Jumper’s Knee, formally known as patellar tendinopathy, is an overuse injury affecting the tendon connecting the kneecap (patella) to the shinbone (tibia). The condition causes pain localized just beneath the kneecap. It is common in athletes involved in sports requiring repetitive, powerful leg extension, such as basketball, volleyball, and running. This injury results from accumulated mechanical stress that exceeds the tendon’s capacity to recover, leading to degeneration (tendinosis). It is primarily a load management issue, not an acute trauma.
Initial Pain Management and Activity Modification
The immediate response to a flare-up of patellar tendon pain focuses on reducing strain and managing symptoms, not complete rest. Stopping all activity that triggers pain, such as jumping or deep squatting, is paramount to prevent further irritation. This is known as relative rest: modifying activity to a pain-free level while avoiding complete immobilization, which can weaken the tendon.
Applying ice below the kneecap for 10 to 15 minutes after discomfort can help with pain relief. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may also be used temporarily to manage symptoms. These initial measures are a short-term strategy intended to calm the pain and allow active rehabilitation to begin.
Targeted Rehabilitation and Tendon Loading Protocols
The most effective long-term treatment for patellar tendinopathy is a structured, progressive loading program designed to strengthen the tendon and improve its tolerance to stress. This therapeutic loading is a gradual process that stimulates the tendon’s repair and adaptation mechanisms. The goal is to safely increase the tendon’s strength and capacity for force, effectively treating the underlying issue of load intolerance.
The initial phase involves isometric exercises, which are static muscle contractions without joint movement. Holding a Spanish squat or a seated knee extension (e.g., 70% of maximum contraction for 45 seconds, repeated five times) can provide immediate pain relief for up to 45 minutes. These holds reduce pain signals and serve as a low-irritation starting point for loading the muscle-tendon unit.
Once isometrics are tolerated, the program progresses to Heavy Slow Resistance (HSR) training. This is an isotonic exercise emphasizing slow movement, such as performing leg presses or squats with a heavy weight, using a slow tempo. This slow, heavy loading applies mechanical tension necessary for long-term adaptation without the high-speed, spring-like energy storage that causes pain.
The next progression incorporates eccentric training, focusing on the lengthening phase of the muscle contraction. Modern protocols often integrate eccentric work within HSR or use it in later stages, as isolated eccentric movements can be too aggressive for highly irritable tendons. The rehabilitation process requires consistency, often lasting three to six months, and demands careful pain monitoring. Pain levels should not exceed a mild threshold (e.g., 3/10) and must return to baseline within 24 hours of exercise.
Professional Interventions and Advanced Treatment Options
If consistent home rehabilitation, including relative rest and progressive loading, does not lead to improvement after six to eight weeks, professional guidance is necessary. A physical therapist can provide a personalized program, identifying and correcting biomechanical factors like weakness in the glutes or hips that increase strain on the patellar tendon. They may also use therapeutic taping or a patellar strap to temporarily offload the tendon during initial rehabilitation.
For pain unresponsive to conservative measures, a physician may offer advanced, non-surgical options. Platelet-rich plasma (PRP) therapy involves injecting concentrated platelets into the damaged tendon to stimulate healing. Extracorporeal shockwave therapy (ESWT), which delivers sound waves to the affected area, is another option for chronic cases.
Corticosteroid injections are generally avoided for patellar tendinopathy because they can weaken the tendon tissue and increase the risk of rupture, despite offering short-term pain relief. Surgery, such as tendon debridement, is reserved for chronic, severe cases that have failed to improve after at least six months of consistent non-operative treatment. Procedures like Tenex or Tenjet use specialized tools to remove the damaged tissue with minimal incision.
Strategies for Safe Return to Activity
A safe return to activity begins when the tendon has regained sufficient strength and can tolerate higher loads without significant pain. The final phase of rehabilitation involves reintroducing energy-storage and release activities, such as hopping, jumping, and cutting, which mimic the demands of sport. These exercises, known as plyometrics, must be gradually layered into the training schedule to prepare the tendon for the powerful, quick forces required for full sport participation.
Long-term prevention is built upon the principle of load management, meaning carefully controlling the volume, intensity, and frequency of training. Increases in training load should be slow and progressive to allow the tendon time to adapt and avoid recurrence. Addressing biomechanical deficiencies, such as improving landing mechanics and ensuring adequate strength in the entire lower kinetic chain (hips, glutes, and calves), is also a crucial long-term strategy. A proper warm-up prepares the tendon for stress, while supportive gear like patellar straps can be used to manage symptoms during activity.