Knee Injuries

Q. I am a woman in my mid-40s who plays tennis up to four times per week. I have been relatively injury-free up to now but have a concern over a developing problem, a feeling of stiffness and soreness in my knees. This pain is apparent when I first get up in the morning as well as after I play. I play tennis almost exclusively on hard courts. What can I do in terms of warm-up exercises, shoe inserts, etc. that can help stop this problem from becoming worse?

A. The pain you are describing could be from a number of things including tendinitis or arthritis. Playing exclusively on hard courts forces your knees to take quite a beating. Either way your problem likely has to do with inflammation around the joint causing the stiffness you feel in the morning. You can stretch your quadriceps out regularly during the day (hold for at least 30 sec) as well as before and after you play. It is also beneficial to warm-up gradually before starting high level play.

The USTA has developed a DVD of warm-up exercises that tennis players can perform to help get the body ready for tennis.

Taking some anti-inflammatory medication, like ibuprofen (Advil), before you play may help alleviate some post-activity soreness as well. On the days that you are already sore, I recommend decreasing your playing time or rescheduling and immediately icing after you get off the court. Stretching, ibuprofen, and icing should help alleviate your symptoms.

Check with your doctor to verify why you are feeling pain, and as always, check with a physician before starting or changing medications.

Q. Do you have any data that suggests how long after an ACL reconstruction a female in her 40's can return to tennis fully? Are there tennis specific rehab exercises?

A. Age/sex of the athlete doesn’t seem to matter with reconstructed ACL’s when it comes to return to sport. What is important is how strong you were before the surgery, how well the surgery was performed, and what rehabilitation exercises have you successfully completed already, before you try to get back on the court. There is no set time frame, but 4-6 months after surgery if everything went well is a reasonable amount of time to be back playing normally. Of course there will be exceptions on either end and it could take longer or less time depending on the circumstances. Specific tennis exercises should focus on building leg strength, balance, agility and improving reaction time.

Q. My daughter is 14 and has grown 6 inches in the last 12 months. She plays USTA and varsity tennis for her high school. She has been experiencing pain in the tendons in her knees. I have been icing and giving her Advil. Is there a recommended routine or exercises that she can I do help strengthen her knees. I was planning on hiring a personal trainer to work with her in her off season. What do you recommend?

A. It sounds like a typical growth spurt. Our bones grow faster than the muscles do, so the muscles are continually being stretched by the attached tendons during these times of rapid growth. You have been doing things properly. I would just add some thigh and hip flexor stretches to your routine to help maintain/improve flexibility. Strengthening the muscles around her knee will help some as long as the exercises don’t hurt her while she is performing them. She should definitely avoid seated leg extensions and lunges which will aggravate the already stressed tendons.

Q. I had knee surgery a couple of years ago for a torn meniscus. I'm still playing 2-3 times per week, but think it would be good to have one of those knee sleeves on hand for support. I'm 39. Any recommendations on the best knee sleeve for support.

A. Surgery on a torn meniscus does not significantly affect the stability of the knee and therefore an external "support" (brace or sleeve) is generally not necessary. However, following this type of surgery, it is important to rehabilitate (stretch and strengthen) the muscles which support the knee, primarily the hamstrings and quadriceps.

Though knee supports do not take the place of well conditioned muscles, they may be of some benefit, primarily by keeping the area warm and providing a psychological sense of support. If you wish to wear a knee support, choose one that fits well, is comfortable and does not impair your ability to bend the knee or move well on the court.

Q. I am an avid 65 year old tennis player that is currently suffering from what most 65's suffer from - bad knees. I know that there are "Dynamic Warmups" that I have seen put out by the USTA. I am a member in Northern CA and wonder if there is a way for me to receive them on the net?

A. Michael, thank you for your question. There is downloadable strength and conditioning information on the USTA Player Development website, under the Strength and Conditioning link. On this page, choose the USTA Strength and Conditioning Program link and you will find you have access to over 60 dynamic warm-up, strengthening, and movement exercises.

Q. For over 1 1/2 years my right iliotibial band is so tight at its insertion point just below the lateral side of my knee that it prevents me from moving to my lateral right. I've tried to stretch the band to no avail. Any suggestions?

A. The iliotibial band (IT band) is a band of connective tissue that runs along the outside of the thigh from the hip to the knee. Pain can occur near the outside of the hip but more commonly it arises on the outside of the knee. The pain is caused by increased friction beneath the IT band (rubbing over bone) that can result when the fibers in the connective tissue shorten.

There are a number of factors that can contribute to IT band syndrome including poor shoes, poor flexibility in the calf, thigh and/ or hips, strength imbalances, poor running mechanics/ overpronation, a leg length discrepancy, or increasing training to much, too fast.

Treatment of IT band syndrome should be approached in much the same way as any musculo-tendinous injury – ice, avoidance of activities that cause pain, and use of anti-inflammatory medication. IT band syndrome can also be helped by stretching and massage. There are several stretches that can be performed to target the IT band. Some of these are illustrated at the following website: (http://www.nismat.org/ptcor/itb_stretch/index.html).

Another method commonly used to treat IT band syndrome is self massage, using a foam roll. Lying on your side, place the foam roll under the affected hip. Slowly roll your body across the foam roll until it reaches your knee and then roll back to the starting position. Start gradually and try to build up the time and the number of times you “roll over” the IT band.

Please note that there may be some pain as you massage and break up the scar tissue. You should also strengthen the muscles of the hip, particularly the muscles on the outside of the hip. A good exercise is the monster walk.

If pain persists, you should seek the advice of an orthopedist who may provide more aggressive treatment methods and/or prescribe orthotics.

Q. I believe I have “jumper's knee” because I feel pain when I serve. I have been taking it easy lately as well as taking supplements that will supposedly help with joint pain. Do I need to do anything more besides R.I.C.E. and the supplements for my knee to heal properly? Will it ever be like it was before without surgery?

A. To start, as with anyone complaining of muscle or tendon pain, we recommend you consult a physician to get a specific diagnosis and treatment plan.

Jumper’s knee is another term for patellar tendonitis and is an irritation and inflammation of the thick patella tendon where it attaches just below your knee cap (patella). It occurs most frequently in jumping athletes, like basketball or volleyball players, but occurs in tennis players too.

With each jump, small micro-tears occur in the tendon until eventually tendonitis develops.

Exercise technique can also play a role: improper squatting or lunge form, allowing the “knees to come over the toes” when bending, places increased loads on the patellar tendon.

Jumper’s knee is also a frequent complaint of young boys and girls who are going through rapid growth spurts. In this instance, the long bones of the legs grow rapidly and the muscles do not grow at the same rate, thereby placing an increased stress on the patellar tendon.

As with any tendonitis, R.I.C.E. (rest, ice, compression & elevation) is the best way to manage or treat the symptoms of pain and swelling. An aggressive stretching program will also help elongate the muscles and help reduce the tension at this site. A physician may be able to prescribe anti-inflammatory medication as well.

Rest is an important component to this to allow the body to “catch up” and repair the damaged tendon. Otherwise, you will continue to damage the tissue every time you play tennis, lift or run.

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