Patellar tendinopathy, often called jumper’s knee, is a load-related pain at the front of the knee, just below the kneecap. It’s common in sports with a lot of jumping, sprinting and landing, such as basketball, netball, volleyball and football, and in people who’ve recently ramped up squatting or running. It can be a stubborn problem if it’s rested and rushed back, but it responds well to the right progressive loading.
Understanding patellar tendinopathy
The patellar tendon connects the bottom of the kneecap to the shin bone and transmits the force of your quads when you jump, land and change direction. When the load on the tendon rises faster than it can adapt, it becomes painful and its structure and capacity change. This is a loading problem, not simple inflammation, which is why anti-inflammatory approaches and rest rarely resolve it on their own.
Factors that commonly contribute include:
- A sudden increase in jumping, sprinting or training volume
- Congested training or competition schedules with limited recovery
- Reduced strength and capacity in the quadriceps and calf
- Hard surfaces
- Previous tendon problems
Symptoms we commonly see
- Pain in a specific spot just below the kneecap
- Pain that builds with jumping, sprinting, squatting and stairs
- Warming up eases it at first, then it returns after activity or the next day
- Tenderness when pressing on the tendon just below the kneecap
- Pain after long periods of sitting with the knee bent
Our evidence-based approach
Clinical guidance on patellar tendinopathy emphasises accurate diagnosis, careful load management and progressive tendon loading. In a 2021 randomised trial of 76 people with mostly long-standing patellar tendinopathy, progressive tendon-loading exercise gave greater improvements at 24 weeks than eccentric exercise therapy (28 versus 18 points on the VISA-P score). Our approach includes:
- Assessment to confirm the diagnosis and rule out patellofemoral pain, fat pad irritation and other causes of knee pain
- Load management, adjusting the volume of jumping, sprinting and squatting so you can keep training without flaring the tendon
- Isometric holds where they reduce pain and make loading easier to tolerate
- Progressive loading from heavy, slow strength work through to energy-storage and sport-specific work such as hopping, jumping and cutting
- Whole-leg strengthening of the quads, hamstrings, calf and hip
- VALD strength testing, so you can see where your strength and jump performance sit and track progress
- Criteria-based return to sport, based on how the tendon handles load rather than a date
See our tendon pain page for how tendon problems are managed in general and knee pain for other causes of knee pain.
What to expect: recovery timeline
- Early cases: can settle within a few weeks of load management and starting progressive loading
- Established cases: typically need around three months or more of consistent loading for meaningful change
- Long-standing cases: can take six months or longer, which is why the 24-week follow-up in the trial above is a reasonable guide
When to seek help urgently
Get assessed promptly if you can’t straighten your knee or lift your leg, felt a sudden pop or tearing after a jump or landing, or have significant swelling, redness or warmth around the knee. These can indicate a tendon rupture or another significant injury.
References
- Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. J Orthop Sports Phys Ther. 2015;45(11):887-898.
- Breda S, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021;55(9):501-509.
- Rio E, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277-1283.
- Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7:1.