Skip to main content

Patella tendinopathy


Patella Tendinopathy (sometimes known as tendonitis or tendinitis) is usually an overuse injury affecting your knee. It is the result of repeated stress of your patella tendon beyond its capacity (Beyond what it is able to do).  

It can affect up to 45% of athletes, especially those involved in sports which require a large amount of explosive or repetitive jumping (such as basketball, volleyball, football, rugby, athletics, etc). This is why Patella Tendinopathy is commonly known as jumper’s knee. However, even people who don’t participate in jumping sports can still get patella tendinopathy.  

It is most common in the younger population, with 90% of all people with patella tendinopathy being under the age of 30. Patella tendinopathy can be very debilitating and can cause long absences from sport if not managed appropriately.


Pain is usually the first symptom of patella tendinopathy. The patella tendon is located between your knee cap (patella) and the top of your shin bone (tibia).  Pain is usually localised to the patella tendon at its insertion into the patella. This pain at the tendon will usually increase when you work the muscles that control the straightening of your knee.  

Initially you may only feel pain in your knee as you begin physical activity or just after a workout but over time, if not managed, this may worsen and start to interfere with playing sport or exercising. Eventually the pain may start to interfere with daily movements such as walking, going up and down stairs or getting up out of a chair.  

Patella Tendinopathy is often diagnosed by expert assessment as imaging has often proved unreliable. One test that is routinely painful for persons with Patella Tendinopathy is a single leg partial squat with your heel elevated and supported. This should reproduce the pain at the patella tendon.

Physiotherapy Management
Warning: The management and rehabilitation of patella tendon issues can be very complex and individually specific. The following information can help educate but should not be used in place of your physiotherapists advice. Contact us; if you need help.

Physiotherapy management of patella tendinopathy will predominantly involve addressing strength issues and advice about pain management and rest.   

Rest Advice  

Rest from aggravating factors is often advised but is not always possible, especially if involved in high level sport. Some exercises have been suggested to help with pain and can often be used like a painkiller allowing people to continue playing sport in season. Appropriate short term rest after an episode of overloading or intense exercise involving the knee should also be allowed to enable appropriate recovery.  

Isometric Exercises 

Isometric exercises are push and hold exercises. These exercises have been found to provide up to 45 minutes of pain relief, and in some cases enable sports persons to play their sport without pain. For the knee, this is a knee extension (straighten) to hold in the mid position with up to 70% maximum effort against an immovable object (like a wall) in a sitting position or on a leg extension machine or with a resistance band. The idea with these is to hold the contraction for 45 seconds and repeat this 5 times, up to 4 times a day.  

Isotonic Exercises 

Isotonic exercises are exercises which involve the muscle contracting and lengthening under the load in a controlled manor. The current evidence suggests that using heavy resistance and performing the repetitions at a slow controlled pace is the best at improving function and pain more so than any other exercise type. This method can be used on a leg press or leg extension machine or using a bodyweight squat progressing to barbell squats and lunges etc. These exercises are performed 3 times a week with at least 1, but preferably 2 days between sessions. For the first 2 weeks, they should be performed in 4 sets of 15 repetitions at the maximum weight possible. Then performed for 4 sets of 12 repetitions at the maximum weight possible for the second two weeks. Then the next 2 weeks, the exercises are performed at 4 sets of 10 repetitions at the maximum weight possible and so on until you are performing 4 sets of 6 repetitions at the maximum weight possible.  This cycle of exercises can be repeated if required. Pain during these exercises is acceptable, provided that the pain is not worse after you have finished these exercises. 


Energy Storage Loading Exercises/ Return to sport exercises 

Note; This stage can vary for person to person, if you are unsure about anything with this, please contact your physiotherapist. 

When strength and pain have improved with isometric and isotonic exercises, an introduction of more explosive/quicker exercises is required to enable your tendon to deal with the stresses of sport. The aim is that your legs are equal in strength and power. The type of exercises for this should involve jumping, bounding, skipping etc. Firstly, you should keep the height of jump/length of bound/etc. at a minimum and increase the amount of repetitions as able before increasing the height or distance.  Once these exercises become manageable with minimal pain a return to sport approach of steadily increasing sport specific training drills should be started. 

A protocol of rehabilitation progressing through isometrics and isotonic exercises, to more explosive exercises and then sport specific drills has been proposed by Malliaris et al. (2015). 

Exercise Dosage
Indication to progess to next stage
1) Isometric loading
5 repetitions of 45 seconds, 2 to 3 times per day; progress to 70% maximal voluntary contraction as pain allows
Minimal pain during isometric exercise  
2) Isotonic loading
3 to 4 sets at a load of 15RM, progressing to a load of 6RM, every second day; fatiguing load  
Minimal pain during isotonic exercise  
3) Energy-storing loading
Progressively develop volume and then intensity of relevant energy-storage exercise to replicate demands of sport  
Adequate strength and consistent with other side and load tolerance with initial-level energy storage exercise (ie, minimal pain during exercise and pain on load tests returning to baseline within 24 hours)  
4) Return to sport
Progressively add training drills, then competition, when tolerant to full training  
Load tolerance to energy-storage exercise progression that replicates demands of training  

Unsure how to return to your activity? This may help: Return to sport

Rydym yn croesawu gohebiaeth a galwadau ffôn yn y Gymraeg neu'r Saesneg. Atebir gohebiaeth Gymraeg yn y Gymraeg, ac ni fydd hyn yn arwain at oedi. Mae’r dudalen hon ar gael yn Gymraeg drwy bwyso’r botwm ar y dde ar frig y dudalen.

We welcome correspondence and telephone calls in Welsh or English. Welsh language correspondence will be replied to in Welsh, and this will not lead to a delay. This page is available in Welsh by clicking ‘Cymraeg’ at the top right of this page.