Jumper's Knee (Patellar Tendinopathy).
What is patellar tendinopathy?
Jumper's knee, also known as patellar tendinopathy, is a common overuse injury affecting the patellar tendon — the structure connecting the kneecap (patella) to the shinbone (tibia). It is most commonly seen in athletes who engage in sports that involve repetitive jumping or explosive movements such as basketball, volleyball, high jump and netball.
Patellar tendinopathy is characterised by degeneration and disorganisation of the collagen fibres in the tendon, an increase in mucoid ground substance, and fibroblast proliferation — the same failed healing response seen in other tendinopathies including Achilles tendinopathy and gluteal tendinopathy. This histological picture — degeneration rather than active inflammation — is why purely anti-inflammatory treatments are largely ineffective for established patellar tendinopathy, and why progressive tendon loading is the cornerstone of management.
How common is it?
Patellar tendinopathy is an overuse injury that occurs in professional as well as recreational athletes, prevalent in participants of several sports but occurring mostly in jumping sports. Studies report prevalence rates of 45% in elite volleyball players and up to 32% in elite basketball players, making it one of the most common chronic conditions in jumping sport athletes. It also occurs in non-athletes from repetitive stair climbing, squatting and kneeling occupations.
Proximal pole versus mid-tendon
This distinction matters for management. The vast majority of patellar tendinopathy affects the proximal pole — the attachment of the tendon to the inferior pole of the patella — where the tendon experiences the highest compressive and tensile forces during knee flexion under load. A small proportion affects the mid-tendon substance or the distal insertion at the tibial tubercle.
Proximal pole tendinopathy is aggravated by positions of deep knee flexion — squatting, lunging, landing — that compress the tendon against the inferior pole of the patella. This compressive mechanism is an important therapeutic target: avoiding sustained deep knee flexion (particularly stretching in this position, which is counterproductive) and managing the compressive load during rehabilitation is central to recovery.
What are the symptoms?
Pain localised to the inferior pole of the patella — the bottom tip of the kneecap — is the hallmark. It is characteristically provoked by jumping, landing, squatting, stair climbing and prolonged sitting with the knee bent. The Victorian Institute of Sport Assessment — Patella (VISA-P) questionnaire is the validated outcome measure used to track symptom severity and functional capacity over the course of rehabilitation.
A characteristic feature of patellar tendinopathy is the warm-up phenomenon — the tendon pain is often worst with the first repetitions of an activity, improves as the tendon warms up, and may worsen again with prolonged loading or the following morning. This contrasts with patellofemoral pain syndrome — which typically worsens progressively with activity — and helps distinguish the two conditions clinically.
How is it diagnosed?
A physiotherapist will conduct a thorough examination, assessing range of motion in the knee and palpating the knee to check for tenderness and swelling. Imaging tests such as ultrasound or MRI may be ordered to confirm the diagnosis and assess the severity. The single-leg decline squat test — performing a squat on a 25-degree decline board on the affected leg — is the most sensitive clinical provocation test, loading the patellar tendon eccentrically in a controlled and reproducible way.
Ultrasound directly visualises tendon degeneration, hypoechoic areas, neovascularisation and tendon thickness. It is the preferred imaging modality for monitoring tendon structural response to rehabilitation over time.
How can physiotherapy help?
Progressive tendon loading is the most evidence-based treatment for patellar tendinopathy and the intervention with the largest effect sizes in clinical trials. The loading program follows the same principles as Achilles tendinopathy — isometric loading first, then isotonic, then heavy slow resistance, then sport-specific loading — but with specific attention to managing the compressive loads at the proximal patellar tendon.
Isometric knee extension — the quadriceps contracting without movement, maintaining a fixed knee angle — is the first loading stage and has the additional benefit of producing immediate and clinically meaningful pain reduction, which is valuable for athletes who need to continue training during rehabilitation. Holding isometric contractions at 45 to 60 degrees of knee flexion for 45 seconds, five repetitions, is the standard protocol.
Heavy slow resistance loading — slow, controlled leg press and squat movements with significant load — is introduced as the isometric phase is tolerated and progresses through increasing ranges of knee flexion as the tendon adapts. The patellar tendon's response to loading is highly dose-dependent: too much load too fast provokes a reactive flare; too little load produces no adaptation.
Hip and gluteal strengthening is equally important — deficiencies in proximal hip control increase the demands placed on the patellar tendon during jumping and landing, and are a consistent finding in athletes with patellar tendinopathy. Addressing these proximal deficits alongside the direct tendon loading program produces better outcomes than tendon loading alone.
Load management — temporarily reducing the volume of jumping, landing and squatting that is provoking reactive pain while the loading program builds tendon capacity — is the essential parallel intervention. For in-season athletes, this involves careful modification of training rather than complete cessation, as the tendon continues to need stimulus to adapt.
Real time ultrasound monitors tendon structural changes over rehabilitation and can guide loading progression decisions. Clinical Pilates provides a controlled environment for progressive lower limb loading during rehabilitation phases when full sport training is not yet appropriate.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in knee tendinopathy management and are members of the Australian Physiotherapy Association. Eliane's doctoral research in knee biomechanics is directly relevant to the load management and landing mechanics analysis central to patellar tendinopathy rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Jumper's knee, also known as patellar tendinopathy, is a common overuse injury affecting the patellar tendon — the structure connecting the kneecap (patella) to the shinbone (tibia). It is most commonly seen in athletes who engage in sports that involve repetitive jumping or explosive movements such as basketball, volleyball, high jump and netball.
Patellar tendinopathy is characterised by degeneration and disorganisation of the collagen fibres in the tendon, an increase in mucoid ground substance, and fibroblast proliferation — the same failed healing response seen in other tendinopathies including Achilles tendinopathy and gluteal tendinopathy. This histological picture — degeneration rather than active inflammation — is why purely anti-inflammatory treatments are largely ineffective for established patellar tendinopathy, and why progressive tendon loading is the cornerstone of management.
How common is it?
Patellar tendinopathy is an overuse injury that occurs in professional as well as recreational athletes, prevalent in participants of several sports but occurring mostly in jumping sports. Studies report prevalence rates of 45% in elite volleyball players and up to 32% in elite basketball players, making it one of the most common chronic conditions in jumping sport athletes. It also occurs in non-athletes from repetitive stair climbing, squatting and kneeling occupations.
Proximal pole versus mid-tendon
This distinction matters for management. The vast majority of patellar tendinopathy affects the proximal pole — the attachment of the tendon to the inferior pole of the patella — where the tendon experiences the highest compressive and tensile forces during knee flexion under load. A small proportion affects the mid-tendon substance or the distal insertion at the tibial tubercle.
Proximal pole tendinopathy is aggravated by positions of deep knee flexion — squatting, lunging, landing — that compress the tendon against the inferior pole of the patella. This compressive mechanism is an important therapeutic target: avoiding sustained deep knee flexion (particularly stretching in this position, which is counterproductive) and managing the compressive load during rehabilitation is central to recovery.
What are the symptoms?
Pain localised to the inferior pole of the patella — the bottom tip of the kneecap — is the hallmark. It is characteristically provoked by jumping, landing, squatting, stair climbing and prolonged sitting with the knee bent. The Victorian Institute of Sport Assessment — Patella (VISA-P) questionnaire is the validated outcome measure used to track symptom severity and functional capacity over the course of rehabilitation.
A characteristic feature of patellar tendinopathy is the warm-up phenomenon — the tendon pain is often worst with the first repetitions of an activity, improves as the tendon warms up, and may worsen again with prolonged loading or the following morning. This contrasts with patellofemoral pain syndrome — which typically worsens progressively with activity — and helps distinguish the two conditions clinically.
How is it diagnosed?
A physiotherapist will conduct a thorough examination, assessing range of motion in the knee and palpating the knee to check for tenderness and swelling. Imaging tests such as ultrasound or MRI may be ordered to confirm the diagnosis and assess the severity. The single-leg decline squat test — performing a squat on a 25-degree decline board on the affected leg — is the most sensitive clinical provocation test, loading the patellar tendon eccentrically in a controlled and reproducible way.
Ultrasound directly visualises tendon degeneration, hypoechoic areas, neovascularisation and tendon thickness. It is the preferred imaging modality for monitoring tendon structural response to rehabilitation over time.
How can physiotherapy help?
Progressive tendon loading is the most evidence-based treatment for patellar tendinopathy and the intervention with the largest effect sizes in clinical trials. The loading program follows the same principles as Achilles tendinopathy — isometric loading first, then isotonic, then heavy slow resistance, then sport-specific loading — but with specific attention to managing the compressive loads at the proximal patellar tendon.
Isometric knee extension — the quadriceps contracting without movement, maintaining a fixed knee angle — is the first loading stage and has the additional benefit of producing immediate and clinically meaningful pain reduction, which is valuable for athletes who need to continue training during rehabilitation. Holding isometric contractions at 45 to 60 degrees of knee flexion for 45 seconds, five repetitions, is the standard protocol.
Heavy slow resistance loading — slow, controlled leg press and squat movements with significant load — is introduced as the isometric phase is tolerated and progresses through increasing ranges of knee flexion as the tendon adapts. The patellar tendon's response to loading is highly dose-dependent: too much load too fast provokes a reactive flare; too little load produces no adaptation.
Hip and gluteal strengthening is equally important — deficiencies in proximal hip control increase the demands placed on the patellar tendon during jumping and landing, and are a consistent finding in athletes with patellar tendinopathy. Addressing these proximal deficits alongside the direct tendon loading program produces better outcomes than tendon loading alone.
Load management — temporarily reducing the volume of jumping, landing and squatting that is provoking reactive pain while the loading program builds tendon capacity — is the essential parallel intervention. For in-season athletes, this involves careful modification of training rather than complete cessation, as the tendon continues to need stimulus to adapt.
Real time ultrasound monitors tendon structural changes over rehabilitation and can guide loading progression decisions. Clinical Pilates provides a controlled environment for progressive lower limb loading during rehabilitation phases when full sport training is not yet appropriate.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in knee tendinopathy management and are members of the Australian Physiotherapy Association. Eliane's doctoral research in knee biomechanics is directly relevant to the load management and landing mechanics analysis central to patellar tendinopathy rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
