Jumper’s Knee Exercises

Jumper’s knee is when there is irritation of the patella tendon, the tendon just beneath your knee cap. Patella tendon pain is a common source of anterior (front) knee pain often occurring from repetitive or excessive overload onto the patellar tendon. This is often a condition of younger athletes, especially men, who participate in jumping sports such as volleyball, tennis, football, and basketball. Patella Tendinopathy is debilitating and can result in the prolonged absence and potential retirement from sports. Loading the tendon is the primary stimulus which helps with tendon health! This article will take you through a few common jumper’s knee exercises!

Before we get into treatment of the patella tendon, we must first know it is truly your pain generator. Patella tendon pain is typically experienced during periods of load which will immediately cease upon removal of the load. Often times people think they have patellar tendon pain when in reality they have patellofemoral pain, which is pain manifesting from where the knee cap or patella meets the femur or thigh bone. Hallmark signs of patellar tendinopathy include:

1-pain localized to the inferior pole of the patella, AKA pain just underneath the kneecap

2- load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon.

Jumper's Knee Exercises

How Do You Fix Patella Tendon Pain?

The most investigated intervention is exercise!

First, load modification is used with the goal of reducing pain. What do I mean? If playing soccer is your trigger to pain, at a minimum you should reduce the volume or intensity at which you are stressing that tendon. Likely you will just take time off of the trigger for a short period of time.  While you are temporarily taking a break from your sport, you will begin a progressive loading program. Some pain is acceptable during or after exercise, however, symptoms should resolve quickly and should NOT worsen over the course of the loading program. Actually, loading often makes tendon pain feel better! This is known as the “warm-up effect.”

Jumper’s Knee Exercises

I am going to progress you through the first 3 stages and provide you with some jumper’s knee exercise examples through each stage.       jumper's knee exercises

Isometric exercises

With isometrics shoot for 5 repetitions of 45-second holds with a 2-minute rest break, you want to go heavy! The load should be at about 70% of the maximal amount of strength that you can hold. After 45 seconds you should be getting fatigued. Isometrics have shown to reduce pain, which is why I love beginning my patients here. In this phase, you can also perform other exercises targeting your gluteals and calves in the meantime. Don’t progress quickly through this phase, this often takes a few weeks to progress through.

 

Seated Knee Extension Isometric Holds

Sample PrehabX Video

HOW:  Begin in a seated position with a band wrapped around your shin bone. Straighten out your knee by pulling into the band. Hold the desired position.

FEEL: You will feel the thigh muscles working with this exercise. These are your quadricep’s muscle.

COMPENSATION: Please avoid moving at the entire trunk while performing this exercise, isolate the motion to the knee joint.

Typically you want to perform this exercise around 30 to 60 degrees of knee flexion.

wall squat

HOW: Begin in a standing position with your feet about hip-width apart. Next focus on lowering yourself halfway down and hold this position. Make sure to keep your back on the wall for the entirety of this exercise. The further you bring your feet away from the wall, the more challenging this exercise will be.

FEEL: You will the muscles in the front of your thigh working with this exercise.

COMPENSATION: Avoiding rounding at the back as you lower yourself on the wall. Maintain a straight back as you lower yourself.

Patellofemoral Pain [P]Rehab Program

Knee cap and anterior knee pain can be one of the most frustrating and self-limiting injuries to deal with. The common issue we see is most of these injuries are never addressed or rehabbed correctly in the first place and the same underlying issues remain, which can be a recipe for another vicious cycle of pain and setbacks in the future. We’ve designed a comprehensive solution for you to get back to normal life and simple things like squatting and going down stairs pain-free! For more information, click HERE.

 

Double Leg Isotonic

Isotonic exercises, just mean that you are keeping a load on a muscle while it’s moving through a range of motion. Loaded isotonic exercises can begin when performing these exercises create pain of 3/10 or less. The more knee bending the more stress on the patella tendon, so work within your range of motion.  When begging this stage you will likely limit the knee bending to between 10 – 60 degrees of knee bending, proceed with caution here!

In this stage exercises should be performed for 15 repetitions max, meaning that you are at failure come 15 repetitions, for 3 to 4 sets. Every second day you can progress the load until you are at a 6 reputation max. This progression is based on a clinical trial by Kongsgaard et al.

double-leg Spanish squat

HOW:  Anchor a band roughly knee height and place the band around the back of your lower leg. You will then perform a squat while leaning into the band and keeping your trunk straight.

FEEL: You will feel the muscles on the front of your thigh working with this exercise.

COMPENSATION:  Avoid leaning your trunk forward. The more you lean into the band the easier it will be to keep your trunk upright.

Goblet Squat With Load

 

Single-Leg Isotonic

Often times, when pain is present individuals will compensate by biasing their opposite side. Single leg exercises are great to isolate each side independently. I also like the balance challenge single-leg exercises provide.

Good strength is defined by performing 4 sets of 8 repetitions of a single-leg press with around 150% body weight for jumping athletes. This means that if you are 150 pounds, you should be able to single-leg press 225 pounds for 8 repetitions for 4 sets! That is a lot of weight!

Single leg Spanish squat

Anterior reach with a wedge with load

 

 

Energy storage loading- Jumper’s Knee Exercises

This is the last phase of jumper’s knee exercises prior to returning to their desired sport! The power needed for jumping, landing, cutting, and pivoting requires the patellar tendon to repetitively store and release energy.  Think of the tendons as springs, to help store and release energy. Introducing energy storage loads are critical to increasing load tolerance of the tendon.

Energy-storage exercises are a bit more provocative, based on a 72 hour collagen response to high tendon loading. Which is why in this phase the exercises are recommended to be performed every third day.

Single leg jump with pause

During your rehab from knee pain, that body seeks the path of least resistance. What is this path? Landing with a stiff knee to avoid stressing the quadriceps and patella tendon. This is a very common compensatory pattern seen after patellar tendinopathy. Key is to absorb the shock actively, this is achieved by landing softly!

Single leg plyometric jump

Sample PrehabX Video

HOW: Start with one leg on the ground. Load the weight-bearing leg to jump as high as you can. Control the landing and repeat.

FEEL: You will feel all the muscles in your leg working to control the landing and descent.

COMPENSATION: When you land, make sure your knee is aligned over your toes. Your knee should not dive inwards on the landing. Your goal is to absorb as much of the landing forces as you can and land softly. That means that you want your hip and knee to bend as much as they can to absorb the force. If you do not let them bend much, you will land “stiff” and hard. Let your hips go back and your chest go down to help absorb the forces. Your toes should touch the ground first when you land and quickly your heels will follow. You should land in a “ready position” like you would if you were playing sports, with your weight ever so slightly forward on the balls of your feet. You should not fall forward or backward after landing.

 

Jumper’s Knee [P]Rehab

Return to sport is recommended when full training is tolerated without symptom provocation. You must also make sure there are no remaining power deficits. Power can be measured testing a triple hop test for distance or a maximal vertical hop height.

Prehab is HUGE when it comes to most injuries, and jumper’s knee is no different. You must prepare your body for all the jumping, cutting, pivoting that your sport requires. Strengthening exercises are recommended at least twice per week, preferably loaded and single-legged for the remainder of your athletic career!

Rehab for jumper’s knee can be slow and frustrating, make sure to progress through each of these phases. Rehab here has been known to take 6 months or longer, be patient! If you enjoyed this article on jumper’s knee exercises please comment below!

 

REFERENCES

  1. Kountouris A, Cook J.  Rehabilitation of Achilles and patellar tendinopathies. Best Pract Res Clin Rheumatol.  2007; 21: 295– 316.
  2. Rio E, Moseley L, Purdam C, et al.  The pain of tendinopathy: physiological or pathophysiological? Sports Med. 2014; 44: 9– 23.
  3. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009; 19: 790802
  4. Malliaras P, Cook J, Purdam C, et al. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic & Sports. Physical Therapy, 2015 Volume:45 Issue:11 Pages:887–898 
  5. Langberg H, Skovgaard D, Petersen LJ, Bülow J, Kjaer M. Type I collagen synthesis and degradation in peritendinous tissue after exercise determined by microdialysis in humans. J Physiol. 1999; 521 pt 1: 299306.

 

Jumping Fundamentals & Plyometrics [P]Rehab Programs

Looking for two comprehensive guides that respectively take you through a step-by-step linear progression of mastering the landing ‘base’ position and practicing jump, bound, and hop variations? Our Jump Fundamentals Program is designed for those working back towards jumping and plyometrics after an injury or surgery and for those who don’t feel comfortable with jumping and landing just yet. Whereas our Plyometrics Program is designed to expose your body to all of the various potential landing and jumping movements that sports demand. This includes double and single-leg variations as well as multi-directional and continuous movements! These programs are rooted in scientific evidence, strengthening & conditioning principles, and our clinical expertise as physical therapists!

6 Comments
  • Angela Peirce
    Posted at 11:58h, 07 May Reply

    Doing the various squat exercises – if I have pain am I supposed to just push through in order for it to feel better??

    • Michael Lau
      Posted at 12:06h, 03 June Reply

      Hi Angela –

      I would suggest reaching out directly to a local physio in your area who can best assist you if you are dealing with pain!

  • Nicolas Castaneda
    Posted at 10:04h, 30 June Reply

    When we move on to the next stage, do we stop doing the exercises from the previous stage? Also, do I continue doing the isometric, isotonic and energy storage exercises when i’m back to playing basketball or no?

    • arash maghsoodi
      Posted at 17:55h, 14 September Reply

      Typically it is a blend of each progression, meaning it is not simply isometrics -> isotonic -> Energy storage. Rather we are preparing the body for the following phase by slowly dosing here. Yes you should be training typically at least isotonic and energy storage while playing sports.

  • Francis McCann
    Posted at 13:01h, 31 August Reply

    For the isotonic exercises should you do all 4 every other day or a subset of the 4?

    • arash maghsoodi
      Posted at 17:48h, 14 September Reply

      I usually reccomend every other day. This may be regressions of these movements. Not everyone will start at this point.

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