Patellar Tendinopathy (Jumper’s Knee): Why Your Knee Hurts, How to Fix it, and How to Prosper After

The “Behind the Scenes” of Jumper’s Knee

If you are someone who sprints, runs, jumps (obviously), or skates, you might have felt a growing or sharp pain on the front part of your knee just below the bony bit (the patella also known as the kneecap). So, you decide to do what we were taught since the old ages and rest it, ice it up, maybe wear a sleeve knee brace, and take some time off to make it feel better.

But here’s the problem: You do that and it feels a little bit better and the next week when you decide to try your verb of choice, it gets angry again and you can’t exercise the way you want.

This is the classic story of patellar tendinopathy; it’s that annoying friend that hangs around way too long and too late after all the chips, dips, and tasty beverages of choice are long gone. It is one of the common sporting injuries and honestly, one of the most misunderstood.

Let’s break down the big ol’ why of it all, why resting alone usually doesn’t work, and how to make a blueprint on how to get back in the game.

So What’s Going On (Marvin Gaye Voice)

For decades, there have been a slew of names for knee pain: tendonitis, tendonosis, tendinopathy, patellofemoral pain syndrome, and of course, the dreaded knee-bola. And for a while, we thought, we follow the RICE method (rest, ice, compress, elevate), take some anti-inflammatories and if that doesn’t work, maybe get a corticosteroid shot.

The consistent problem is that my athletes and active folk don’t get better and feel like they can’t perform the way they want to due to the stubborn consistent pain.

But why? Researchers have taken a look at tendons that patients/subjects deemed painful and found that that was little to no inflammation (crazy right!). But, the researchers did find disorganized collagen fibers, extra ground substances, and new blood vessels forming.

Turns out, it’s not much of an inflammatory issue, but a tendon overload problem. There’s a saying for this phenomenon; you did too much too soon after doing too little for too long aka slow and steady wins the race when progressively loading tendons.

Good to Know, But Why Do I Still Have Pain?

Tendinopathy happens when training load exceed tendon capacity (you tried to go 5 miles on 3 miles worth of gas) often from:

• Rapidly increasing amount of sprinting, jumping, skating, etc
• Adding heavy lifts too quickly (whether adding too much weight, adding too much speed, etc)
• Limited recovery in-between session
• Poor load sharing, compensations, or weakness between trunk, hips, glutes, quads, hamstrings…basically all your leg muscles

This typically presents with the jumping and high volume running/sprinting athletes (fitness athletes, basketball, volleyball, track, hockey, …). The pain typically pops up just under the kneecap and runs down to the shin bone.

Stage Left With the Tendon

Tendons are not made up of the same things that muscle is. When tendons get irritated, they will stay irritated. Tendon pain doesn’t appear overnight and progresses through stages.

1 – The Reactive Stage

The stage is a big increase in load or activity and the tendon is swollen and irritated. Short term rest and isometric exercises work well here.

2 – Dysrepair Stage

There are structural changes in the tendon but it’s still adaptable. Progressive loading/strength training here is key.

3 – Degenerative Stage

Longer term irritation and structural changes in the tissues’ collagen (what it’s made out of). Here you deload to reload (go slow and steady to win the race).

4 – Reactive on Degenerative

These are the chronic guy who also needs to deload to reload.

Simply put, progressive load and monitoring your volume of work is your medicine. The right amount stimulates healing and reorganization. However, too much or too little will have you stuck in each stage.

Shouldn’t I Just Get an MRI?

Well, imaging doesn’t tell the whole story; it gives a picture in that particular moment. The big scary words of “tendon degeneration” and “partial tearing” may pop up and we immediately think this is the end of my knees. But, at least according to recent studies, imaging findings don’t always link to pain. Plenty of pain free athletes have these degenerative changes. So it’s good data to have but we can’t go off of just the picture.

Don’t panic over imaging results, it’s a piece of the puzzle. More importantly is function and how your tendons handle load and movement.

But Why Do I Still Have Pain?

This is where we talk about the nervous system’s role in tendon pain. When those symptoms linger for months (this is known as becoming “chronic”) the problem isn’t just tendon or the musculoskeletal system anymore, it’s partially the nervous system.

Chronic pain makes the nervous system and the nerves around the tendon get real sensitive and annoyed. Because of this, normal everyday activities like getting out of bed, going down the stairs first thing in the morning, doing that short run to the bus, really irritates that tendon even though you’ve put it through so much more before.

Us rehabilitation professionals call this phenomenon central sensitization. Central sensitization is basically your brain saying this has hurt for so long that I need to protect it at all costs, increase pain so this person doesn’t hurt themselves more. This explains why the pain persists even after the tissue heals and you have resumed most exercises/activities.

The solution to this problem isn’t to chase pain, you have to retrain the system through gradual loading and listen to the pain response. Some pain is normal but we aren’t following the no pain no gain rules yet.

Ok So What’s The Plan?

Let’s break it down into phases to make it easier.

Calm It Down (Early On)

Reduce load/deload temporarily; modify running distance, speed, terrain, etc to a tolerable level.

Do isometric exercises help reduce pain without over-stressing the tendon. Start small (~15-30 seconds) and gradually build from there.

For pain management; some like ice, others like heat, some like compression, some like bracing. All fine to address pain but it only manages the symptoms and not the cause.

Build Up Load Tolerance 

This is basically “get a bigger gas tank to go further” in the middle phases.

Once pain starts calming down (anything below a 3-4/10 on the pain scale; you feel it but it doesn’t ruin your day) start with exercises like slow, shallow depth squats, reverse nordic curls, and so on.

Anything to start teaching that tendon that load is ok. Remember to work on muscles around and that connects to the knee as well.

Restore Elasticity

Now it’s time to bring back that bounce in late stage phases.

Tendons act like springs and store and release energy during explosive movements. You have to return that spring to return to sport.

Low level bounces/low impact plyometrics then lateral and single leg hopping then once that feels ok, sport like activities.

Can’t Go Wrong Being Strong

Once you’ve covered all of that, build a layer of extra strength. You can never fully prevent injury from occurring but you can reduce the risk and stronger people tend to fare better than ones not as strong.

1. Strengthen glutes, hips, calves, and hamstrings to help distribute load more effectively.
2. Hip abductors and abductors work to help control knee position.
3. Calf strengthening supports energy transfer during jumping and sprinting.
4. Lateral and rotational drills build real-world stability.

And track your progress. One week squatting to a certain depth might hurt and be hard but a couple weeks later, it might feel just fine!

That’s when you progress it again but challenging it to something harder. You’ll usually see improvement in 6 to 12 weeks (tendon function usually comes back well before pain fully subsides) but full tendon remodeling can take several months. Consistency always wins here!

Can’t I Just Rest It?

Ummm, no. Sorry. Prolonged rest may reduce the pain which is great, but also will cause you to lose lean muscle mass and the tendon will most likely get weaker and more sensitive when you try doing activity again. Even getting massages, dry needling, and other passive treatment options will help the pain but not restore the function.

You have to actively build that tendon back up again and teach it what to do.

Patellar tendinopathy, or any tendon issue for that matter is frustrating but fixable. You aren’t washed up and worn out. It’s just probably time to modify your training and exercise load to accommodate your tissue capacity. Follow the steps of:

1. Calm it down
2. Gradually rebuild
3. Restore power and spring
4. Keep the whole system strong

Don’t let that tendon pain keep you from living that active lifestyle, just modify it so you can return pain free and more resilient than before!