Patellar tendinopathy and how physiotherapy can help

What is patellar tendinopathy

The patellar tendon connects the kneecap to the shinbone and helps transmit the force needed to straighten your knee. Patellar tendinopathy means persistent tendon pain and reduced function related to loading. Often called jumper’s knee, it typically causes localised pain near the tendon’s attachment to the bottom of the kneecap. It is not simply a short-lived episode of inflammation. [1]

Why it develops

Repeated jumping and other demanding activities can expose the tendon to more load than it currently tolerates. Training volume, recovery opportunities and recent changes in activity are worth discussing. However, there is no single proven cause. Research linking flexibility, ankle movement or training exposure to future tendinopathy is limited or inconsistent, so blaming one movement pattern or ‘tight’ muscle is usually too simplistic. [2]

Common symptoms

Symptoms usually centre on a fairly specific spot below the kneecap, rather than the whole knee. Jumping, landing, running, squatting or stairs may provoke pain, and the area may be tender. These features suggest a tendon problem but cannot confirm the diagnosis on their own. [1]

What a physiotherapist checks

Assessment includes your symptom history, activity demands and goals, followed by checks of tenderness, knee movement, strength and pain during suitable loading tasks. No single examination test is definitive. Ultrasound or MRI is not routinely needed initially: tendon changes can occur in people without pain. Imaging may help when the diagnosis remains uncertain or progress is unexpectedly limited. [1,3]

Other possible causes

Other explanations include patellofemoral pain around or behind the kneecap, fat-pad irritation, osteoarthritis and, in growing adolescents, Osgood–Schlatter disease. A sudden injury may indicate a different problem, including a tear. Physiotherapy assessment helps identify when medical review is needed; it does not replace investigation of concerning symptoms. [1,3,7]

Treatment and what the evidence says

The Dutch guideline recommends education and individually adjusted exercise as initial care, while acknowledging low or very low certainty evidence. The plan usually modifies aggravating activity and progressively rebuilds loading tolerance, rather than relying on prolonged complete rest. [3]

Exercises may progress from tolerable static holds to controlled resistance work, then jumping and sport-specific tasks when appropriate. Your response guides progression. A 2021 trial involving 76 patients found better pain-and-function scores with progressive tendon loading than eccentric-only exercise after 24 weeks; the difference in return-to-sport rates was not statistically significant. [4]

Importantly, a 2025 Cochrane review judged the evidence for strengthening exercise very uncertain, based on small trials conducted in athletes. This means we cannot confidently predict the size of benefit, harms or who will respond best. A 2026 review also did not establish clear superiority over heavy slow resistance training for the other exercise approaches it compared. [5,6]

Progress should be reviewed regularly. If there is no meaningful improvement after about 12 weeks of structured rehabilitation, reconsider the diagnosis and plan. Injections and surgery are not routine first-line options, and additional treatments have uncertain benefits. [3]

When to seek medical advice

Most gradual tendon pain is not an emergency. Seek urgent medical assessment for a hot, red, swollen knee with fever or feeling unwell, or after an injury if you cannot bear weight or straighten the knee. Arrange review sooner if pain or swelling is worsening. [8,9]

For ongoing activity-related pain, a physiotherapy assessment can help clarify the problem and discuss realistic options. This article provides general information, not an individual diagnosis or exercise prescription.