Patella Tendinopathy (Jumper’s Knee)

As stubborn overuse injuries go, patella tendinopathy or jumper’s knee is one of the most frustrating, often with explosive sports like basketball, volleyball, and tennis, overloading the patellar tendon.

The patellar tendon connects your kneecap to your shinbone and transmits the power of your quads to let you accelerate into that final sprint or launch off the ground for a jump shot. 

Patella tendinopathy usually starts as a dull ache below the kneecap and can rapidly escalate into a stubborn case that interferes with your training. 

Proper physiotherapy and rest will get you on the road to overcoming this tendon pain once and for all.

Symptoms of Patella Tendinopathy

• Nagging pain localised to the patellar tendon just below the kneecap.
• Morning stiffness and decreased knee mobility, especially with stairs.
• Visible thickening or swelling over the inflamed tendon area.
• Tenderness to the touch along the tendon’s course.
• Weakness or inability to straighten the knee against resistance.
• Pain increases during activities and decreases with rest (aggravating injury). 

Causes of Jumper’s Knee

Overtraining

Inadequate rest between hard training loads promotes repetitive microtears in the tendon that can affect the body’s healing capacities. A steady recovery timeline is the key to keeping jumper’s knee and other injuries under control. 

Increased training volumes

Rapidly escalating training frequency, duration or intensity, before the tendons can adapt leaves you prone to overload. A gradual, systematic training progression is critical for conditioning tendon resilience.

Muscle imbalances

Overly tight quads combined with inhibited hamstring and calf flexibility overwork the patellar tendon through unbalanced forces. Correcting muscular imbalances relieves excessive tendon loading.

Poor movement patterns

Excessive knee rotation, improper landing biomechanics and general muscular control deficits reinforce potentially detrimental movement habits that increase unnatural tendon stresses. Retraining optimal technique is crucial.

Training oversights

Factors like inappropriate footwear, high-impact surfaces and skipping warm-ups amplify mechanical stresses through the knees and tendons – perpetuating the overuse injury cycle.

Biomechanical faults

Anatomical variations like increased Q-angles, overpronation or leg length discrepancies can cause abnormal knee mechanics that can cause pathology to the patellar tendon over time.

Diagnosis

Restricted movement

Patella tendinopathy is apparent when you can’t jump or lunge without pain directly below the kneecap. Pain can also occur when bending or straightening out your leg. It is often a sharp pain with a dull ache afterwards. 

Passive-extension test

Your physiotherapist or doctor will start by feeling along the front of your fully straightened knee to find the area of maximum tenderness, usually right at the bottom of the kneecap where the patellar tendon attaches.

They then may bend your knee to a 90-degree flexed position and repeat the palpating along that same tendon area – the “passive extension-flexion sign” is considered positive if there is a notable decrease in tenderness when your knee is bent at 90 degrees.

Ultrasound

An ultrasound examination is non-invasive and offers visualisation of structural tendon changes over time:

• Early stage: Swelling and thickening of the damaged tendon fibres.
• Intermediate stage: Non-uniform/mixed appearance with areas of different echogenicity (brighter and darker areas), without swelling (granuloma formation).
• Late stage: Irregular tendon sheath thickening with a non-homogeneous, disorganised fibre pattern.

Physiotherapy Treatment

Initial management

Early treatment centres on:

• Load management – Education on temporarily modifying or avoiding activities stressing the patellar tendon is crucial. Continuing to push through tendon pain only compounds the injury cycle. Relative rest from provocative movements reduces irritation.
• Pain relief—Ice packs help numb pain signals and reduce inflammatory swelling around the tendon. NSAIDs like ibuprofen can also assist by lowering inflammation during acute flare-ups. However, these are short-term solutions, not replacements for addressing root causes.

Hands-on techniques

Targeted massage over and around the patellar tendon relaxes tense muscle fibres, releases myofascial restrictions, and helps prepare the tendon and surrounding tissue for movement.

Gentle oscillatory movements applied to the knee and patellofemoral joints improve mobility and reduce compressive tendon loading. Restoring natural joint mobility prepares the tendon to handle heavier rehab.

Eccentric strengthening

Performing eccentric (controlled lengthening) knee extensions through a full range of motion activates the tendon’s remodelling capacity. 

The high tensile load stimulates the proliferation of tendon cells, aligning collagen fibres along the lines of muscular force transmission.

Starting with lower loads and higher reps, your physiotherapist incrementally increases the resistance, slowing the eccentric phase and encouraging maximal tendon overload, a systematic approach that builds resilience to handle heavier eccentric stresses over time.

Addressing impairments

After identifying contributing factors like muscle tightness, strength deficits or faulty mechanics, your physiotherapist prescribes a personalised plan to correct mobility restrictions, muscular imbalances, and movement control deficits.

Limited flexibility in the quadriceps, hamstrings, or calf muscles disrupts force distribution and increases compressive patellar tendon loading, while imbalances or weakness in muscle groups like the hip abductors, external rotators, and core alter lower body mechanics – shifting excessive load onto the patellar tendon.

Return to sport

Finally, a specialised personal training program will replicate the demands of your sport through graded plyometric, power and agility drills. 

Jumping drills like box jumps, bound sequences, and depth jumps expose the patellar tendon to the ballistic forces required for rebounding and explosive power activities. Multidirectional cone drills and ladder work recreate the decelerating, cutting, and pivoting actions that strain the tendon on the field.

When to Seek Physiotherapy

Get assessed if:

• Pain persists beyond 2 weeks despite RICE (rest, ice, compression, elevation).
• Pain increases despite deloading training volume.
• Pain reduces your ability to complete normal daily activities.
• Mechanical symptoms like locking, catching or instability arise.

Early treatment accelerates recovery versus prolonged self-management attempts. Prompt intervention halts abnormal tendon loading before it progresses.

For elite/professional athletes, seek physio at the first twinge – expedited care minimises disruption to performance and training for a quick return to play.

Patella Tendinopathy Recovery Timeframes

Mild cases resolve within 6-12 weeks, while severe or chronic tendinopathies may require 4-6+ months of dedicated rehab and load management. 

Several factors influence recovery length:

• Age.
• Weight.
• Activity levels. 
• The level of tendon degeneration.
• Consistency in adhering to the prescribed rehab.
• Capacity to regulate load through activity modification.
• Biomechanical deficits from previous or coinciding injuries. 
• Sticking to the recovery plan – deviation can aggravate injuries. 

Summing Up 

Patella tendinopathy is one of those frustrating injuries that stops specific movements like jumping and lunging or causes difficulties with everyday activities like stairs or walking.

Your pain might start out manageable, but continuing to load the tendon can lead to more severe inflammation that puts you out of action for months. 

Adequate rest, physiotherapy, tendon-strengthening exercises, and activity modifications are the keys to overcoming this injury. 

Contact us to discuss physiotherapy for jumper’s knee and injury prevention strategies that’ll help you stay active in the future.