Frogs, charley horses and basketball - a story of patellar tendinopathy
Patellar tendinopathy - not quite the bane of my basketball career but not far off…It all started when I was 15 years old and playing basketball for Ireland. I suffered a dead leg into my left thigh, which became myositis ossificans, a calcification in the belly of my quad muscle- a severe “corked thigh”, “dead leg” or “charley horse”. I got over that and got back playing but I consequently developed “jumper’s knee”; I know…that’s a lot of slang terms and quotation marks - apologies. Bear with me…this will be worth the read.
Jumper’s knee, or patellar tendinopathy is a source of anterior knee pain, characterised by pain localised to the lower pole of the knee cap, or patella. Pain is aggravated by inappropriate loading and overuse, and increased with the demand on the knee extensors, or quadriceps. Generally there is no pain when the person is at rest, but a regular symptom would be resting stiffness. Complications may include patellar tendon rupture, which is potentially career-ending in the sporting world. I am now 34 years old and still manage my tendon soreness and stiffness most days. Let’s not do the math but that’s a few years from the initial presentation in my teens.
There is a huge amount of science and clinical evidence-based methods and research published in journals and textbooks outlining strategies to prevent and manage tendon-related problems for the patellar tendon. It’s hard to know what works and what is really crucial to get right if you start to notice soreness around the kneecap, mainly below it. A clinical examination with a sports medicine physician or chartered physiotherapist, perhaps with an ultrasound scan is imperative to start this process to investigate potential differential diagnoses ranging from chondromalacia patella, bursitis, plica issues, or arthritic changes, etc,
If a diagnosis of patellar tendinopathy is in place then at least you can start managing the tendons health appropriately. A thorough deep dive into current training loads and schedules is a good place to start to understand what could be precipitating structural and functional changes within the tendon.
Following that…strength, conditioning and physiotherapy comes into play. There is conflicting evidence as to whether to focus on eccentric (lengthening) or isometric (static) muscle strength exercises for the quads - find what works for you. I’m leaning into isometric contractions more these days but still do the occasional decline squat or spanish squat. Devoloping power and strength in the glutes and overall posterior chain will help offload off the front so include those in your programme of prevention or management and self-care.
Mobility is a must - opening up the hip flexors and alleviating muscle tendon along the quad will help take off tension downstream at the patella and tendon insertion. Some patients of mine find value in wearing a cho-pat or buttress to mechanically put tension on the tendon when they are training; this is seen a lot with basketball players. Frictioning the tendon manually can help in cases. Shockwave therapy is commonly used by professional athletes to break down adhesions in the tendon. I am a fan as have used it personally and with several clients, but it’s not for everyone. Platelet-rich plasma injections and other forms of injection therapy have been used by researchers and clinicians but I am not sold on their long-term results for pain reduction or performance.
Back to the title…research from the University of Groningen in the Netherlands came up with a finding a few years ago that frogs don’t get jumper’s knee yet they are constantly jumping and loading all the time. The simple answer is that they do not play volleyball, netball or basketball; a scientific explanation could be that frogs have kneecaps made of dense, fibrous cartilage rather than bone, which we as humans do. These kneecaps (patellae) appear to be much better suited to absorbing strains of leaping, hopping and bounding than the bony human patella. That would be a tricky operation to go for though! Perhaps we need to keep evolving to keep jumping more, further and higher.