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Basketballers are some of the most powerful and explosive athletes, with their speed and agility crucial to success on the court.
But nearly 50% of all basketballers will experience knee pain while playing.
The two most common causes of knee pain are:
We are going to go into detail on these two causes and outline some things you can be doing to help manage your knee pain.
If you have persistent knee pain, its best to get assessed by a Physiotherapist to get a plan then get on top of the issue - learn more about the RAD physio team here
Osgood Schlatters is a growth-related apophysitis of the knee. This simply means there is inflammation on or around the growth plates.
Osgood Schlatters generally presents with pain and/or swelling localised to the tibial tuberosity (which is where the patellar tendon inserts onto the shin). This is a common condition in adolescents (affecting 1 in 10).
Osgood Schlatters is often aggravated with knee loading activities (such as running and jumping). Early sports specialisation is also associated with a greater relative risk of developing the condition.
“There is a lack of evidence-based interventions, and passive approaches (eg, rest and avoidance of painful activities) are often prescribed.” (Rathleff, Winiarski et al. 2020) This is NOT the answer.
Patellar Tendinopathy is a chronic load-related injury characterised by patellar tendon pain. Tendinopathy is a term used to highlight structural changes of the tendon tissue with minimal inflammation.
This is why anti-inflammatory treatment options are discouraged and largely ineffective for treating tendinopathy.
Patellar Tendinopathy can affect up to 45% of elite jumping sport athletes (eg, basketball/volleyball) often leading to:
Normal tendons adapt to load over time. Acute overload leads to a reactive tendinopathy or a grumpy tendon. Think of a jumping athlete who suddenly increases the number of jumping/landing repetitions they are performing each week. This athlete may then develop patellar tendon pain.
Rest is not always the answer. Tendons exposed to low levels of load (start of pre-season or after injury) may also develop a reactive tendon when exposed to a moderate increase in load.
The term capacity is used to describe whether or not you can perform a task (ie jump/land) or play basketball without causing injury. Tendinopathy occurs gradually over time when the load exceeds what the tendon is able to tolerate and recover from. This is often the case with basketball athletes that train and play multiple times per week with little variation in the type of loading they are performing.
Tendon pain usually increases with load. This can be identified in two ways:
Activity modification does not always mean rest.
The key to activity modification is avoiding activities that aggravate your knee pain (i.e. jumping/landing/playing basketball). This does not always mean full rest. Depending on the severity of your symptoms - sometimes reducing your overall weekly load may be enough to help manage your knee pain.
Reducing your exposure to running/jumping/landing and playing basketball will help reduce your pain in the short-term. This is a great time to focus on training around your injury and building lower limb strength. The aim is simple - increase your overall capacity to tolerate running/jumping and landing when you return to sport.
“Rehab is training in the presence of injury.” - Phil Glasgow
What else can you train without increasing your knee pain? Building strength throughout the kinetic chain (think calves/hamstrings/glutes) can help maintain strength/power and a return to performance. This is also a good time to work on upper body strength, core exercises, or energy system development via cross-training.
Building lower limb strength may sound provocative. Remember that tendons respond well to a combination of isometric exercises and heavy, slow resistance training. This process generally starts with isometric exercises (static holds) as they can help reduce pain in the short-term. Progressive loading then becomes important to ensure your symptoms are not flared when you return normal training and sport.
Isometric loading is a form of muscle strengthening that occurs without any movement.
Static holds can be used to introduce a new load as they are generally less provocative than other forms of exercise. Static holds may also help with pain relief in the short-term however this is not a blanket rule for all painful tendons.
The aim of isometric loading is to build strength in comfortable positions before progressing to more challenging and functional positions.
Isometric variations can be progressed and regressed in-season based on your symptoms.
An example session would include 3 sets of 35-45 second holds.
A progressive loading program with additional exercises targeting risk factors, load management and patient education is the best treatment for physically active patients with tendinopathy.
Progressive loading may start with isometric exercise with the aim of reducing pain. A combination of isometric and isotonic exercises are then used to build muscle strength. Isotonic exercises aim to build strength through your required range of motion. Explosive exercises are then used to bridge the gap between strength and sport specific movements before an eventual return to sport.
Exercise programmes should be first-line treatment for tendinopathy as this is an effective option to reduce pain and improve function.
Rathleff, Winiarski et al. 2020 implemented a 12-week program that led to a reduction in pain and increase in performance. Pain scores dropped from an average of 7/10 to 2/10 in this cohort. This means that it is possible to reduce pain - but low levels of pain are likely to remain with participation in jumping sports like Basketball. Progressive strengthening and a graduated return to sport also allowed these athletes to increase their hip and knee muscle strength, and improve their jumping performance.
These results are similar to adult athletes with patellar tendinopathy. Return to sport rates were higher, and pain scores were lower when progressive tendon loading was used (Breda, Oei et al. 2021). Again - this takes time with outcomes measured after 24-weeks.
This highlights a couple of important things:
There is no quick fix when it comes to Osgood-Schlatters and Patellar Tendinopathy.
We know that a combination of activity modification, pain monitoring, progressive strengthening, and a graduated return to sport is an effective way to reduce pain in adolescent athletes with Osgood-Schlatters. This takes time.
In the case where your knee pain is persisting it is best to get it assessed by a Physiotherapist. At RAD we have an awesome team of Physios in Ballarat with a keen interest in sports who will be able to help get you back to your best - follow this link to learn more about our rehab team - https://www.radcentre.com.au/physiotherapy-and-injury-rehabilitation
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