Kyrie Irving battled through to play game 5 despite MRI showing tendon pathology at his left knee. The Cavs point guard is also carrying a right foot strain he sustained in Game 2 of the Boston series. Despite an eight-day layoff following the opening series, this may be something he has to play through this postseason. Kyrie grimaced as he limped from the arena. However, he was unloading the left leg not the right. In recent games Kyrie has had his left knee strapped to offload the tendon. It could be presumed this tendon pathology is caused by overcompensation for the foot injury. Add this overcompensation to the grueling 82-game season, increased minutes in high octane play-off ball and insufficient rest, overuse injuries such as ‘patella tendinopathy’ or ‘jumpers knee’ are pandemic. These issues exist on a continuum of low-grade (available to play limited minutes or intensity) to highly reactive and restricted to non-weight bearing. In rare occasions they require surgery to debride damaged tissue.
Basketball is a sport primed for tendon pathology. A tendon can be simply viewed to act like a spring, storing energy and rapidly recoiling to promote explosive movements, more than the muscle itself. The repetitive jumping nature of basketball requires the knees spring (the patella tendon) to endure massive loads. Traditionally, healthy tendons are densely packed collagen fibres, uniform in nature. They require mechanical stimulus to load, be that from compressive force or tensile stress, and with sufficient recovery time, repair microdamage to strengthen. Insufficient recovery time and sudden increases in load trigger the tendon to cycle into dysrepair and pain. Older tendons require even more recovery time and slower increases in load. Enough damage to the tendon through repeat flare ups can lead to a patchy degenerative tendon that looks like Swiss cheese. These tendons are likely to rupture. Unfortunately evidence has indicated that two thirds of tendons may rupture without any prior warning of pain.
Did we mention Kobe Bryant? Or can you already piece the puzzle together?
To visualize a fresh healthy tendon, think of a brand new rope, and two people pulling in separate directions at each end. Repeated bouts of activity that places stress on to the tendon (‘high’ load – fast, bounding activity) slowly cuts away to fray the rope in the middle. Two people then pulling the rope from separate ends results in the rope snapping…That is unless you provide enough time/rest from insulting load activity for someone to get in there and repair the rope.
Keep posted in the next few days as we will discuss tendon pathology and the role of inflammation. Later we will be producing an ebook with everything you need to know about Jumper’s Knee, prevention and rehab.
Pic source = Cliff1066: flickr.com