Patellar tendonitis or tendinopathy

Synonym for patellar tendon tendinopathy

• Patellar tendinopathy
• Patellar tendinopathy
• Jumper's knee
• Jumper's knee
• Quadriceps Tendinopathy

What is the difference between tendinitis and tendinopathy?

Tendinitis refers to inflammation of the tendon, while tendinopathy encompasses all tendon pain, with or without inflammation. Here's the good news: recent research shows that inflammation is not always present in tendon pain.

Imaging studies show that many painful tendons have degenerative rather than inflammatory changes.¹ Therefore, the term tendinopathy is more medically accurate.

In practice, this distinction changes little for you. Whether your tendon is inflamed or not, physiotherapy treatment remains similar: progressive exercises, load management, and correction of contributing factors.

What is patellar tendinopathy?

Patellar tendinopathy is an irritation of the tendon that connects the kneecap to the shin bone. This tendon transmits the force from the quadriceps muscle, allowing you to straighten your knee.

Anatomy of the Patellar Tendon

The patellar tendon is about 4 to 5 cm long. It attaches to the lower tip of the kneecap (inferior pole) and ends at the tibial tuberosity, the bump you feel below your knee.

When the quadriceps muscle contracts, the force travels through the patellar tendon to straighten the leg. This mechanism is essential for walking, running, jumping, and climbing stairs.

Patellar Tendon vs. Quadriceps Tendon

The quadriceps tendon is located just above the kneecap, connecting the quadriceps muscle to the kneecap. The patellar tendon, on the other hand, is below the kneecap and connects it to the shin bone. Both can become irritated, but patellar tendinopathy (below the kneecap) is more common in athletes.

The management of both conditions is very similar. The term "patellar tendinopathy" is often used to refer to both.

Who is affected?

Patellar tendinopathy affects 14% of recreational athletes.² This percentage rises to 40-50% among high-level volleyball and basketball players.³ Sports involving repeated jumping carry the highest risk, hence the nickname "jumper's knee."

What are the causes of patellar tendinopathy?

Patellar tendinopathy occurs when the tendon experiences repetitive stress that exceeds its ability to adapt. The main causes include training overload, biomechanical factors, and errors in activity progression.

Training Overload

The most common cause is increasing activity too quickly. The tendon needs time to adapt to new demands, and an overly aggressive progression doesn't allow it that time.

Classic examples:

• Resuming running after winter without gradual progression
• Starting an intensive squat program
• Increasing the frequency or intensity of workouts
• Going on a mountain hike without preparation

Biomechanical factors

Certain factors increase stress on the patellar tendon:

• Weakness of the gluteal muscles
• Stiffness of the quadriceps or hamstrings
• Limited ankle dorsiflexion range of motion
• Dynamic knee valgus (knee collapsing inward)

A study showed that athletes with patellar tendinopathy had an average of 5 degrees reduced ankle dorsiflexion.⁴

Risky movements

Movements that put the tendon under maximum tension include:

• Jumps and landings (volleyball, basketball)
• Deep squats with weight
• Lunges
• Going down hills or stairs
• Sprinting and changing direction

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To better understand my pain

What are the symptoms of patellar tendinopathy?

Patellar tendinopathy causes localized pain at the tip of the kneecap or just below it. The pain gets worse with activities that put stress on the tendon.

Typical location

The pain is located precisely:

• At the lower tip of the kneecap (inferior pole)
• Just below the kneecap, on the tendon itself
• Sometimes above the kneecap (quadriceps tendon)

You can often reproduce the pain by pressing on this area.

Characteristic pain pattern

The typical pattern of patellar tendinopathy follows this progression:

Activities that increase pain

• Doing a squat or a lunge
• Going up or down stairs
• Running, especially downhill
• Jumping and landing
• Sitting for a long time with the knee bent (cinema sign)
• Getting up from a chair

How is patellar tendinopathy diagnosed?

Diagnosis is based on your symptom history and a physical examination. X-rays do not show tendinopathy. Ultrasound or MRI can visualize changes in the tendon, but they are not always necessary.

Clinical evaluation

Your physiotherapist will assess:

• The precise location of the pain
• Movements that reproduce your symptoms
• Quadriceps strength and flexibility
• Ankle mobility
• Lower limb biomechanics

Specific tests

Two tests are particularly useful:

Imaging

X-rays are typically normal in patellar tendinopathy. They can be useful to rule out other causes of knee pain.

Ultrasound shows tendon thickening and texture changes in established cases.⁵ MRI is generally not necessary unless the diagnosis is uncertain.

What are the risk factors?

The main risk factors include high training volume, jumping sports, muscle stiffness, and errors in progression.

Modifiable factors

• Excessive training volume or too rapid progression
• Quadriceps and hamstring stiffness
• Weakness of the gluteal muscles
• Limited ankle dorsiflexion
• Inadequate jumping/landing technique
• Hard training surface

Non-modifiable factors

• Male sex (slightly higher risk)
• Age (peak between 15-30 years old)
• Tall stature and high body weight in athletes
• History of patellar tendinopathy

When to consult a physiotherapist and how do they treat patellar tendinopathy?

Consult a physiotherapist if the pain persists for more than 7 to 10 days despite relative rest, if it limits your sports or daily activities, or if you want a safe return-to-sport plan.

Signs that warrant a consultation

• Pain that does not improve after one week
• Pain that limits your daily activities
• Inability to play sports at your usual level
• Pain at rest or at night (less typical, requires investigation)
• Desire for a personalized rehabilitation program

Direct Access

In Quebec, you can consult a physiotherapist directly without a medical referral. If your condition requires further investigation, your physiotherapist will guide you to the appropriate professional.

If you also experience pain in other areas of the knee, such as pain behind the knee or on the sides, please mention it during your assessment.

How Physiotherapy Treats Patellar Tendinopathy

Physiotherapy treatment relies on progressive strengthening exercises, managing training load, and correcting contributing factors. This is the first-line treatment recommended by research.⁶

Comprehensive assessment

Your physiotherapist will assess:

• Your sports and training history
• Your ankle, knee, and hip mobility
• The strength of your quadriceps, glutes, and calf muscles
• Your squat and jumping technique, if relevant
• The biomechanical factors contributing to the problem

Progressive exercise program

Strengthening exercises are the cornerstone of treatment. The typical protocol progresses in four phases:

Isometric contractions (holding a position without movement) can quickly reduce pain.⁷ For example, holding a partial squat for 45 seconds.

Slow, controlled movements through the full range of motion: squats, leg press, knee extensions.

Gradual increase in weights and intensity.

Jumps, landings, and power exercises to prepare for return to sport.

Load management

Complete rest is generally not recommended. A load management approach allows you to remain active while allowing the tendon to heal:

• Reduce training volume by 30-50%
• Temporarily avoid very painful movements
• Maintain tolerated activities (swimming, cycling, walking)
• Gradually reintroduce problematic activities

Complementary Techniques

Depending on your assessment, your physiotherapist may also use:

• Manual therapy to improve mobility
• Taping to support the tendon
• Dry needling to release tension points
• Advice on equipment and technique

What exercises can you do at home?

Quadriceps strengthening exercises are essential. Progression should be guided by pain: a slight increase is acceptable during exercise, but it should not persist afterward.

Isometric exercises (initial phase)

• Seated with leg extended
• Contract your quadriceps by pushing your knee towards the floor
• Hold for 45 seconds, 5 repetitions
• Can provide immediate pain relief

• With your back against the wall, slide down until your knees are bent at a 60-70 degree angle
• Hold for 45 seconds, 4-5 repetitions
• Adjust the angle to find a comfortable position

Strengthening Exercises (Intermediate Phase)

• Heels raised 2-3 inches (using a book or plank)
• Lower yourself slowly over 3 seconds
• Rise back up over 3 seconds
• 3 sets of 15 repetitions

• Light to moderate load
• Slow and controlled movement
• 3 sets of 15 repetitions

• On a 4-6 inch step
• Slowly lower down on the affected leg
• 3 sets of 10 repetitions per leg

Complementary Stretches

• Standing, grab your foot behind you
• Keep your knees together
• Hold for 30-45 seconds

• Sitting, with one leg extended forward
• Lean forward while keeping your back straight
• Hold for 30-45 seconds

Can You Treat Patellar Tendon Tendinitis Yourself?

Self-treatment can relieve mild patellar tendon tendinitis (ice, rest, gentle stretches). However, without adapted load progression, you risk worsening the tendinopathy. Without an accurate diagnosis, you risk maintaining compensations or doing counterproductive exercises that delay healing.

The physiotherapist guides load progression to optimize tendon healing. An assessment helps identify the exact cause, rule out red flags, and create a progressive treatment plan. Exercises are tailored to your specific condition, not generic.

Our approach: professional assessment + supervised home exercise program = better long-term results.

Are you hesitating between self-treatment and a consultation? Free 15-min consultation to discuss your situation.

How long does recovery take, and how can recurrence be prevented?

Healing from patellar tendinopathy typically takes 3 to 6 months with a proper rehabilitation program. Mild cases may improve in a few weeks, while chronic cases can take longer.

Factors that influence healing

• Early consultation
• Adherence to the exercise program
• Appropriate load management
• Correction of contributing factors

• Delay before seeking treatment (risk of becoming chronic)
• Continuing activities that cause severe pain
• Not doing exercises regularly
• Returning to sport too quickly

Back to sports

Returning to sport should be done gradually, guided by objective criteria:

• Symmetrical quadriceps strength (less than 10% difference)
• Ability to jump without pain
• Ability to perform specific sports movements
• Confidence in the knee

Returning too quickly increases the risk of recurrence. Patience pays off.

How to prevent recurrence

Prevention involves maintaining a strengthening program, gradually progressing your training, and paying attention to your body's signals.

• Continue strengthening exercises 2-3 times per week
• Adhere to the 10% weekly increase rule
• Warm up adequately before intense activities
• Vary your activities to avoid repetitive stress
• Maintain good flexibility in your quadriceps and hamstrings

Reduce intensity if you notice:

• Pain that gradually increases over several days
• Morning stiffness that lasts more than 30 minutes
• Pain that persists for more than 24 hours after exercise
• Decreased performance

If pain persists despite these adjustments, consult a professional. It's better to act early than to wait for the problem to worsen.

If you are a runner, the prevention principles are similar to those for shin splints or Achilles tendinopathy: gradual progression and regular strengthening.

References

• Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999;27(6):393-408.

• Lian OB, Engebretsen L, Bahr R. Prevalence of jumper's knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005;33(4):561-567.

• Ferretti A, Puddu G, Mariani PP, Neri M. The natural history of jumper's knee. Patellar or quadriceps tendonitis. Int Orthop. 1985;8(4):239-242.

• Backman LJ, Danielson P. Patellar tendinopathy-clinical diagnosis, load management, and advice for challenging case presentations. J Orthop Sports Phys Ther. 2011;41(11):832-839.

• Warden SJ, Brukner P. Patellar tendinopathy. Clin Sports Med. 2003;22(4):743-759.

• 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.

• Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277-1283.