This is the second post in a series on common knee injuries suffered in Ultimate Frisbee. If you missed the first post on ankle sprains, be sure to check it out as well!
The most common knee injuries in ultimate frisbee are patellar tendon pain, patellar tracking disorders, and iliotibial band syndrome. In this post, we will discuss how each of these knee injuries occurs and what can be done to treat them.
The patellar tendon connects the knee cap (patella) to the shin (tibia) and is an extension of the quadricep muscles. When the patellar tendon becomes irritated through overloading the pain is felt below the knee cap and is worse while bending the knee and jumping. Patellar tendon pain goes by many different names including: patellar tendinitis, patellar tendinopathy, patellofemoral arthralgia, and jumper’s knee. For simplicity, patellar tendon pain will be used throughout this post to refer to this condition.
The first thing to look at with patellar tendon pain is the amount of force being placed on the tendon. Since patellar tendon pain is an overload condition, the amount of load being placed on the patellar tendon should be reduced in the short term to allow it to calm down. There is not a magic amount, but the load should be reduced enough that the pain is between a 0-3 on a scale of 0 to 10.
Stretching the quads for patellar tendon pain? The standard standing stretch for the quads causes compression of the patellar tendon against the bone which can lead to similar tendon changes that occur with overloading. Try avoiding stretching the quads when the patellar tendon is irritated.
The goal of rehabilitation is to strengthen the patellar tendon so that it can tolerate the amount of load being placed on it. Isometric exercises (exercises that contract the muscles but don’t move the joint) are used in the beginning stages of patellar tendon pain because they have been shown to reduce the pain. The Spanish Squat or a wall sit are two examples of an isometric exercise used for patellar tendon pain. The rehabilitation program then gradually progresses to loaded squats and finally jumping as the tendon becomes stronger.
Patellar tracking disorders and iliotibial band syndrome have a similar root issue but with pain experienced in different areas.
Patellar tracking disorders occur when the leg (femur) internally rotates causing irritation of the tissues under the knee cap. The pain is usually vague located around and underneath the knee cap. Any knee movement can cause pain with patellar tracking disorders, but it is usually exacerbated when going up and downstairs.
RockTape (kinesiology tape) can be helpful in the initial stages of patellar tracking disorders to decrease the pain. The tape works by stimulating the receptors in the skin which helps reduce pain. This is similar to when you hit your elbow on something and then you rub it to decrease the pain.
The rehabilitation program for patellar tracking disorders focuses on the quadricep and gluteal muscles. A spasmed muscle will alter how the muscle functions, so many rehabilitation programs begin with some sort of soft tissue work to the quadricep and gluteal muscles. The strengthening program for patellar tracking disorders can begin with wall sits and glute bridges and gradually progress to squats and split squats when tolerated.
Iliotibial band syndrome also occurs when the leg internally rotates but the irritation occurs on the outside of the knee. The internal rotation of the leg causes compression of the tissues between the iliotibial band and the shin bone, leading to pain. The pain is usually localized to the outside portion of the knee and is worse when the knee is slightly bent (ie. with running).
As with patellar tracking disorders, RockTape can be a helpful treatment option for iliotibial band syndrome to reduce pain in the initial stages.
Should you foam roll the iliotibial band? In short, no you shouldn’t. The iliotibial band is an incredibly dense tissue that connects the hip to the knee. It requires a lot of pressure to stretch the IT band (far more force than foam rolling or stretching can achieve). Foam rolling compresses the IT band against the femur which can lead to further irritation, therefore, foam rolling isn’t generally recommended for ITB syndrome.
Rehab for ITB syndrome is similar to that of patellar tracking disorders, but focused more on the glutes than the quads (although the exercises for patellar tracking disorders can be used as well). Exercises that can strengthen the glute muscles include penguin walks, hip isometric holds, and skater walks. The great thing about these exercises are that they don’t require much equipment and can be performed anywhere.
In conclusion, patellar tendon pain, patellar tracking disorders, and iliotibial band syndrome are common injuries occurred in ultimate frisbee. Soft tissue therapy, kinesiology taping, and quadricep/gluteal strengthening can all be used to help recover from these issues. If you need help figuring out what is going on and what is the best treatment plan for you, seek the advice of a qualified health professional.
In the final post on injuries in Ultimate Frisbee, we will discuss lower back pain.