Patellar tendonitis (Patellar tendinopathy) is commonly known as Jumper’s knee. It is an overuse injury causing pain at the front of the knee, specifically at the bottom of the kneecap (patella).
Patellar tendonitis symptoms
Symptoms usually develop gradually over time and include:
- Pain at the bottom of the patella (kneecap), known as the lower pole of the patella
- Contracting your quadriceps muscles or squatting is painful
- Aching and stiffness after exercise
- At times chronic pain may flare up and be acutely painful
- Pressing in over the bottom of the patella will be tender
- Thickening of the affected tendon
- In particular, jumping activities cause most pain or discomfort, hence the term Jumper’s knee.
How bad is my Jumper’s Knee?
Jumper’s knee injuries are graded from 1 to 4 depending on how bad your pain is.
- 1: Pain only after training.
- 2: Pain before and after training but the pain eases once warmed up.
- 3: Pain during training which limits your performance
- 4: Pain during everyday activities
Other signs include a weak or atrophied vastus medialis oblique (VMO) muscle on the inside of the thigh, as well as weakness in the calf muscles.
VISA pain questionnaire for Patellar tendonitis
The VISA pain questionnaire is excellent for monitoring symptoms which can often be difficult to describe or measure with a long-term chronic condition. The lower your score, the worse your injury. Do this regularly, for example, once per week to measure progress.
Warning!! – This injury may seem like a niggling injury that is not that bad. Many athletes continue to train and compete on it as it may not be a debilitating injury and recovers after a short period of rest. However, neglect jumper’s knee at your peril! If left to become chronic it can be very difficult to treat and may require surgery.
What is Patellar tendonitis?
Patella tendonitis is inflammation of the patella tendon at the front of the knee. In chronic, long-term cases, wear and tear or degeneration is more likely than acute inflammation, hence the term ‘ Patella tendinopathy‘ is often more appropriate. For the purposes of this article, we interchange the terms Patella tendonitis and tendinopathy.
The patella tendon, also known as the patella ligament, is extremely strong. It joins the patella (kneecap), to the shin bone or tibia. The large quadriceps muscles at the front of the thigh pull on the kneecap, producing huge forces through the patella tendon, especially when jumping and landing.
What causes Jumper’s knee/Patella tendonitis?
Jumper’s knee is an overuse injury. In practice, the majority of chronic cases are more likely to be degeneration of the tendon rather than acute inflammation, which should settle down after a few days’ rest.
With repeated strain, micro-tears and collagen degeneration occur in the tendon. This is known as patellar tendinopathy or Jumper’s Knee.
Although it is an overuse injury there are a number of factors that make people more likely to suffer including poor foot biomechanics, weak quadriceps muscles, and incorrect training practices.
Q angle of the knee & VMO
The Q angle of the knee refers to the angle of the femur (thigh bone) to the tibia (shin bone).
Often athletes with patella tendonitis also have poor Vastus medialis obliquus (VMO) function. This is the muscle on the inside of the quadriceps near the knee. They may also have significant calf muscle weakness.
- Learn more about Q angle
Patellar tendonitis treatment
The aims of treatment for Patellar tendonitis are:
- To reduce pain
- Stretch the quadriceps muscles
- Gradually increase the load through your knee
More on patellar tendonitis treatment
Download our Jumper’s knee rehabilitation program.
Apply the PRICE principles of protection, rest, ice compression, and elevation. Apply cold therapy on a regular basis, especially during the first 24 to 48 hours and after any form of exercise.
A cold therapy wrap or gel ice pack is ideal. If your tendon is painful then apply ice for 10 minutes every hour, reducing the frequency as your symptoms improve.
Jumpers knee taping
A simple patella taping technique can help relieve the symptoms of patella tendonitis. It works by changing the direction of forces transmitted through the tendon.
By compressing your patella tendon just below the knee, the angle at which the tendon pulls on the patella is varied, therefore reducing strain on the painful area.
- More on Patella tendon taping
Patella tendonitis strap
Wear a knee support, or jumper’s knee strap to reduce pain and ease the strain on the tendon.
A jumper’s knee strap wraps around your knee, over the tendon, and just below the patella. As a result, it changes the angle of the tendon against the patella, therefore, changing the part of the tendon the forces are transmitted.
A doctor may prescribe anti-inflammatory medication e.g. ibuprofen. Do not take ibuprofen if you have asthma and check with a doctor before taking any medication.
It is thought that anti-inflammatory medication may help in the short term with acute inflammation and pain but may even hinder healing later on.
A professional therapist may use electrotherapy in the form of ultrasound or laser treatment to reduce pain and inflammation and aid the healing process
Cross-friction massage for Patella tendonitis involves applying deep pressure transversely across the tendon. It is often used for more chronic cases as the frictions help realign new fibres. Deep friction massage may trigger an acute response, stimulating the healing process.
Thigh massage may help loosen thigh muscles and increase the effectiveness of stretching exercises.
Aprotinin injections may help tendinopathies by restoring enzyme balance in the tendon. If the knee does not respond to conservative treatment, surgery may be required.
Exercises for Patella tendonitis
Our comprehensive Patella tendonitis rehabilitation program takes you step-by-step from initial injury to full fitness.
It consists of 4 phases and tells you what treatment and exercises to do each day and when you can move on to the next phase.
Stretching exercises for the quadriceps muscles at the front of the thigh should be done regularly. This will lengthen the muscles and place less stress on the tendon.
Eccentric strengthening exercises are the most important and thought to stimulate healing. These involve the quadriceps muscles lengthening whilst also contracting.
The aim of activation exercises is to keep the hip and gluteal muscles firing and in good condition whilst you are unable to train properly.
Movement control or proprioception exercises improve your coordination, balance and spatial awareness.
Functional exercises are more dynamic and sports-specific and include agility drills and exercises.
Neal Reynolds talks about managing Patella tendonitis.
Surgery for Patellar tendonitis
The surgical procedure for treating jumpers knee can vary depending on the individual and the surgeon’s preference. The success rate of about 60-80%. You may not ever return to the level of sport you had before the operation – many do though. It could take 6 to 12 months to return to competition after surgery.
Surgery may be indicated (needed) only after conservative methods have been properly tried first.
Surgeons differ in their approach to treating Patellar tendonitis. In most cases, a longitudinal or transverse incision is made over the patella tendon. Abnormal tissue is then removed. Some prefer a longitudinal cut into the tendon and some prefer a transverse one. They may take out the abnormal tissue. Some will do the operation by arthroscopy (keyhole surgery) and others may prefer open surgery.
The following injuries have symptoms similar to Patella tendonitis:
- Patella tendon rupture is a tear of the patella tendon and can be either complete or partial. It is often caused by an explosive jumping or landing action and may follow a chronic case of patella tendonitis.
- Osgood Schlatter disease is a common cause of knee pain in children and causes pain at the front and just below the knee.
- Sinding-Larsen-Johansson Lesion or syndrome causes symptoms very similar to Jumper’s knee, but occurs in young athletes and children and is more like Osgood-Schlatter disease.
References & research
- Blazina ME, Kerlan RK, Jobe FW et al. Jumper’s knee. Orthop Clin Nirth Am 1973;4(3):665-78
- Kahn KM, Bonar F, Desmon PM et al. Patella tendinosis (jumper’s knee): findings at histopathologic examination, US and MR imaging. Radiology 1996;200(3):821-7
- Maffuli N, Khan KM, Puddu G. Overuse tendon conditions. Time to change a confusing terminology. Arthroscopy 1998;14:840-3