Patellar tendinopathy is pain at the bottom of the kneecap where the patellar tendon attaches. It's common in jumping sports (hence the old term 'jumper's knee'), but it affects runners, cyclists, and gym-goers too. The defining feature is pain that warms up with activity and returns worse the day after heavy loading. Understanding the biology of tendinopathy is essential to recovering from it — and to not making it worse.
Why does tendinopathy respond poorly to rest?
Tendons don't heal passively. Unlike muscles, they have poor blood supply and depend on mechanical loading to stimulate the collagen remodelling needed for recovery. Prolonged rest weakens the tendon and creates a cycle where return to activity re-aggravates it. The evidence is now clear: progressive tendon loading — starting with isometric holds and advancing to heavy slow resistance exercise — is the most effective treatment.
The challenge is finding the right dose. Too much load too soon flares the tendon; too little delays recovery. Clinical guidance through this is where the difference is made. For athletes across Berwick and South-East Melbourne, this is one of the most common reasons we see people who've been 'managing' the pain for months without real progress.
The RISE Sports & Spinal approach to patellar tendinopathy
We begin with a thorough assessment of tendon irritability, training load history, and biomechanics — particularly hip and knee control during landing and single-leg loading. Treatment involves a structured loading programme, load management advice for sport, and manual therapy where appropriate.
Patellar tendinopathy can be fully resolved with the right approach. Book an appointment and we'll build a programme that lets you train through recovery rather than waiting on the sidelines.
The role of hip and gluteal strength in patellar tendinopathy
Patellar tendinopathy is often framed as a knee problem, but the hip and gluteal musculature play a significant role in its development and persistence. Insufficient hip abductor and external rotator strength allows femoral adduction and internal rotation during single-leg loading, which increases patellar tendon stress per repetition. Athletes who develop patellar tendinopathy in one sport frequently have this hip loading pattern on assessment. Strengthening the hip in parallel with progressive tendon loading produces significantly better outcomes than isolated eccentric knee work alone.
Training surface and footwear also contribute to tendon load. Consistently training on hard surfaces, sudden changes to training volume, or switching footwear mid-season can spike the cumulative load on the patellar tendon beyond its current capacity. At RISE Sports & Spinal in Berwick, load history is taken as carefully as symptom history — identifying the specific spike that initiated symptoms helps guide the load reduction and reintroduction protocol. For jumping sport athletes in the Berwick and South-East Melbourne area, patellar tendinopathy is manageable with the right programme, and full return to competition is the expected outcome.
What are the symptoms of patellar tendinopathy?
Pain is usually well localised to the bottom of the kneecap, at the top of the tendon. It's typically worse with jumping, landing, squatting, stairs and getting up after sitting. It often warms up during activity and then aches afterwards or the next day. Unlike many knee problems, it doesn't usually cause swelling, locking or giving way.
Can I keep playing sport with patellar tendinopathy?
Often yes, with changes. Reducing jumping and sprinting volume for a period, while starting a strengthening program, is usually better than stopping completely. A useful guide is keeping pain during and after activity at a low level, and checking that it has settled by the next day. If pain is climbing week to week, the load needs to come down further.
Do patellar tendon straps help?
A strap worn just below the kneecap can reduce pain during sport for some people and is fine to use. It doesn't treat the tendon itself, so it works best alongside a loading program.
How is patellar tendinopathy different from Achilles tendinopathy?
Patellar tendinopathy is provoked by high knee flexion under load — deep squats, landings, and jumping. The tendon tolerates straight-leg and isometric loading well, so rehab begins with seated leg press at comfortable range and isometric holds. Achilles tendinopathy, by contrast, is provoked by stretch loading — uphill running, calf stretching, and heel drops — while compression of the tendon against the heel bone (seen in insertional Achilles tendinopathy) is a distinct subtype requiring specific modification.
Why does patellar tendinopathy keep coming back?
Tendinopathy recurrence is common and follows a predictable pattern: the athlete loads progressively, symptoms improve, training resumes, the load exceeds capacity during a high-demand period, and symptoms return. The root cause is almost always incomplete progression through the loading protocol — specifically, inadequate completion of the sport-specific and plyometric phases before return to full competition loads. Tendons remodel slowly and the full loading programme typically takes twelve to sixteen weeks, even when symptoms resolve much earlier.
That's why a loading programme should build past the point where symptoms settle, not just to it, including heavy slow resistance, jumping and landing, and sport-specific phases before a return to full competition.
For heel and Achilles pain, see our post on Achilles tendinopathy.
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Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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