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Patella tendinopathy

What is it?

Patella tendinopathy is associated with pain at the front of the knee under the knee cap. It is sometime called jumper’s knee.

A tendon is the structure that attaches muscle to bone. The patella tendon (blue arrow on picture) connects the lower end of the knee cap (patella) to your shin bone (tibial tuberosity). It helps the large powerful thigh muscles (1 quadriceps) move the lower leg.

Muscles around the knee

  1 Quadriceps (front of the thigh)

  2 Hamstrings (back of the thigh)

  3 Gastrocnemius (back of the calf)

  Blue arrow Patella tendon

It is often caused by an overload to the tendon due to an activity that the knee is unaccustomed to or a sudden increase in activity. There may be structural changes to the tendon over time that may contribute to the ongoing pain.

It most commonly affects people in the age group 15-30. It is more common in men than women and more common in those who play sports involving jumping. Other factors thought to contribute to developing patella tendinopathy include poor fitness levels, being overweight and repetitive heavy load or strain on the tendon.

What are the common symptoms?

Pain is aggravated by activities that increase load going through the quadriceps muscles for example: sitting, squatting, stairs and jumping. Initially it may be a sharp localised pain at the front of the knee, becoming a dull ache around the knee as time goes by.

How to manage it?

Modify your activity

Initial relative rest and modifying activity is recommended. This allows for appropriate tendon healing following a period of overloading or unaccustomed exercise.

This does not mean complete rest from all activity but rest that reduces the load on your tendon.

Examples of ways you can offload your tendon are:

  • Going up the stairs with your unaffected leg first and coming down the stairs with your affective leg fist
  • Putting your affected leg out in front of you when you sit and stand
  • Avoiding hill walking/ hill running/ jumping
  • Rest from sporting activities which involve jumping, squatting etc.

Note these offloading methods should only be used short term as it is important to get back to your usual activates as quickly as possible.

During this stage isometric exercise of your thigh muscles may help your pain; these are exercises in which you tense your muscles without much movement of the knee.

Speak to a physiotherapist for further guidance on relative rest and exercise during this stage.

Strengthening exercises

Isometric knee extension in lying

Lie on your back with one leg bent and the other leg straight.

Bend the ankle of the straight leg and press the back of the knee against the floor using your front thigh muscles.

Hold the tension for a moment and then relax.

Repeat 10 times. Rest for 1 minute. Repeat 3 times.

Heel raise

Stand tall, with your weight distributed evenly on both feet, and take support if needed.

Rise up onto your toes and in a controlled manner return to the starting position.

Repeat 10 times Rest for 1 minute. Repeat 3 times.

Rehabilitation exercises

In order for the tendon to heal and to prevent future problems it is important to strengthen your thigh muscles (quadriceps).  Eccentric exercises (exercises that load the muscle as it lengthens) are recommended for this condition.

A common exercise used is a small squat on two legs, this is gradually progressed to a deep squat on two legs and then single leg squats.

It may also be helpful to strengthen other muscles groups including your calf muscles, hip and buttocks muscles.

In the later stages of rehabilitation if you play a sport involving jumping then jumping and hopping exercises may also be added to your program.

It is important to take a gradual graded approach to your exercises. Doing too much too soon may slow down the recovery. Equally doing too little will not give the tendon the stimulus it needs to heal properly.

Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards. Keep your chest up and your spine and neck in a neutral position.

Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Note
– Keep your hips, knees and toes aligned
– Keep your weight evenly on your whole foot.

Repeat 10 times rest 1 minute. Repeat 3 times.

Deep Squat

Squat down by sitting back and bring your arms upwards. Push back up through the heels, chest up, and straighten your hips.

– keep hips, knees, toes aligned.

– Go only as low as you feel comfortable with.

– Keep weight evenly on whole foot.

Repeat 10  times rest 1 minute. Repeat 3 times.

Single-leg Mini Squat

Stand tall on one leg with the other leg raised behind.

Squat down keeping your knee in line with the toes and your pelvis level. Push back up to the starting position.

As your technique improves and pain reduces, you can progress the exercises to a deeper squat.

Repeat times 10 times rest 1 minute. Repeat 3 times.

Further progression of exercise may include an eccentric strengthening programme and a gradual return to sport or activity. If you need guidance on this please self-refer to a physiotherapist.

Changes to the muscles and tendon takes time, you may need to do the exercises for 3-6 months to aid your recovery.  Be patient and continue to do them regularly.

Mild discomfort during exercise is acceptable but if you get severe pain or increased symptoms stop and inform your physiotherapist. As a guide your pain should not go above 4/10 (0 being no pain, 10 being the most severe pain).

For guidance on the right exercises for you speak to a physiotherapist.

Weight management

If you are overweight this increases the load and demand being placed on the quadriceps and patella tendon. Therefore reducing you weight to a healthy BMI may help reduce your symptoms.

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

How to prevent and manage future symptoms?

Tendons do not respond well to a rapid increase to the load placed upon them.

To avoid excessive load it is best to keep your exercise and activities varied.

Build up your activity and exercise gradually, especially if it is an activity, exercise or sport that you are unaccustomed to.

If you do ‘overdo it’ take some relative rest days to allow the tendon to recover before gradually getting back to your usual activities.

You can also reduce your risk of developing this condition by maintaining a healthy weight.

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