What patellar tendinopathy is
The patellar tendon runs from the bottom of the kneecap to the top of the shin bone and takes very high loads during jumping and landing. Tendinopathy here almost always affects the deep posterior portion right at the lower pole of the kneecap.
The distinguishing feature is how localised it is. Most people can put one fingertip on the exact spot, which separates it clearly from patellofemoral pain, where the whole hand cups the front of the knee.
Prevalence is high in jumping sports, reported at around 14 per cent in elite volleyball and basketball populations, and it is one of the more common reasons an athlete has to modify training for a whole season.
What causes it
The tendon stores and returns energy in jumping, and the load in the landing phase is considerably higher than in take-off. A spike in jump volume, particularly landing volume, is the usual trigger.
Court surface, training density and preseason ramp-up all contribute. So does a stiff ankle, since limited dorsiflexion pushes more of the landing load into the knee.
Common contributors
- A rapid increase in jumping and landing volume, typically at the start of a season
- High training density with insufficient recovery between sessions
- Reduced ankle dorsiflexion, which shifts landing load toward the knee
- Quadriceps and calf weakness relative to jumping demands
- Hard court surfaces and a sudden change of surface
- A previous episode, which strongly predicts recurrence
A useful in-room test is the single-leg decline squat on a 25-degree board. It isolates the patellar tendon far better than a flat squat and typically reproduces the pain precisely. It also doubles as the main loading exercise, so the assessment tool and the treatment are the same movement, which makes tracking progress straightforward.
What the evidence says
The four-stage model has become the standard approach: isometrics for pain relief, then heavy slow resistance, then energy-storage loading, then a return to sport. It is well described in the sports medicine literature and holds up in practice.
Isometric holds, typically five repetitions of 45 seconds at around 70 per cent of maximum, produce immediate reductions in tendon pain lasting up to 45 minutes in several studies. That makes them useful before training as well as as a starting point.
Heavy slow resistance training has trial evidence showing outcomes comparable to eccentric protocols, with better adherence because the time commitment is lower.
Corticosteroid injection produces short-term relief and worse outcomes at six months and beyond, and is generally avoided in this tendon.
Rushing the return to jumping is the most common cause of recurrence. The energy-storage phase exists precisely because strength gained in slow lifting does not transfer automatically to the demands of landing.
Recovery timeline
A full return to jumping sport typically takes three to six months, and longer for a case that has run across a season. The strength phases each need four to six weeks, and they cannot be compressed much without the tendon objecting.
The decline squat pain score is the tracking measure. Pain during the squat dropping from 7 out of 10 to 3 is the signal to progress to the next stage.
| Stage | ✓ Do this | ✗ Avoid this |
|---|---|---|
| Stage 1, weeks 1–3 | Isometric holds, 5 × 45 seconds, twice daily. Reduce jumping volume substantially. | Continuing full training volume and hoping it settles |
| Stage 2, weeks 3–8 | Heavy slow resistance: leg press, squat, decline squat, 3–4 sets, slow tempo, three times a week. | Adding plyometrics before the strength base is in place |
| Stage 3, weeks 8–14 | Energy storage: skipping, hops, bounding, progressing to sport-specific jumps and landings. | Skipping this stage and going straight from the gym back to court |
| Stage 4, from ~14 weeks | Graded return to training and then to competition, monitoring pain the following morning. | Full match minutes in the first week back |
How we treat it at Kingsway
Treating jumper's knee
The assessment confirms the tendon as the source, sets a baseline decline squat pain score, and works out what in your training produced it.
- Palpation and single-leg decline squat testing to confirm and score the pain
- Ankle dorsiflexion and quadriceps strength assessment
- Soft tissue release through the quadriceps and IASTM around the tendon
- Isometric loading in the room to demonstrate the immediate pain-relief effect
- Radial shockwave therapy for cases that have not progressed after three months of loading
- A staged loading programme with clear criteria for moving between stages
This is a months-long programme, so sessions are usually every two to three weeks with the decline squat score reviewed each visit. The ten session package generally suits the timeline.
When to get it checked
Book an assessment if pain at the bottom of the kneecap has lasted more than three weeks or is changing how you train. Getting the staged programme started early makes a substantial difference to how much of a season you lose.
See a doctor or go to A&E if
- Sudden inability to straighten the knee against gravity, which can indicate a tendon rupture
- A palpable gap below the kneecap after a sudden injury
- The knee locking, catching or giving way
- Marked swelling within hours of an injury
- Redness, heat and fever with a swollen knee
Common questions
Can I keep playing?
Often yes at reduced volume, particularly during stages one and two. Cutting landing volume matters more than cutting total training time.
A practical rule is that pain the next morning should be no worse than the day before. If it is climbing week on week, the volume is still too high.
Why do isometrics help so quickly?
Sustained isometric contractions produce a measurable reduction in tendon pain that can last around 45 minutes, thought to relate to changes in how the nervous system processes the pain rather than to any change in the tendon itself.
That makes them useful immediately before training as well as as the first stage of the programme.
Should I use a strap?
A patellar strap gives some people useful short-term relief by altering load distribution through the tendon, and it can help you get through a session.
It does not change the outcome, so it works as a support alongside the loading programme rather than instead of it.
How is this different from runner's knee?
This is pinpoint tender at the lower pole of the kneecap and provoked by jumping, landing and deceleration. Runner's knee is a diffuse ache around the whole front of the knee, provoked by stairs, hills and prolonged sitting.
The loading programmes differ, so getting the distinction right at the start saves a lot of time.