Patellar Tendonitis (Jumper’s Knee): Treatment and Exercises

01What

What is patellar tendonitis?

The patellar tendon connects the lower edge of the kneecap (patella) to the shinbone and transmits the force of the quadriceps. In patellar tendinopathy, repeated overload makes the tendon structure change and become painful, usually at its upper end next to the kneecap. The term “tendonitis” suggests inflammation, but in long-standing cases the problem is mainly a failure of the tendon to adapt to load, hence the preferred name “tendinopathy”.

It is common in basketball, volleyball, football, running, jumping and weightlifting, hence “jumper’s knee”, but also in people who suddenly increase activity.

02Symptoms

Symptoms

• Pain just below the kneecap, often localised to a fingertip-sized spot.
• Pain during or after jumping, sprinting, squatting, going downstairs or kneeling.
• Stiffness or pain after sitting for a long time, or on first steps in the morning that eases as you warm up.
• Tenderness when pressing the lower pole of the kneecap.
• Swelling is mild or absent; significant swelling suggests another problem.
• In advanced cases, pain also occurs with daily tasks.

03Causes

Risk factors

• Sudden increases in training volume or intensity, or too little recovery.
• High jumping and landing loads, hard surfaces.
• Weak or tight quadriceps, hamstrings, glutes and calves.
• Being taller, heavier or having a higher body mass.
• Previous knee injury; age (typically 15–40).
• Footwear and technique, such as a stiff landing pattern.

04Diagnosis

How it is diagnosed

A doctor or physical therapist can diagnose it from the history and by finding the localised tenderness and reproducing pain with a single-leg decline squat. An ultrasound or MRI can show tendon changes, but images do not always match symptoms, and many people with abnormal tendons have no pain, so they are used mainly to exclude other diagnoses (such as fat pad irritation, patellofemoral pain or a stress fracture).

05Phase 1

Phase 1: calm the pain with isometrics

• Isometric wall sit or leg-extension hold: push into a fixed position with the knee at about 60° and hold for 30–45 seconds; repeat 4–5 times.
• Do it once or twice a day, or before activity if it helps reduce pain.
• Pain during exercise should be 4/10 or less and settle within 24 hours.
• Reduce, but do not eliminate, jumping and sprinting; replace with cycling or swimming for fitness.
• This phase usually lasts 1–3 weeks.

06Phase 2

Phase 2: build strength with slow heavy loading

• Slow leg press or leg extension, hack squat or single-leg squat on a decline board: 3–4 sets of 6–15 repetitions, 3 seconds up and 3 seconds down, three times a week.
• Calf raises, hamstring curls and glute bridges to improve the whole leg’s capacity.
• Progress the load as long as pain stays tolerable (4/10 or less) and settles quickly.
• This phase usually lasts 6–12 weeks.

07Phase 3

Phase 3: return to jumping

When you can do single-leg squats and heavy loading comfortably, add jumping drills gradually: skipping, bilateral hops, box jumps, single-leg hops and finally sport-specific movements. Stay at each stage until pain-free (or minimal) for a few sessions. Return to full sport is typically after 3–6 months and may take longer in long-standing cases.

08Other

Other treatments

• Activity modification: manage load rather than total rest. Total rest tends to leave the tendon weaker.
• Pain relievers: paracetamol or short-term anti-inflammatories can help comfort but do not fix the tendon.
• Patellar tendon strap: may offer short-term relief during sport for some people.
• Shockwave therapy and injections (such as platelet-rich plasma) have mixed evidence; corticosteroid injection is generally avoided in the patellar tendon.
• Surgery is rarely needed and is reserved for persistent cases after a well-conducted rehabilitation of at least 3–6 months.

09Cases

Three common situations

Volleyball player with pain after increasing training: reduce jumping volume, start isometrics and progress with a structured plan.

Runner with pain on stairs and after sitting: distinguish from patellofemoral pain; see knee strengthening (Spanish), and consider a physiotherapy assessment.

Recreational athlete with pain for a year: a progressive, supervised loading programme for 3–6 months is likely to help.

10Differences

Patellar tendonitis versus patellofemoral pain

The two are often confused. Patellar tendinopathy produces a localised pain below the kneecap that is triggered by loading the tendon (jumping, decline squats). Patellofemoral pain causes a more diffuse ache around or behind the kneecap, typically with stairs, prolonged sitting with bent knees and squatting. They respond to different emphases in rehab, so a clinical assessment helps. Fat pad irritation, Osgood–Schlatter disease (in adolescents) and Sinding-Larsen–Johansson syndrome are other causes of pain at the front of the knee that a clinician can distinguish.

11Summary

Key points to remember

Patellar tendinopathy improves with progressive loading, patience and activity management. Start with isometrics, move to slow heavy strength work, then return to jumping gradually. Seek advice if pain is severe, sudden or does not improve.

This guide is for general information and does not replace an assessment by your own doctor or physical therapist.