Basketball Knee Pain – Causes & Prevention

As basketball grows in Australia we see more and more people come into the clinic with knee pain. You’ll see it at all levels from casual social basketball to district level as well as big names in the NBL and NBA. Being a keen Basketballer myself, I truly understand the frustrations when pain limits your playing ability; there is nothing worse than being on the sidelines due to an injury.

  • But why does knee pain occur more frequently in basketball players?
  • What are the things we can do to keep you playing basketball through knee pain?
  • And should you keep playing basketball if you’ve got knee pain?

Realistically the answer to all of these questions is ‘it depends’. That’s because there are a lot of different things that can contribute to it. With basketball in particular it is a highly explosive sport where there’s lots of change of direction and jumping. This is also combined with many basketball players being above the average height, therefore increasing the length of the levers of the body – which in turn can increase the stress on the joints, resulting in a knee injury.

The top 5 reasons I see people getting knee pain during basketball are as follows: 

  • Poor jumping and landing technique 
  • Weakness of the glutes 
  • More load than the body can tolerate at this point in time
  • Fatigue
  • Unexpected forces (bumps, knocks etc)

Poor Jumping and landing technique

When we jump and land, ideally there should be coordination of joints allowing a relatively straight line from our foot to the top of our leg when viewed from the front. This means that our knee isn’t falling in or out. As with any movement, the more we practice and reinforce the ideal technique, the less risk there is of injury.

When the knee is falling out (away from the midline of your body) during jumping or landing, there is an increased risk of meniscal tears and lateral collateral ligament injury.

When the knee falls in you are at a higher risk of an ACL (anterior cruciate ligament) injury and meniscus injury, whilst also losing a large amount of power as you are placing your body at a mechanical disadvantage to produce force.

Basketball knee injuries due to poor landing and jumping technique are also more pronounced when fatigue is added into the mix – which we’ll discuss in more detail later in this article & often results in injuries such as patellar tendonitis. Building strength and changing your technique can take a bit of time and often needs guidance so keep an eye out for part 2 where we’ll discuss that in more depth! 

Weakness of the glutes

Your glutes (also known as your butt muscles) have a larger role to play in force production and injury prevention than you may think! In fact, if your goal is to be able to dunk, move faster, more explosively, and jump higher than any player on the court, then this is an area you should definitely be paying close attention to in your conditioning training.

You have three different glute muscles:

  • Gluteus maximus
  • Gluteus Medius
  • Gluteus Minimus

The gluteus maximus has the largest role to play in force production and not surprisingly is the largest of the three and is what you would focus on to improve explosiveness to hit your dunk!

We’re more interested in the gluteus medius muscle, because the gluteus medius has a large role in stabilising your pelvis whilst you are on one leg. For example, when you are standing on your right leg, your right glute medius is working hard to maintain a stable pelvis so that your left side doesn’t just fall away (when this happens it is called a Trendelenburg gait pattern). When the pelvis drops due to a glute medius issue, this causes the body to lean towards the planted foot and the knee to fall inwards to try and regain the centre of mass – resulting in an increased risk of ACL injury! This is especially important in a dynamic explosive sport like basketball where you are often jumping or landing on one leg continuously.

Aweakness of the glutes, however, doesn’t usually mean that they are too weak to support the pelvis initially. Usually what we see is that the glutes fatigue over time and by the end of a taxing session the above-mentioned technique flaws begin to slowly creep in.

More load than the body can tolerate at this point in time

One of the main factors in any knee injury is too much load. This can be broken down into two aspects:

  • Too much load in one single instance
  • Too much accumulated load over a period of time

When we are talking high-velocity knee injuries, such as ACL tears or injury, it is typically due to too much load in a single movement, albeit the risk also goes up when there is too much load accumulated over a period of time.

When we are looking at too much accumulated load over a period of time, this often refers to knee injuries such as jumper’s knee (patellar tendinitis/patellar tendinopathy). In this injury, the collagen inside the quadriceps/patellar tendon just below the kneecap experiences degeneration due to inadequate recovery for the amount of load, which builds up over time. The onset of patellar tendinitis is typically over a period of months and as a result the recovery also takes place over a period of months, often with periods of time out of the game. These injuries are particularly frustrating and can become flared up quite easily throughout your rehabilitation journey.

This is why load management is so important.

However, load management can be really simple. Managing load doesn’t mean stopping everything. It can mean moderating it to a level that your body can comfortably tolerate. This will be different for everyone but here are some strategies you can try: 

  • Taping to off-load the joint
  • Reducing minutes in each game that you play 
  • Spreading your games across the week rather than multiple on the same night
  • Changing position on the court (if possible)
  • Total exercise volume throughout the week 

If none of these things seem to be working for you have a read of part 2 for some ideas of how to change the other factors! 

Fatigue

Fatigue is an undermentioned yet critical factor in injury risk. Most injuries happen later in a game and at times of the season when there is an increased training and game load.

When we are considering fatigue in the short term, it’s essential to look at things such as the perceived exhaustion of the athlete, and their competition schedule, and combine it with subjective measures from coaches and other players. When an athlete is performing consistently below the level that would be expected during a time where the load has increased, this is a good sign that it may be time to decrease the load and focus on rest and recovery to prevent injury.

When we are considering fatigue in the longer term, it’s important to establish periods of decreased load throughout the season. As basketball is played all throughout the year at the junior and amateur levels, it’s especially important to make sure there are periods of de-loading. This can be hard to programme as it will ideally take into account a lot of different factors and this may be where it is useful to consult a sports Physiotherapist to assist you.

Unexpected forces

This is really as simple as the name implies and is also almost impossible to prevent injury from. An injury here occurs when an external force, ie another player on the field, bumps, knocks, or lands on you and this force places strain on your knee in an abnormal manner. Our bodies are incredibly resilient when we are expecting even very large forces, however, an unexpected force can wreak havoc; and these are usually out of our control.

Final say…

Sometimes, as with unexpected forces, things go wrong and injuries occur, that is part of being an athlete. However, we encourage our athletes to focus on what is inside their control to reduce their risk as much as possible by ensuring they have great landing/jumping technique, strong glutes, increased load capacity, and a sporting calendar that manages fatigue throughout the season and, if a knee injury occurs, to be proactive with early-onset treatment in the form of rest, ice and compression.

Frequently Asked Questions

Why does my knee hurt after basketball?

Patellar tendinopathy, also known as jumper’s knee, is the most common reason for knee pain in basketball players. Patellar tendinopathy is caused by too much and irregular loading of the patellar tendon (quadriceps tendon) just below the knee cap. This is a degenerative condition that can be worsened with the chronic use of anti-inflammatory medications.

Why do basketball players ice their knees?

Basketball players will use ice to help to decrease pain, swelling, and inflammation in their knees – usually due to overuse or injury. This can help them to recover faster for the next game or to be able to keep pain at manageable levels whilst continuing to play.

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Mana NankivellMana Nankivell
00:38 18 Apr 23
I highly recommend Trent and the Physio Fit team.I sustained a knee injury (fat pad impingement) in a half-marathon around 18 months ago, and after 12 months of seeing a (different) physio and sports doctors without any improvement, I was told by the doctor that I would "probably just have to put up with the pain".I booked in with the team at Physio Fit for another opinion, and it was the best decision I ever made. Trent put together a very manageable rehab plan for me and was quick to respond and adapt when something didn't work out. In the past 6 months, I've gone from not being able to walk without pain or even think about hiking, running or cycling without my knee flaring up, to running my first post-injury 5.5km trail run and hiking 10km with a 10kg pack!
Laura O'ConnorLaura O'Connor
08:47 05 Feb 23
This clinic is the pinnacle of physiotherapy in Adelaide. Ive seen a couple of different physios at physiofit over the years for different injuries and the experience has been absolutely amazing each time! Highly recommend seeing the team here for all your physio needs!
Ryen ArcherRyen Archer
02:50 03 Feb 23
Corey is absolutely fantastic, worked out my issues and we have been working to improve them for a few months now and all I can say is I am feeling a million times better! thanks physio fit! Keep up the great work!
Amy SzyndlerAmy Szyndler
02:44 03 Feb 23
I attended Physio Fit to get my tennis elbow treated. Always a friendly greeting from the lovely reception staff, and my physio, Corey, was fantastic; very friendly, knowledgeable and provided treatment that was personalised and holistic. Following Corey's advice and exercise regime helped me get back to the activities I enjoy, pain-free. Highly recommended.
Debbie MossDebbie Moss
07:21 02 Feb 23
Have been taking my daughter here for quite a few months now for ongoing back issues. The care that she has been given through her Physiotherapist Corey, has been fantastic. Everything has been explained and if exercises have needed to be modified he has. Would thoroughly recommend this place for any Physio needs. All staff that we have dealt with have been friendly and professional. A great team and environment.
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