Jumper’s Knee Forces Rafael Nadal out of Wimbledon this year

If you are a tennis fan, you’ve no doubt heard that Rafael Nadal has withdrawn from this year’s Wimbledon tournament due to “jumper’s knee,” also called patellar tendinopathy.  And there’s worrisome news long term. It’s unclear whether he’ll ever completely return to form, according to research conducted by Tibesku and colleague.

So what exactly is Jumper’s Knee?  Patellar tendonopathy is an an overuse injury that causes pain and swelling where the thigh meets the knee, in an anatomical area called the extensor mechanism.  This extensor mechanism pulls the thigh straight in relationship to the lower leg; it's the movement that happens when you are crouched, with your legs bent at the knee, and then you jump up, straightening your legs.  

The first step in fixing jumper's knee is taping the knee and resting.  Taping the knee reduces the force applied to the front part of the knee knee, and reduces symptoms. 
 
While Jumper’s Knee has long been known as a simple overuse injury that recognized by inflammation and treated with rest, this viewpoint has been called into question.  Peers and colleague refer to numerous reports that patellar tendinopathy appears to be more of a degenerative disease.  Degenerative diseases, like osteoarthritis, occur when normal or accelerated wear and tear or aging deteriorate the function or structure of organs.  This suggests that simple non-steroidal anti-inflammatory medications and rest may not improve Nadal's situation. 

A treatment called eccentric strength training has been used to improve patellar tendinitis.  As opposed to concentric strength training, or weight lifting, eccentric strength training involves the controlled lengthening of muscle fibers, as one might experience when hiking downhill, or putting a heavy box down on the ground.  Bahr et al found that eccentric strength training of the leg and thigh, such as an exercise in which one squats on a decline board set at 25 degrees, should be tried for 12 weeks before any surgical options; there was no apparent benefit to surgery compared to strengthening exercises alone. 

Tibesku and colleague found that most athletes who recover from jumper’s knee usually are pain free but do not return to their original athletic levels.  We hope that Nadal is not "most athletes," and that these events do not forecast the wrap-up of his extraordinary tennis career.

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