Jumper’s (Downhill Runner’s) Knee
Now that I’ve had my nap…
Having dealt previously with patellofemoral dysfunction, the most common knee injuries to runners, let us turn our attention to another ailment often found in this anatomical region, patellar tendinitis. Inflammation of the patellar tendon, which connects the kneecap to the tibia (shin), is a classic overuse injury, but one which is most often associated with athletes involved in jumping sports such as basketball, volleyball, high, long and triple jumps, etc. Hence, in the medical nomenclature this injury has become generically known as “jumper’s knee.” We runners should be so lucky that this problem would appear in only those vertically overdeveloped athletes…unfortunately, this is not the case.
Patellar tendinitis does affect many runners, especially those who aggressively train on hills, and most particularly individuals who run downhills hard. The forces sustained by the patellar tendon during downhill running are immense and far surpass those found in level or even uphill running. This is due to the “braking action” of the quads, which controls the knee bending movement which occurs just after the foot hits the ground. This controlling action is known as an “eccentric contraction,” which means that even while the muscle is contracting to provide force, it is actually increasing in length. These opposing forces magnify the potential for injury to the muscle and to the patellar tendon as well, since the quadriceps muscle connects through the kneecap to that structure. Anyone who runs hills regularly knows almost intuitively that the “braking” on the downhills is more stressful than the “take-off” of the uphills, even though the latter is more tiring to the body in general.
The athlete with what I call “downhill runner’s knee” will have point tenderness and perhaps swelling just below the lowest part of the kneecap, as opposed to the pain behind the kneecap of “runner’s knee.” General treatment is the same as for most overuse injuries: ice, anti-inflammatory medication, sometimes cross-friction massage, and in severe cases complete rest. In less severe instances, the first step should be to eliminate hard downhill running, which means the runner may be able to tolerate level or easy uphill workouts. Of course, what goes up must come down, so unless you can take the escalator or roll back down the hill, the best you can do is jog or walk down the hill slowly and painlessly. If you cannot accomplish any of these alternatives without pain, then unfortunately it is time to take a few weeks off completely, since chronic patellar tendinitis is not something you want to try to run through, as it will most likely just worsen to the point that simple walking is painful.