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Hi, 

I'm Maximilian, my goal is to help keep the BJJ community injury free.

Kneeling Knee Pain

Kneeling Knee Pain

Kneeling knee pain is quite common in BJJ. The pain is typically felt at the front of the knee and has a gradual onset caused by repetitive kneeling. It can also be caused by an acute incident such as falling abruptly onto the kneecap.  The positions that most commonly aggravate it are kneeling in your partner’s closed guard or shooting for a double/single leg takedown with the front knee hitting the mat. There are a number of similar conditions that can be the cause of the pain;

1.     Infra-patellar bursitis (AKA Clergyman’s knee)

2.     Pre-patellar bursitis (AKA Housemaid’s knee)

3.     Fat pad syndrome

4.     Osgood Schlatters disease

5.     Patella tendinopathy.

Repetitive compressive forces against these various tissues can cause them to become inflamed and irritated. For an accurate diagnosis, it is important to see a licensed practitioner. Usually, the diagnosis is made clinically, however for more complex cases an MRI or Ultrasound might be required.

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Prepatella bursitis typically presents with pain and swelling around the patella bone.  Infrapatellar bursitis can be superficial or deep. The superficial infrapatellar bursa is located between the tibial tubercle and the overlying skin, whereas the deep infrapatellar bursa is located between the posterior aspect of the patellar tendon and the tibia.

Most of the kneeling knee pain I have seen in BJJ athletes has been infra-patella bursitis. Interestingly, a high proportion of carpet and floor layer’s knees are also known to show signs of infrapatellar bursitis.  There are approximately 160 bursas located throughout the body, they are thin, lubricated cushions located at points of friction between a bone and the surrounding soft tissue, such as skin, muscles, ligaments and tendons. The bursa is encapsulated by a thin synovial membrane and contains synovial fluid within this outer membrane. The synovial membrane is semi-permeable which means that certain materials can enter and exit the bursa. Following a traumatic injury to the bursa, it can temporarily fill with blood for example. The main roles of the bursas are to provide cushioning and lubrication to the surrounding tissues.
 

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When there is irritation to the synovial membrane, the inflamed synovium will thicken and produce excessive synovial fluid which results in swelling of the bursa. Inflammation can be caused by excessive friction, compression, infection or underlying conditions such as rheumatoid arthritis. If there is fever, localized skin warmth and redness, tenderness and joint pain – then medical assessment is needed to rule out septic bursitis.

Strategies to manage kneeling knee pain.

1. Use softer mats. There have been quite a few times when my knee has flared up when I have been rolling on the harder Muay Thai mats at my gym instead of the BJJ mats.

2. Reduce time spent on the knees. Working on your bottom game might be a good idea to give your knees a break and give some much needed time for them to recover. Utilizing more standing passing might also be another solution. Also consider your takedowns such as the double leg and whether or not you allow your knee to hit the mat.

3. Use a soft shell knee pad. This will help cushion and disperse the forces to the other tissues in the knee and reduce the localized impact to the irritated tissues.

2. Possible light stretching of the quadriceps. This can benefit some people with knee bursitis as a less tensioned quadriceps can place less pressure on the underlying tissues. It is important however to rule out other conditions such as patella tendinopathy as stretching can worsen it. 

 

 References:

Chatra PS. Bursae around the knee joints. The Indian journal of radiology & imaging. 2012 Jan;22(1):27.

Draghi, F., Corti, R., Urciuoli, L., Alessandrino, F., & Rotondo, A. (2015). Knee bursitis: a sonographic evaluation. Journal of Ultrasound18(3), 251–257. http://doi.org/10.1007/s40477-015-0168-z

Le Manac’h AP, Ha C, Descatha A, Imbernon E, Roquelaure Y. Prevalence of knee bursitis in the workforce. Occupational medicine. 2012 Jul 9;62(8):658-60.

Kivimäki, J. (1992). Occupationally related ultrasonic findings in carpet and floor layers' knees. Scandinavian Journal of Work, Environment & Health, 18(6), 400-402. Retrieved from http://www.jstor.org/stable/40966027

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