Patellar Tendinopathy

What is patellar tendinopathy?

Patellar tendinopathy is persistent pain in the tendon beneath the kneecap that limits activities that place stress on this tendon. It is also known as “jumper’s knee” because it particularly affects athletes who jump frequently. Its prevalence varies widely depending on the sport and the population studied.¹Read the international definition of tendinopathy.

Anatomy of the Patellar Tendon

Your patellar tendon is short and thick. It connects the lower part of your kneecap to a bump at the top of the tibia, the bone at the front of the leg. This bump is called the tibial tuberosity. The tendon transmits the force from your quadriceps, the group of four muscles at the front of your thigh. This muscle group allows you to straighten your knee so you can run, jump, or climb stairs. The attachment to the patella also covers part of its front surface.

The tendon contains collagen fibers, a protein that forms strong fibers. These fibers are grouped into bundles—like small clusters—oriented primarily in the direction of the force being applied. This structure allows the tendon to transmit significant forces. Certain jumps subject it to forces several times the body’s weight. Read the study comparing the forces involved in different exercises.

Pain from patellar tendinopathy most often occurs at the tendon’s attachment to the patella, on its lower part. This is where the pain is felt, not necessarily the tendon’s weakest point from a mechanical standpoint.²

Tendinopathy or tendinitis: What's the difference?

The term “tendinitis” refers to inflammation of a tendon, a tissue reaction that may be accompanied by pain and swelling. A 1999 review primarily described changes in the fibers—without inflammatory cells—in the painful tendons of athletes.³ More recent research has observed cells or signs of inflammation in some tendons, but not in all. Read the review of 53 studies on inflammation. The term “tendinopathy” describes the pain and associated difficulties without implying a single cause.^{4, 3} The choice of medication therefore depends on its benefits and risks, not just on the name of the condition. Progressive exercises remain central to treatment.

What are the causes of patellar tendinopathy?

Patellar tendinopathy is associated with repeated strain on the tendon, particularly during jumping, but its cause varies from person to person. Increased strain can exceed the knee’s tolerance. Training volume, recovery, and muscle strength are factors to consider, though no single factor explains all cases. Read the review of factors associated with this condition.

The Mechanism of Tendon Overload

Your tendon transmits force like a strong rope. Jumping and running subject it to repeated stress. Physical activity and periods of recovery help it adapt.

One model suggests that excessive strain relative to the tendon’s capacity disrupts its adaptation. This can lead to cellular changes and disorganization of the fibers.⁴ These changes have been observed in painful tendons.³ This model does not imply that every instance of pain follows the same stages or that it accurately reflects the extent of tendon damage.

Factors to Consider

In this study, the jumper’s knee involved pain at the attachment site of the patellar tendon or the quadriceps tendon. Volleyball can involve numerous jumps in a single week. The height, technique, and type of exercise all affect the force placed on the tendon. Monitoring the amount of activity and the knee’s response helps in adjusting the training regimen. This does not mean that every jump causes a small tear.

What are the symptoms of patellar tendinopathy?

The main symptom of patellar tendinopathy is knee pain located just below the kneecap, at the site of the tendon. This pain occurs during or after jumping and running. Morning stiffness is common. The pain often subsides after warming up.

Typical Presentation

Pain in the patellar tendon is often located at the bottom of the kneecap, near where the tendon attaches. It is usually specific enough that the person can point to the exact spot.

Pain may occur after a workout or during physical activity. Some people first notice the pain after exercise, and then during it. This progression is not always the case.

How can you tell where you stand?

The timing of the pain—along with its intensity and how it affects your movements—can help you adjust your activities. If pain occurs only after a workout, you may be able to continue by adjusting the intensity of your efforts. If pain interferes with your activity or persists at rest, you should reassess your exercise program. Tendinopathy does not always go away on its own. Relative rest involves reducing activities that worsen your symptoms while continuing those you can tolerate.

How is Patellar Tendinopathy Diagnosed?

A healthcare professional diagnoses patellar tendinopathy based on your symptoms and an examination of your knee. In particular, they look for pain at the bottom of the patella, tenderness upon touch, and pain associated with strain on the tendon. They also rule out other possible causes. Imaging is generally not necessary.

Clinical evaluation

Your physiotherapist makes the diagnosis by combining several factors.

• When did the pain start?
• What Activities Make It Worse?
• Have You Recently Increased Your Training Volume?

• Tendon palpation (tenderness to touch?)
• Single-leg knee flexion test, known as a squat, on an inclined surface²
• Quadriceps strength assessment
• Thigh muscle flexibility tests

The single-leg squat on an inclined plane is one of the possible tests. Under the supervision of a healthcare professional, you slowly bend your knee while balancing on one leg. An inclined board set at a 25-degree angle is used in some protocols. The test puts stress on the tendon and may trigger pain, but the results alone are not sufficient to confirm the diagnosis.

The role of imaging

Some athletes may show changes in the tendon on an ultrasound scan without experiencing any pain. Therefore, the image alone is not sufficient to make a diagnosis.² In a review conducted primarily among athletes, a patellar tendon exhibiting these changes without pain was associated with an approximately fourfold higher risk of subsequently becoming painful. This association does not predict what will happen to each individual.⁵ Most diagnoses do not require imaging.

How does physiotherapy treat patellar tendinopathy?

Physical therapy treats patellar tendinopathy with progressive strengthening exercises and activity modifications. Isometric exercises—in which the muscle works without moving the knee—rapidly reduced pain in a study of six volleyball players.⁶ However, available comparisons do not show a clear advantage over range-of-motion exercises in terms of this immediate pain relief.⁷

Exercises that involve movement—particularly slow squats and slow strength training with weights—can help alleviate pain and improve daily activities. Clinical reviews recommend them.⁷ A 2025 Cochrane review included seven trials involving 211 athletes, mostly young men. It examined comparisons other than those between two strength-training programs. One small trial favored strength training for pain relief compared to no treatment, but with very low certainty. The other results remained uncertain, with low or very low certainty depending on the outcome measure and the treatment being compared.⁸ The program is therefore built up gradually based on your needs and progress.

The Principle of Load Management

The program adjusts the intensity of the exercise to what your knee can handle. A prolonged break does not prepare you to resume sports. Activities that cause symptoms to worsen over time may require a temporary reduction in intensity.

Your physical therapist will tailor the exercises based on the pain you experience during exercise, how you feel afterward, and your abilities. The weight, number of repetitions, and recovery days may change as the program progresses.

Specifically, this means:

• Temporarily reduce or eliminate aggravating activities (jumping, sprinting)
• Continue with activities that are considered safe, such as biking, swimming, or walking
• Gradually introduce therapeutic exercises

Types of Therapeutic Exercises

Which approaches require special precautions?

Some approaches require an adjustment or medical advice:

• Prolonged complete rest: Does not help you regain your strength and athletic skills
• Aggressive stretches: Can further irritate the tendon
• Long-term anti-inflammatory medications: Their benefits and risks should be discussed with a healthcare professional
• Cortisone injections: Risk of weakening the tendon

A historical description of tendinopathy without inflammation is not sufficient to determine the course of treatment.³ In a trial involving 39 men, cortisone and two exercise programs improved pain and functional ability at 12 weeks. At six months, the benefit of cortisone had diminished, while that of the exercises persisted. The measured mechanical properties of the tendon remained unchanged in all three groups.⁹ Injections near this tendon, however, require caution: the AAOS, an association of orthopedic surgeons, warns of a risk of weakening and rupture.

Treatment progression

Treatment progresses based on your abilities and symptoms. The therapist monitors your pain during and after exercise, as well as your strength and the movements you can perform. Non-movement exercises may be used initially if you tolerate them better. The program then incorporates strength training and sports-specific movements. The pace varies from person to person.

How long does it take to recover from patellar tendinopathy?

Recovery from patellar tendinopathy often takes several months, with the timeframe varying depending on the activities to be resumed. Symptoms, the amount of exercise, and the demands of the sport guide the progression of recovery. A follow-up evaluation after about twelve weeks allows for a reassessment of the plan if progress is insufficient. This milestone is not a date for full recovery. Read the treatment guide.

What factors influence recovery time?

Improvement is still possible even when pain has persisted for a long time. In a trial involving 76 people—many of whom had already received treatment and whose symptoms had lasted for about two years—two programs improved pain and functional ability at 24 weeks. The progressive program resulted in greater improvement than eccentric lowering exercises alone. A return to sports appeared to occur more frequently, but the difference remained unclear. Read the study by Breda and colleagues. If resuming activity worsens symptoms, an adjustment is needed—not necessarily a complete cessation of all activities.

Factors that Guide Monitoring

The table compares situations to be discussed during follow-up. None of these factors, on its own, predicts the duration of recovery.

Return to Sport

Returning to sports involves several benchmarks. These are tailored to the sport, the individual’s starting level, and how the knee responds, rather than imposing the same thresholds on everyone.

The return to activity can involve light running, followed by more intense running, small jumps, and sport-specific movements. The order depends on your goals. How you feel during exercise and the next day will guide your transition to the next stage. Your physical therapist will adjust your progression. Read about a progressive program designed for people with patellar tendinopathy.

When should you see a doctor for patellar tendinopathy?

You should see a doctor if the pain limits your activities or shows little improvement despite a tailored physical therapy program. If a tear is suspected, you should seek an urgent evaluation without waiting until the end of the program. Depending on the results of the examination, the doctor may discuss other treatment options or refer you to a medical specialist.

Warning signs

Seek urgent medical attention if you experience any of the following symptoms:

• Very severe knee pain, especially if it begins suddenly after a sudden, explosive movement
• Inability to move the knee or put weight on the leg
• Significant swelling or a change in the shape of the knee, or the appearance of unusual bruising around the knee
• A sensation of snapping or tearing, especially when having difficulty straightening the knee
• A stiff knee, a knee that gives out, or a knee that clicks and hurts
• High fever, chills, or feeling hot or cold, along with a red or warm knee

These symptoms may indicate a torn tendon or another problem that requires immediate medical attention. Do not try to confirm them by jumping or exercising. Read about the warning signs of knee pain and the signs of a torn patellar tendon.

Other options to discuss

For persistent tendinopathy, surgery is considered only after non-surgical treatments have been tried. The guidelines generally recommend at least six months of appropriate care before considering surgery. Read the recommendations on the role of surgery. A complete tear following an injury is a different issue, which may require prompt surgery.

What are some frequently asked questions about patellar tendinopathy?

The most frequently asked questions concern full recovery, the possibility of continuing to play sports, the effectiveness of patellar straps and anti-inflammatory medications, and how to prevent symptoms from returning.

Can patellar tendinopathy heal completely?

Pain and functional ability can improve significantly, but a full recovery is not guaranteed. It often takes several months to return to sports. When symptoms persist, a healthcare professional will review your exercises, the demands of your sport, and other factors specific to your health. A physical therapy evaluation helps tailor this plan.

Can I continue playing sports if I have patellar tendinopathy?

In some cases, you can continue exercising with patellar tendinopathy by adjusting the intensity of your activity. The decision depends on the pain and how it affects your movement, both during and after the activity. A period of relative rest may help if symptoms worsen. However, the urgent signs described above require medical evaluation.

Do knee braces or straps under the kneecap help?

A strap placed under the kneecap may provide temporary relief when resuming activities. In a trial involving 97 athletes, straps and adhesive tape reduced pain during a test compared to no support. Their benefit was not clear when compared to tape used as a sham treatment. Read the study on straps and adhesive tapes. This support can improve comfort but is not a substitute for progressive exercises.

Are anti-inflammatories helpful?

Anti-inflammatory medications can provide temporary pain relief. A doctor or pharmacist can advise you on their benefits, side effects, and how long to use them. They are not a substitute for progressive strengthening exercises, which remain central to treatment.

How can you prevent symptoms from returning?

To prepare for a return to activity, stick to a strength-training program and gradually increase the intensity. Warming up before jumping and paying attention to the first signs of worsening symptoms can help you adjust your activity. Progress depends on your tolerance. These measures do not guarantee that the pain will not return.

A study of 1,055 Norwegian female soccer players aged 13 to 17 found that high participation in a warm-up program was associated with fewer injuries than moderate participation. This comparison focused on injuries in general, not specifically on patellar tendinopathy.¹¹ It does not prove that warm-ups alone prevent the recurrence of this tendon pain.

Key takeaway: Patellar tendinopathy can improve with progressive exercises and adjustments to your activities. Returning to sports takes time and varies from person to person. Your program should take into account your progress, your goals, and your symptoms.

References

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1. 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):561-7. (Back to sections: 1, 2)
2. 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):887-98. (Back to sections: 1, 2, 3)
3. 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. (Back to sections: 1, 2, 3, 4)
4. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-16. (Back to sections: 1, 2)
5. McAuliffe S, McCreesh K, Culloty F, Purtill H, O'Sullivan K. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. British Journal of Sports Medicine. 2016;50(24):1516-1523. (Back to section: 1)
6. Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277-83. (Back to sections: 1, 2)
7. Challoumas D, Pedret C, Biddle M, Ng NYB, Kirwan P, Cooper B, et al. Management of patellar tendinopathy: a systematic review and network meta-analysis of randomized studies. BMJ Open Sport & Exercise Medicine. 2021;7(4):e001110. (Back to sections: 1, 2, 3, 4)
8. Lopes AD, Rizzo RR, Hespanhol L, Costa LO, Kamper SJ. Exercise for patellar tendinopathy. Cochrane Database Syst Rev. 2025;5(5):CD013078. (Back to section: 1)
9. Kongsgaard M, Kovanen V, Aagaard P, Doessing S, Hansen P, Laursen AH, et al. Corticosteroid injections, eccentric decline squat training, and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790-802. (Back to sections: 1, 2)
10. Barman A, Sinha MK, Sahoo J, Jena D, Patel V, Patel S, et al. Platelet-rich plasma injection for the treatment of patellar tendinopathy: a systematic review and meta-analysis. Knee Surgery & Related Research. 2022;34(1):22. (Back to section: 1)
11. Soligard T, Nilstad A, Steffen K, Myklebust G, Holme I, Dvorak J, et al. Compliance with a comprehensive warm-up program to prevent injuries in youth soccer. Br J Sports Med. 2010;44(11):787-93. (Back to section: 1)