As a sports physical therapist, I frequently see patellar tendinopathy in my clinic, especially among basketball and volleyball players. This overuse injury, also known as jumper's knee, is caused by repetitive loading of the patellar tendon through jumping and landing. If you're a jumping athlete, here's what you need to know about patellar tendinopathy.

What is jumper’s knee?

Patellar tendinopathy refers to pain and dysfunction of the patellar tendon, that is independent of actual pathology within the tendon structure. That means the tendon can be painful with touching the tendon or using it (i.e jumping, hopping, sprinting) but it may or may not actually show changes in the tendon on imaging (ultrasounds, MRI doppler). So some people have patellar tendinopathy and have changes in the tendon on imaging, but others have perfectly healthy tendons on imaging, yet have pain.

Patellar tendonitis is characterized by pain at the bottom of the knee cap or on the top of the shin bone. More jumping or loading with running, stairs, and squatting tend to make the pain worse. Other signs and symptoms, such as pain with prolonged sitting may be present as well. These symptoms overlap with other common causes of knee pain (like patellofemoral pain {PFP]), so a thorough examination by a physical therapist is needed.

What causes jumper’s knee?

Patellar tendonitis is causes by frequent jumping and explosive movements. In fact, the athletes who jump the most and are the best at jumping have the greatest risk of developing “jumpers knee”. Sports like basketball, volleyball, and track & field that involve a lot of jumping, place high loads on the patellar tendon and do so at very high speeds. These tissues have to recover from the loading placed on them and when the load is too much or too frequent, the tendon can become reactive and painful. Most times, this is a workload issue that creates too much load on the tendon.

Other risk factors are:

• High body weight

• Poor thigh muscle strength (quadriceps and hamstrings)

• Stiff ankles or limited foot and ankle mobility

• Higher training intensities (training load and days without rest)

• Greater training volumes (training longer and more often)

• More match exposures

Can physical therapy help jumper’s knee?

Absolutely. With a customized course of physical therapy, you are likely to make a full recovery.

When beginning the rehab process, an in-depth evaluation by a physical therapist is critical. There are many structures in the knee that contribute to pain, but the source of the problem extends beyond the knee. A skilled physical therapist experience in sports medicine (and jumping sports in particular) will know to evaluate your ankle and hip mobility, core strength, and more. Misdiagnosis can happen without proper evaluation, and patellar tendonitis is often missed or classified as anterior knee pain/patellar femoral pain, despite warranting vastly different treatments.

If you are suffering from knee pain, rehabilitations should focus on active movement with progressive loading of the tendon. Pain-free exercise is key, but can be combined with manual therapy, dry needling, and mobility exercises as well. Passive treatments like massage, ultrasound, injections, and rest are not recommended!

When can I return to sport after jumper’s knee?

To prepare for sport, progression from rehabilitation to heavy resistance strength training are the first steps, but we can’t stop there. Jumping sports, like basketball, happen at a fast pace and jumping is a fast moment. At the end of rehab, there needs to be a graded exposure of intensity and volume of jumping so the tendon can become tolerant. I find this to be the missing link for many people and something that contributes to the pain coming back.

Working on different landing mechanics can also be beneficial, as stiffer landing with less knee bend tends to place more stress on the patellar tendon compared to bending the hips and knees more. Patience is required, as full rehab can take 4 months or more! The goal is to rebuild tendon capacity to withstand high loads from jumping and what better way to do that than to actually jump, just in a smart way.

Can I prevent jumper’s knee?

There are some main things you can focus on to reduce your risk of getting patellar tendinopathy.

• Maintain proper lower body flexibility through regular stretching of the calves, hamstrings, and quadriceps: Tight muscles increase strain on the tendon.

• Strengthen the quadriceps and calves with both heavy strength training and higher rep endurance work: These muscles absorb forces from jumping to protect the tendon.

• Have a proper graded exposure into a basketball or volleyball season so your tendons are prepared for that workload.

• Use proper landing mechanics - land softly on the balls of your feet with ankles, knees, and hips bending to dissipate force: Avoid stiff, "locked" landings.

• Allow adequate rest between high jump sessions to enable tissue remodeling and prevent overload.

• Wear proper footwear with adequate cushioning and forefoot flexibility.

The takeaway

Patellar tendinopathy is common in jumping athletes but can be prevented and effectively treated. Maintain strength, flexibility, and proper mechanics. If you develop symptoms, the physical therapists at Live4 will develop an individualized rehab program to correct impairments and gradually increase tendon loading capacity. With the right plan, you can get back to jumping pain-free!

1. Breda SJ, et al. Br J Sports Med. 2021.

2. Docking SI, Ooi CC, and Connell D. J Orthop Sports Phys Ther. 2015.

3. Malliaras P, et al. J Orthop Sports Phys Ther. 2015.