The Coach's Guide to Managing Patellar Tendinopathy

Patellar tendinopathy, commonly known as Jumper’s Knee, is one of the most stubborn injuries in sport.

It affects athletes in sports with repeated jumping and deceleration, like basketball, volleyball, and track.

Unlike acute or traumatic injuries, patellar tendinopathy creeps in over time.

The pain can fluctuate, but the underlying issue is progressive tendon overload, not inflammation.

In this post, we’ll break down what’s happening inside the tendon, what makes this injury so persistent, and how to approach training and rehab.

What Is Jumper’s Knee?

Jumper’s knee is a chronic degenerative condition that affects the proximal patellar tendon, typically near its origin at the inferior pole of the patella.

This is a tendinopathy, not tendonitis, which means it’s not driven by inflammation but by microdamage, collagen disorganization, and failed healing.

According to research (1), the key pathological features include:

• Collagen fiber disorganization
• Hypercellularity (increased tenocyte activity, often abnormal)
• Increased vascularity (neovascularization, not necessarily helpful)
• Disruption of the extracellular matrix

All of these changes weaken the tendon’s ability to handle load, especially during high-tension activities like jumping and landing.

What Causes It?

Jumper’s knee is primarily an overuse injury, caused by repetitive and excessive loading without sufficient recovery.

Contributing factors include:

• High volumes of jumping and sprinting
• Rapid increases in training intensity or frequency
• Poor eccentric strength or load absorption capacity
• Biomechanical inefficiencies (e.g., valgus collapse, limited ankle dorsiflexion)

As load exceeds the tendon’s capacity to adapt, small failures occur at the microscopic level.

Instead of healing, the tendon undergoes maladaptive remodeling, which makes it structurally weaker, even if pain isn’t always present.

Symptoms and Diagnosis

Athletes typically report:

• Localized pain at the inferior pole of the patella
• Pain that worsens with jumping, deceleration, or stairs
• Symptoms that may “warm up” with activity but worsen afterward

Imaging (e.g., ultrasound or MRI) may show thickening, hypoechoic areas, or neovascularization, but clinical diagnosis is still most important.

Why Is It Hard to Treat?

The reason jumper’s knee is so persistent is that it's not just a painful tendon; it's a biologically and structurally disorganized one.

Key challenges include:

• The patellar tendon experiences very high loads (often 6–8x bodyweight when landing)
• Symptom relief doesn’t mean healing—pain may reduce, but the tissue may remain weak
• Athletes often return too early or fail to progress loading properly

Additionally, the region most commonly affected, the proximal third, has relatively poor healing capacity due to limited blood flow.

Treatment and Rehab Overview

Research (1) highlights eccentric training as a proven intervention, but notes that some athletes don’t respond and require additional strategies.

Here's a summary approach:

1. Load Management

• Initially, reduce or modify activities that aggravate pain (deep squats, high jumps, repeated landings)
• Keep training where possible, using pain-monitoring models to guide progress

2. Isometric and Isotonic Loading

• Begin with isometric exercises (e.g., Spanish squat holds) to reduce pain and initiate tendon loading
• Progress to heavy, slow resistance exercises (e.g., slow squats, leg press, split squats)

3. Eccentric Emphasis

• Include eccentric leg extensions or decline squats to load the patellar tendon directly
• Progressively increase intensity and range over time

4. Return to Plyometrics and Sport

• Reintroduce jumping, landing, sprinting, and cutting tasks in a graded fashion
• Prioritize tendon capacity over time, not just symptom relief

Additional Supporting Therapies

Research (1) also highlights emerging interventions, such as:

• Platelet-Rich Plasma (PRP) may reduce pain and support healing in stubborn cases
• Stem Cell Therapy is experimental, but promising in degenerative tendinopathies
• Shockwave Therapy can offer pain relief and stimulate tissue regeneration

These are typically reserved for chronic or recalcitrant cases and should be used alongside, not in place of, a solid loading program.

Coaches Takeaways

Whether you're managing an athlete in-season or rebuilding capacity in the off-season, the following takeaways can guide your decision-making and help reduce the risk of recurrence.

1. Jumper’s knee is a degenerative overload injury, not just “inflammation.”
2. Treat the tendon with progressive loading, not rest alone.
3. Eccentric and heavy slow resistance loading remain the gold standard.
4. Load monitoring, consistent progression, and patience are key.
5. Symptom relief does not mean structural recovery; return to sport too early and the cycle continues.

Reference

Morya, V. K., Shin, H., Lee, J., Kim, H., Kim, S. H., & Lee, B. (2024). Pathogenesis and Therapeutic Advances in Degenerative Tendinopathy: Insights into Molecular and Regenerative Perspectives. International Journal of Molecular Sciences