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Sweaters knee.

A sweaters knee involves pain at the front of the knee. It is a complaint that is especially common in athletes, and as the name suggests, especially sports that involve a lot of jumping. So sweaters knee is common in sports such as handball, basketball and volleyball, but also in other sports where explosive jumping is common. Recovering from a sweaters knee can take a long time without proper guidance from a physical therapist.

The knee is made up of several bone pieces, namely the thigh bone (femur), kneecap (patella) and shin bone (tibia). In a sweaters knee, the tendon that runs from the kneecap to the tibia is irritated. This irritation is caused by repeated large pulling forces often demanded in sports. This is due to the frequent slowing down and speeding up of movement that recurs in these sports. Often we see the symptoms arise because the tendon does not get around to recovering sufficiently after strain and therefore the strain capacity of the tendon decreases. We actually see over time changes occur in the structure of the tendon. The quality of the tissue decreases. We regularly hear people say that the affected area is swollen, and this can be true. We know from research that the tendon will still try to repair itself and create extra cells to do so. As a result, we actually get a thicker tendon (more on this later). 

Trochantor major syndrome
Cause

In addition to knowing which athletes may be at risk for sweaters knee, we also see that it is an injury more common in men than in women. Furthermore, the injury is also more commonly seen in young adults and adults. Risk factors for developing a sweaters knee are:

  • Increase in (sports) load
  • Overweight
  • Reduced flexibility of other surrounding muscles (calf muscles, hamstrings, quadriceps)
  • Foot abnormalities
  • Practicing sports at a high level

Did you know that 50% of professional volleyball players experience sweaters knee at some point? En that this percentage is 32% of professional basketball players? In amateur sports, fortunately, the percentages are slightly lower. Here we see 14% of volleyball players. 

A tendinopathy/tendon problem often develops gradually and increases in severity over time. The course of symptoms is often recognizable and goes as follows:

  • Complaints at the start of an activity that gradually disappear. This is followed by an after reaction when the activity is over.
  • Complaints at start of activity that gradually disappear 
  • Complaints that do not disappear during activity.
  • Complaints present even at rest.
physio fitaal physiotherapy
Symptom

A sweaters knee is characterized by pain to the knee below the kneecap. In addition, symptoms may present such as:

  • Morning stiffness
  • Pain related to (sports) strain
  • Being able to exercise less
  • Gradual onset of symptoms
  • Thickening of the tendon.

When and how long the pain symptoms occur depends on degree of irritation of the tendon and the activities you undertake. In some cases, the symptoms are limited to playing sports; others also experience pain during daily activities.

Diagnosis

The diagnosis for a sweaters knee is made by the story the patient tells during the intake that fits a sweaters knee. The physical therapist can then perform tests to confirm if a sweaters knee is indeed present. To do this, we use performing a one-legged squat on an incline. The physiotherapists at Fysio Fitaal Tilburg are well capable of assessing your symptoms. In addition, we have the ability to make an ultrasound of the tendon to map abnormalities in the tendon structure. Other imaging examination is not advised, because we do not gain additional insights with this in this type of complaint. 

Treatments

Treatment of a sweaters knee consists of several stages and components. First, it is often necessary to adjust the sports load. A temporary adjustment is simply necessary to give tissue time to recover. Adapting fortunately does not mean that you have to stop your sport. Slight complaints may in fact be felt during activities. In practice, we see that the extent to which you can practice sports in the first phase varies greatly from person to person. You can often do other activities such as walking and cycling. You can always discuss with your physical therapist what is convenient to do. 

Next, it is important to start determining what may have caused the symptoms. Has anything changed in the intensity (jump load, sprint load), frequency or duration of training. In addition, it is useful to ask yourself whether there has been a change in factors such as your surface or footwear. These are all factors that can be influenced well to increase the chance of recovery but also reduce the chance of the injury returning. 

Then you get to work on train. something badly needed to stimulate the newly formed cells in the tendon (which we talked about earlier) to create new tendon tissue and structure it in the direction of tendon pull. To do this, we use a training structure that research has shown works very well to reduce tendon pain. The training builds up from isometric load to isometric load (building up in load) and finally plyometric training (jumping and running forms) and sport-specific exercises. You can map out this entire path with your physical therapist. 

During your "rehabilitation process," it is okay to feel some pain. Scoring this from 0 (no pain) to 10 (extreme pain), we want pain to score no higher than a 3-4. This applies both during activities and to the reaction in the 24 hours afterwards. If you do find that pain scores higher than a 3 or 4, you will need to adjust the load and postpone your next workout for a while until you get back to your starting point. 

Fortunately, the prognosis of a sweaters knee is good. We see that at least 80% of those who adhere well to his/her rehabilitation plan experience a sharp decrease in symptoms within about six months. Full recovery can take months to years and be variable over time. In addition to exercise therapy and load adjustment, many other treatment methods are offered.

Shockwave

Shockwave is a form of therapy that has gained much popularity in recent years. However, there is little scientific evidence of its efficacy. With sweaters knee, research shows that it seems to have little to no positive effect on the symptoms and recovery. It is therefore not recommended to use shockwave therapy for these complaints. 

Dry needling

Dry needling is well known to many by now. It is a form of therapy in which thin needles are pricked through the skin into painful tissue. Many thoughts on the possible effects of dry needling have already passed in the field. Research has shown that dry needling can help reduce pain in sweaters knee. This in combination with a correctly designed exercise program. We know that reducing pain does not necessarily mean improving the function and quality of the tendon. This is what you work on with the exercise program. 

Injections

Sometimes injection is suggested when recovery just won't happen. We think it is important that the pros and cons of this treatment are well considered. For this treatment you will consult your general practitioner (or rather orthopedist). It is known that injections with corticosteroids can have a good pain-relieving effect in the short term, but do negatively affect the quality of the tissue in the long term. It is for this reason that the use of this type of treatment is advised only when recovery after a long period of exercise therapy really won't work. 

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