injury there are plenty of soft tissues and
joints that can cause more pain than you’d expect. Take time to figure out
where your pain is coming from, and get it treated before the real Spring
season arrives. Stay healthy and injury free, and good luck with your March
Madness brackets!!
