Patellar Tendinopathy (Jumper's Knee)

Pain with long periods of sitting, squatting and stairs can happen with patellar tendinopathy. But it's also typical of patellofemoral pain, so on its own it doesn't settle the question ¹. What points more to the tendon is pain pinned to the bottom of the kneecap that rises and falls with how hard the tendon is working ^1,2.

Other conditions that can look similar include Osgood-Schlatter disease, Sinding-Larsen-Johansson syndrome, fat pad irritation, plica irritation and infrapatellar bursitis ¹. Scans can't confirm tendon pain on their own ¹, so a hands-on examination does most of the work of telling them apart.

This one is diagnosed by examining you. A clinician looks for two hallmark features: pain pinned to the lower tip of the kneecap, and pain that climbs as you ask more of the muscles that straighten your knee, most of all in movements where the tendon stores and releases energy ¹. There may also be tenderness at the front of the knee and a tendon that feels a little thickened ³.

A scan can help rule out other causes. It can't make the diagnosis, because tendon changes show up in people whose pain is coming from somewhere else at the front of the knee ¹. A thorough examination also hunts for what's feeding the problem ¹: weak thigh muscles, tight leg muscles, or activity that's gone up too fast ³.

The evidence here is reasonable, not perfect. A review of 12 trials found that exercise with monitored loading improved pain, function and strength in the short and medium term, although each trial carried a moderate risk of bias ⁷. We'll also be straight with you: this rehab can be slow and sometimes frustrating, and unrealistic timeframes are one of its most common pitfalls ¹.

Patellar tendon rehab follows The Well Motion Recovery Path™. You go up a phase when the tendon tolerates the load in front of it, not when a set number of weeks has passed.

• Reset: while the tendon is irritable. We trim the jumping and impact, keep you fit with cycling or swimming ³, and begin isometric holds ¹. Tape or a patellar strap may take the edge off short term ⁵. Expect the pain to ease, not vanish. We move you on once everyday loads such as stairs stop flaring it up.
• Rebuild: the longest phase. Heavier strength work, then jumping and landing drills ¹, through our exercise prescription and conditioning service. Expect slow weeks ¹ and the odd flare-up ³. We move you on when the tendon copes with spring-type loading and has calmed by the next morning.
• Return: graded training, then competition ¹, guided by sports physiotherapy. If you don't play sport, Return means stairs, squatting and work without the tendon complaining. You leave with a loading plan, because flare-ups are common ³.

How long it usually takes. Allow 6 to 12 weeks of specific exercise before you notice a difference, and more than 3 months for a full program ³. A flare-up usually settles within 6 weeks ³. These figures are patient guidance from a health service, not trial results, and in some people the condition lasts for years ⁵.

Flare-ups are common with this condition, and some people get them again and again ³. The prevention research is thin, and parts of it are surprising:

• Watch the weekly volume. In a four-year study of 141 elite teenage volleyball players, each extra hour of training raised the odds of jumper's knee by 72%, and each extra set played per week nearly quadrupled them ⁹. So add training in steps ³.
• Stretching won't prevent patellar tendinopathy on its own. A review of prevention trials found no evidence that stretching prevents tendon pain ⁸. Tight leg muscles are one of the things that can contribute ³, although the evidence for that is limited ¹⁰, and regular leg stretching is listed as a helpful tip alongside rehab exercises ³. It just hasn't been shown to prevent the problem. In one trial, pain-free professional soccer players were given a combined program of eccentric (slow lowering) exercises and stretching during the season. It didn't reduce injuries, and in players whose patellar tendons already looked abnormal on ultrasound, it raised the injury risk ^8,11. That was a blanket add-on for players with no pain, and it can't tell us what either part did on its own. It isn't the staged loading used to treat a painful tendon ^1,7.
• Add balance work. The same review found limited evidence that a long-term program including balance training helps prevent patellar tendinopathy ⁸. A 2022 analysis that pooled 11 prevention studies found no clear drop in risk overall, though it may have been too small to tell for athletes ¹².
• Keep the other suspects in proportion. Tight thighs, stiff ankles and body weight all get blamed, but a review of 31 studies found no strong evidence for any single modifiable risk factor ¹⁰.