| What We Treat
Patellar Tendinopathy
A sharp, well-localised pain just below the kneecap that warms up as you go and bites the next morning? Jumper’s knee is a load problem — and loading, done properly, is the treatment.
Overview
What Is Patellar Tendinopathy?
The patellar tendon runs from the bottom of the kneecap to the top of the shin bone and transmits the entire force of the quadriceps. Tendinopathy is what happens when the load asked of that tendon repeatedly exceeds what it has been prepared for — the tissue becomes thickened, disorganised and painful. It is not an inflammatory condition, which is why anti-inflammatory approaches disappoint and progressive loading works.
Tap a stage to see how tendon tissue responds to load over time.
A Healthy Tendon
Collagen fibres are densely packed and aligned along the direction of pull, which is what gives a tendon its remarkable tensile strength and its ability to store and return energy during jumping and running.
Symptoms
How It Tends to Feel
Patellar tendinopathy has an unusually specific presentation, which makes it straightforward to identify:
Pinpoint Pain
You can usually put one finger on it, at the lower pole of the kneecap where the tendon attaches.
Warms Up With Activity
Often eases within the first ten minutes of exercise, then returns worse afterwards — a hallmark of tendon pain.
Worse the Next Morning
Stiffness and pain on the day after loading is a more reliable guide to whether the dose was right than pain during it.
Load-Related
Jumping, landing, deep squatting, hills and stairs are the classic aggravators.
Not Usually Swollen
The knee joint itself doesn’t swell; the tendon may feel thickened to touch.
Sitting Discomfort
Prolonged sitting with the knee bent can produce a dull ache, though less markedly than in patellofemoral pain.
Causes & Risk Factors
What Drives It
Tendinopathy is almost always a story about load exceeding capacity, with a few factors that shift the balance.
A Spike in Load
A sudden increase in jumping, running, court sport or heavy squatting is the classic trigger, especially after a break.
Energy-Storage Demands
Sports involving repeated jumping and rapid change of direction load this tendon most — volleyball, basketball, netball, athletics.
Reduced Capacity
Weak quadriceps and calf muscles, and reduced ankle mobility, all increase the demand placed on the tendon.
Training Surface and Volume Changes
Harder surfaces, more sessions per week, or a compressed competition schedule are common precipitants.
Systemic Factors
Raised BMI, diabetes and high cholesterol are associated with tendon problems and with slower recovery.
The Programme
The Loading Ladder
Tendons need progressively demanding types of load, introduced in the right order. Skipping stages is the most common reason rehabilitation fails.
Isometrics
Reduce pain, maintain capacity
- Sustained holds — typically a wall sit or leg extension hold at around 60 degrees
- Around five holds of 45 seconds, once or twice daily
- Often produces useful short-term pain relief, which allows you to keep training
- Reduce provocative loading temporarily, but do not stop moving altogether
Tap through the stages. The order matters more than the exact exercises.
How We Can Help You
Treatment & Management
Tendons respond to load. The skill is choosing the right type at the right time and progressing it consistently — which is the part that’s hard to do alone.
What the evidence says
Randomised comparisons of heavy slow resistance training, eccentric training and corticosteroid injection for patellar tendinopathy found that both loading programmes produced superior outcomes to injection at twelve months, with heavy slow resistance showing the best patient satisfaction and adherence.
Corticosteroid injection can give short-term relief but is associated with worse outcomes at longer follow-up and a risk of tendon rupture. Structural changes on ultrasound frequently persist after symptoms resolve, which is why treatment targets capacity, not tendon appearance.
When to Seek Help
Red Flags — Don’t Ignore These
Tendinopathy is benign but a few features suggest something else:
⚠ Seek prompt medical assessment if you notice:
- A sudden pop with immediate inability to straighten the knee or lift the leg (possible tendon rupture — attend A&E)
- A hot, red, swollen knee with fever or feeling generally unwell (possible joint infection — seek emergency care)
- Marked knee joint swelling, which is not a feature of tendinopathy
- Night pain that is constant and unrelated to activity, particularly in an adolescent
- Inability to weight-bear after an acute injury
These symptoms can point to a cause that needs medical rather than physiotherapy assessment. Please don’t wait for a physiotherapy appointment — contact your GP, call 111, or attend A&E as appropriate.
Common Questions
Frequently Asked Questions
Should I rest it completely?
No. Complete rest reduces the tendon’s capacity further, so when you return the same load hurts more. The evidence supports reducing provocative load while continuing to load the tendon progressively. Relative rest, not absolute rest.
Is it normal for it to hurt during the exercises?
Yes, up to a point. Pain up to a moderate level during loading is acceptable provided it settles by the following morning. Next-day symptoms are the guide, not what you feel during the set.
Why not just have a steroid injection?
Injections give useful short-term relief but are associated with worse outcomes at twelve months than loading programmes, and carry a rupture risk in a weight-bearing tendon. They’re occasionally useful, but not as a first step.
How long will it take?
Three to six months for a full return to jumping sport is realistic. Meaningful improvement usually comes sooner, but stopping the programme when pain settles is the main cause of recurrence — the tendon needs the full course.
Load It Properly and It Gets Better
A clear diagnosis, the right loading programme for the stage you’re at, and progression that doesn’t stall in the middle.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.