Patellar tendinopathy, or “jumper’s knee,” is a common cause of pain at the front of the knee. It happens when the patellar tendon, the band connecting your kneecap to your shinbone, is loaded more than it can currently tolerate, and it usually builds up gradually rather than from a single injury.

In my Sandton physiotherapy practice, I often see patellar tendon pain in runners and gym-goers who increased their jumping, running, or lower-body training faster than the tendon was ready to tolerate.

The good news is that it usually responds well to the right kind of loading and a structured plan. This article explains why it happens, how it’s assessed, and the treatment approaches that tend to help.

The Short Version

Patellar tendinopathy (jumper’s knee) is pain and irritation of the patellar tendon, the band just below your kneecap, from loading it more than it can currently tolerate. The main symptom is localised pain at the bottom of the kneecap that is worse with jumping, squatting, stairs, and running. The most helpful approach is usually not rest, but carefully managed loading: easing the aggravating spikes while gradually building the tendon’s tolerance with exercise. Recovery can be slow and is rarely a straight line, but most people improve steadily with a structured, progressive plan.

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What is Patellar Tendinopathy?

Patellar tendinopathy, or “jumper’s knee,” is a condition where the patellar tendon, connecting your kneecap to your shinbone, becomes painful due to tiny degenerative changes.

This happens most often from repeated strain, especially in sports like basketball or volleyball, which involve lots of jumping.¹

Who’s Most Affected?

Patellar tendinopathy is common in athletes, particularly men, who play high-impact sports. In fact, up to 45% of elite basketball and volleyball players experience it at some point.¹

However, anyone with regular knee strain, including some workers, can develop it.

Why It Develops

The tendon endures stress every time you jump, squat, or lift, leading to micro-tears that build up if rest is insufficient. This continuous strain weakens the tendon over time, causing persistent pain.²

Common Signs You Have Patellar Tendinopathy

Pain Right Below the Kneecap: You feel a dull or sharp ache just under your kneecap, especially after being active.
Knee Hurts When You Squat or Jump: Squatting, jumping, or even climbing stairs makes the pain flare up and often gets worse the more you do it.
Knee Feels Stiff After Sitting: After sitting for a while or first thing in the morning, your knee feels stiff and sore until you move around a bit.
Tender Spot Under the Kneecap: Pressing on the area right below your kneecap is painful or sensitive to the touch.
Pain When Slowing Down or Stepping Down: Lowering yourself down, like stepping off a curb, can make the pain spike.
Slight Swelling Around the Knee: Sometimes, the area under your kneecap looks a bit puffy, especially after a lot of activity.
Knee Feels Warm: The area around the pain may feel a little warmer than usual after you use your knee a lot.
Pain Sneaks Up Gradually: The pain often starts small and slowly gets worse over weeks or even months.

Why Does Patellar Tendinopathy Happen?

Every time you jump, squat, or run, the patellar tendon takes on a load, stretching slightly with each movement. Normally, this stress helps your tendon adapt and grow stronger.

However, when the load is too much or too frequent, small tears develop in the tendon fibers. Instead of healing fully between activities, these tears keep building up, causing the tendon to lose its strength and elasticity over time.

This breakdown is known as “degeneration” and is the main reason for the ongoing pain.²

Why the Pain? Blood Vessels and Nerves

As the tendon wears down, your body tries to repair it by creating more blood vessels and nerve fibers in the damaged area. This is an effort to bring in more healing cells, but it also leads to increased sensitivity.

As a result, even simple movements like stepping down or standing up can become painful, as the nerves are now extra responsive to the load on your knee.⁴

A Condition of Degeneration, Not Inflammation

Unlike typical injuries, patellar tendinopathy isn’t caused by swelling or inflammation that eventually fades. It’s a slow, ongoing degeneration of the tendon tissue.

This means that usual anti-inflammatory treatments, like ice or pain relievers, often don’t help much.

What’s needed instead is a treatment approach that gradually rebuilds the tendon’s tolerance to load, helping it adapt and strengthen over time.³

Common Conditions That Could Be Causing the Pain

Patellofemoral Pain Syndrome (PFPS)

Pain around or behind the kneecap, especially with knee bending. Differs from patellar tendinopathy by involving cartilage instead of the tendon.⁵ It often flares with prolonged sitting and with going up or down stairs, rather than tracking with how much you load the tendon.

Quadriceps Tendinopathy

Pain above the kneecap rather than below, often triggered by sudden acceleration or heavy lifting.⁶ The tender spot usually sits at the top of the kneecap rather than the bottom, and it is more common in older or heavier athletes.

Osgood-Schlatter Disease

Pain where the tendon meets the shinbone, common in adolescents, and is more localized than patellar tendinopathy pain. It usually affects active teenagers during growth spurts and tends to settle as the growth plate matures.

Sinding-Larsen-Johansson Syndrome

Pain at the lower kneecap, typically in growing adolescents and linked to bone growth rather than tendon degeneration.⁷ Like Osgood-Schlatter, it affects growing adolescents and is generally self-limiting with sensible load management.

Meniscal Tear

Sharp pain and possible locking or catching in the knee, typically along the inner or outer side of the knee joint rather than under the kneecap. Swelling is also more common than in patellar tendinopathy.

Common Mistakes People Make When Dealing With Patellar Tendinopathy

Over-Resting or Overdoing It

Total rest weakens the tendon, while pushing through pain worsens damage. A balanced, gradual exercise plan is key.³ The aim is to find the level of load the tendon can handle on a given day and build from there, rather than swinging between complete rest and overdoing it.

Relying on Painkillers

Painkillers only mask pain and don’t address tendon degeneration. Over time, this can worsen the tendon’s condition.² They can have a place for short-term comfort, but they are not a substitute for the loading programme that actually changes how the tendon copes.

Skipping Rehab Exercises

Rehab exercises help restore tendon strength. Skipping them often leads to persistent pain and a longer recovery.³ Consistency matters more than intensity here, and doing a little most days usually beats the occasional hard session.

Consequences of Neglecting the Patellar Tendinopathy

Increased Pain and Limited Mobility

Ignoring symptoms can lead to severe pain, making everyday activities difficult.⁴ Everyday tasks like stairs, squatting, or standing up from a chair can become uncomfortable, and many people start avoiding the activities that provoke it.

Risk of Tendon Rupture

Severe neglect may lead to tendon rupture, requiring surgery and lengthy rehab.⁸ This is uncommon and usually follows a long period of unmanaged, high-load activity, but it is a good reason not to simply push through steadily worsening pain.

Chronic Degeneration

Long-term neglect can make the tendon resistant to treatment, resulting in chronic pain and reduced knee function.⁸ The longer a painful tendon goes without appropriate loading, the more its capacity can decline, which is why starting a structured plan sooner usually makes rehabilitation more straightforward.

Types of Scans for Patellar Tendinopathy

Ultrasound

An ultrasound is a quick and painless scan that uses sound waves to create images of your tendon. With ultrasound, we look for any thickening in the patellar tendon, irregularities in the tendon fibers, and areas of increased blood flow.

These signs tell us that the tendon may be damaged or inflamed.¹

MRI (Magnetic Resonance Imaging)

An MRI provides detailed images of both the tendon and surrounding tissues. It helps us see the exact location and extent of any tendon damage. With MRI, we look for tendon thickening, degeneration, and fluid build-up.

It’s especially helpful if we suspect more extensive issues around the knee.¹

X-Ray

While an X-ray doesn’t show soft tissues like tendons, it can help rule out other conditions, like fractures or bone spurs, that might cause similar knee pain. We mainly use X-rays to ensure there’s no bone-related issue contributing to your symptoms.¹

Surgical Treatment for Patellar Tendinopathy

Surgery is considered for patellar tendinopathy when conservative treatments, like exercise therapy and physical therapy, have not improved symptoms after 6–12 months.

Surgical options generally involve removing damaged tissue from the tendon or, in some cases, reshaping part of the kneecap. This aims to reduce pain and improve knee function, especially in patients wanting to return to high-impact activities.⁹

Open Surgery: The surgeon removes damaged tissue through an incision, which can sometimes involve reshaping the kneecap. This approach provides direct access to the tendon, helping in severe cases but requiring a longer recovery.⁹

Arthroscopic Surgery: Arthroscopy is a minimally invasive approach where the surgeon uses small tools and a camera to remove damaged tendon tissue. It typically results in a faster recovery and less postoperative pain compared to open surgery.¹⁰

Importance of Physiotherapy After Surgery

Post-surgery, physiotherapy plays a key role in recovery. Through structured exercises, we work to rebuild strength in the knee and restore the tendon’s ability to handle stress gradually.

Key areas of focus are flexibility, muscle control, and increasing the load on the tendon over time. A well-structured physiotherapy programme can also help reduce the risk of re-injury and support a better long-term outcome.³

Red Flags: When to Have Your Knee Assessed

Patellar tendinopathy itself is not dangerous, but some knee symptoms deserve prompt medical attention. See a healthcare professional promptly if you experience:

A sudden, severe pain or a “pop” at the front of the knee, especially if you then struggle to straighten your leg or lift it.
The knee giving way, locking, or buckling.
Significant swelling that comes on quickly.
Redness, heat, and fever with a painful, swollen knee.
Pain that is constant, present at rest or at night, and unrelated to activity.

Treatment Options for Patellar Tendinopathy

Exercise Therapy

Exercise is the foundation of treatment. Progressive tendon-loading exercises, like isometric (holding still) and eccentric (slowly lowering) movements, gradually strengthen the tendon, reduce pain, and improve knee function over time.¹¹

Myofascial Release

Gentle soft-tissue or myofascial work over the quadriceps and surrounding thigh muscles may help ease tightness and discomfort, which can make it more comfortable to move and to do your exercises. It is an adjunct, not a treatment on its own.

Orthopedic Manual Therapy

Hands-on techniques may help with knee mobility and discomfort, supporting your rehabilitation and making movement easier. As with the other hands-on approaches, it tends to work best combined with progressive loading rather than used alone.

Laser Therapy

Laser therapy is sometimes used alongside exercise to help manage pain, and some people find it a useful addition in longer-standing cases.

Dry Needling

Dry needling is sometimes used to help ease muscle tension around the knee and may offer short-term pain relief when combined with exercise.¹³

Strapping and Taping

Patellar straps or sports tape stabilize the knee, reducing strain on the tendon during activities, which can temporarily relieve pain.¹²¹⁴

Conclusion

As your physiotherapist, I want you to know that patellar tendinopathy doesn’t have to limit you. With a steady, consistent approach, you can relieve pain and get back to doing what you love.

Recovery takes small, gradual steps, sticking to exercises, moving mindfully, and giving your body time to adapt. Each bit of effort counts and brings you closer to lasting relief.

This condition is challenging, but with tools like strengthening exercises, manual therapy, and options like shockwave or taping, we can rebuild your knee’s resilience.

I’m here to support you, answer questions, and adjust your plan along the way. Stick with the process, and many people are able to get back to the activities they enjoy.