Quad/Patellar Tendonitis & The Dreaded “Movie Theater Knee”.
Jim Dart, PTA
There you are, enjoying watching the 9’ tall blue and yellow neon painted alien warriors as they fight over-zealous caucasian jarheads for peace and unity on their home planet when the throbbing, relentless deep ache starts.
You didn’t even train today; you were minding your own business just enjoying the movie! Then, it starts.
The dreaded “Movie Theater Knee!”
This also tends to occur while driving long distances in a cramped car that’s roomy enough for the Olsen twins. The culprit? Tendonitis. Just what type of Tendonitis ? Well sir, that is defined by it’s location.
If the pain originates at the top of the knee and proximal to the torso it’s quad tendonitis. If the ache originates at or below the knee cap – you guessed it…Patellar tendonitis.
But what is it exactly causing you to squirm in your seat ? Inflammation to the tendon of course! But how?
See, the Patella tracts itself vertically up and down the leg depending on the eccentric/concentric contractions of the quadriceps muscle.
Think along the lines of you you squatting, or running with a yoke or dead lifting massive amounts of weight.
So If there is an uneven force couple or connective tissue imbalance (loose vs. tight tendons/muscles/fascia) then the patella will not track in a pure vertical plane and it will tend to track medially (closer to mid line) or laterally (away from mid line).
This disruption in the tracking mechanism will exacerbate the tendons, making them inflamed and in turn creating pain.
Viola!! You have tendonitis! Hooray!
BUT!!! BRACE YOURSELF!
There is fantastic news ! Finding the solution is actually the easy part! The trick lies in reverse engineering the answer from the question.
First, you must ask yourself the question, “ Why do I have this pain? “ There are a couple answers that may set you on the path to relief.
The starting cause to your plight may be tight Illiotibial bands, pulling on the Lateral Collateral Ligament, or LCL and lateral joint capsule of the patella. Maybe a tight Sartorious Muscle (which attaches medially to the patella)?
Eh, Could be?!
Maybe a weak quadriceps muscle which isn’t allowing proper load bearing on the patellar tendon is the source of your pain, which is a common occurance of stronger/tighter quad muscles vs. hamstrings, pulling vertically on the patellar tendon.
What do you care about the technical jargon ? None. We know
All you know is that “It hurts here, and it’s stopping me from being active.” Which is a great concern!
The Solution, easy like a sunday morning my friends, for the most part.
STOP! WARNING! The following cures are things in which the government does not want you to know!
Let me inform you in the long sought, privately held and secretive solutions of the trade in the medical field which help keep the orthopedic surgeons pocket’s lined with cash and the copays filing in.
Activity Modification, soft tissue work, ice and Ibuprofren !!! Save your 50 dollar copay, because these guidelines are what will cure your ailments!
Mark my words – if you go to see your ortho for this type of pathology (of which I admit I’ve done it) you will be throwing away those hard earned dollars.
Why? Because EVEN though I knew better, I just wanted to BELIEVE that because the pain was sooo intense, it warranted more than its simple explanation.
I paid the price (a copay, time out of my day and pride) because I didn’t want to take my own advice. I dont want the same to happen to you!
Ninety percent of the typical cases of patellar tendonitis I’ve dealt with in physical therapy were from tight IT bands and weak Quadriceps muscle activity.
So here, Let us save you some money and keep reading to ease those aching knees.
Two simple solutions!
Soft tissue work & Activity Modification! What’s that you say? Modification to the activities that exacerbate the pain.
Such as in squatting 60 degrees or higher, like on a box to save the compressive forces of the knee while warming up the tracking mechanism of the knee with some bodyweight or very light weight unilateral knee flexion work pictured below. (Unilateral 4” step downs or Unilateral Terminal knee Extension work.)
Activity Modification will save the tendons from being aggravated by repetitive and chronic work.
Soft Tissue rehab will do several things along with enhance the integrity of the tissue, improve tissue health and create micro circulation to the tissue ridding free radicals (byproducts of inflammation) which interfere with normal healing.
Rolling out your IT bands and tight Quad Tendons out with a lacrosse ball, or foam roller will more than likely release these stubborn structures enough for the needed pressure relief you desire.
So here is the skinny of it. The Guide lines which I have found to work through my experiences… I’ll create a check list –
- Take 1 week off from the Lower body in total.
- When you resume, keep all lower body activities Closed-Chain, which means your feet fixed in place . This allows synergistic musculature to support the tendon, and decreases the movement of the patella.
- Before activity, warmup the tracking mechanism by performing Terminal Knee Extensions with a Band or Unilateral Leg Press (ROM should only be a few inches) for 4 sets of 30 after your general ROM and stretching regiment.
- Pay extra attention to stretch your quads and roll out your IT bands.
- Use supportive sleeves (preferably with an open patella cut out)
- Use muscle rub! Icy Hot & Capsaicin Combo is my favorite!
- If you Squat, or Deadlift – Keep the knee at about 60 degrees of flexion or above to eliminate the compressive forces on the knee. Do this by squatting to above Parallel Box or do Block/ Romanian DL’s.
- Direct quad & patellar tracking work! This should be done as an auxiliary movement – Start with Unilateral Bulgarian Squats onto a box (onto a bosu ball to assist with a smooth eccentric phase and give some extra propulsion during the concentric phase), terminal knee extension on the leg press or with bands. Step downs from a small deficit to keep tension on the patellar tracking mechanism for strengthening the fabled VMO.
BUT ABOVE ALL -
- Stretch Stretch Stretch! Before, during, after.
- Ice Ice Ice! (before, after)
- Ibuprofren ( decrease the inflammation) when you need to!
How about supplements to help with the inflammation? A sure-fire choice…Fishoil, and lots of it! I tend to see anti-inflammatory effect from superdosing fishoil when I take 12grams or more a day. On top of joint health, it’s great for testosterone production, cardiac health, and hair – skin – and nails!
Also, changing footware from a raised heel to flat sole may alleviate unnecessary weight bearing on the patella, should you want to.
Works Cited –
Dr. Splichal, Emily; “Client With knee pain? Barefoot Balance Training”; Evidenced Based Fitness Academy’s Blog.http://blog.
Mychal, Anthony; ”Straightforward Knee Rehab”;T-nation.com. http://www.t-nation.com/
White Fish Sport Center; June Exercise of the Month: Step Downs. Sport Center. http://www.
Anderson, Barton; Foam Roller Exercises: Improving Mobility. Sports Injury Info. http://www.sports-injury-info.
Lipert, Lynn S.;Clinical Kinesiology and Anatomy, 4th Edition; Knee – Common Pathologies. F.A.Davis Company, Philadelphia; 2006 Ch18:252-262.
Maroon, Joseph C. MD, Bost, Jeffery P.A.C.; “FISH OIL: The Natural Anti Inflammatory”. Basic Health Publications; 1st Edition; 2006:176.