Understanding Patellar Tendinopathy: Causes, Symptoms, and Treatment Options

What is patellar tendinopathy?

The patellar tendon is located between the tibial tuberosity and the patella (kneecap), and it is composed of connective tissue made up of long collagen fibers. Patellar tendinopathy, also known as jumper’s knee, develops when the tendon is repeatedly exposed to high levels of stress, leading to the formation of microtears within the tissue. Common signs include pain and tenderness just below the patella, swelling, and discomfort during repetitive jumping or explosive, loaded movements (Drakes, 2023). It's important to understand that the signs and symptoms of tendinopathy should not be viewed negatively; rather, they serve as the body’s way of signaling that we may need to adjust our training methods or modify aspects of our daily routine.

What now?

The goal of rehabilitation is to reduce training volume initially in order to lower pain levels, then gradually reintroduce exposure to training in a controlled manner to build the tendon’s capacity over time (Lee, 2021). Alongside this, it’s important to strengthen the muscles surrounding the knee, hip, and ankle to support the joint and improve overall movement efficiency.

Re-introducing Tendon Load

A systematic review by Lim and Wong (2018), highlighted that isometric exercises can provide short-term pain relief, while eccentric exercises are more effective for long-term pain management and improving knee function. However, it remains unclear whether isometric exercises are superior to eccentric exercises in the overall management of patellar tendinopathy. Based on this, we can infer that tendon loading should be progressive, involving slow and controlled movements to support tendon remodeling. Isometric exercises can be used as a preparatory step to activate the muscles around the knee and offer initial pain relief before transitioning to eccentric exercises.

During eccentric loading, we can adjust various factors such as the type of exercise, number of repetitions, external load, tempo, movement depth, and joint angle to modulate the stress placed on the tendon—ensuring we stay just below the pain threshold. Introducing tendon load in a controlled and gradual manner helps improve the tendon’s capacity to tolerate higher demands. Without consistent exposure to activities like jumping and landing, tendons may become deconditioned and more prone to injury when suddenly challenged by high-impact movements (Li et al., 2024).

Book in with any one of our other registered health providers at Umana Health for expert guidance on managing and navigating patellar tendinopathy!

References:

Drakes, S. M. A. (2023). Patellar Tendinopathy: Diagnosis and Management. Current Physical Medicine and Rehabilitation Reports, 11(3), 344–351. https://doi.org/10.1007/s40141-023-00407-5

Lee, C. (2021). Tendon physiology and repair. Orthopaedics and Trauma, 35(5), 274–281. https://doi.org/10.1016/j.mporth.2021.07.003

Li, Y., Sun, D., Fang, Y., Lu, Z., Shi, F., Liu, G., & Gu, Y. (2024). Mixed comparison of intervention with eccentric, isometric, and heavy slow resistance for Victorian Institute of Sport Assessment Patella Questionnaire in adults with patellar tendinopathy: A systematic review and network meta-analysis. Heliyon, 10(21), e39171-. https://doi.org/10.1016/j.heliyon.2024.e39171

Lim, H. Y., & Wong, S. H. (2018). Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiotherapy Research International : The Journal for Researchers and Clinicians in Physical Therapy, 23(4), e1721-n/a. https://doi.org/10.1002/pri.1721