Patellar tendinopathy

The patellar tendon is the tendon that joins your kneecap (patella) to your shin bone (tibia).

The exact mechanisms of how patellar tendinopathy develops in response to excessive loads (overuse) is not fully understood. The current theory is that the tendon becomes oversensitive due to bio-chemical changes. Sometimes we can find some structural changes in the tendon, however the connection between structure changes in the tendon and pain is not completely understood as structural changes are often find in people who are pain free and will never develop pain. The amount of structural changes does not link up with the amount of pain.

Download leaflet (PDF)

Causes and symptoms

What causes patellar tendinopathy?

Being overweight
Raised cholesterol
Smoking
Sports that involve jumping and landing (e.g. volleyball, basketball and triple jump) or sudden changes of direction (e.g. football and tennis)
Sudden changes to your training program or activities; such as frequency, duration or training surface without a sufficient adaptation period
Poor technique and overtraining

What are the symptoms of patellar tendinopathy?

Patellar tendinopathy classically presents as pain just below your kneecap.
Tendon pain occurs instantly with loading and usually stops almost immediately when the load is removed – like walking down stairs.
Pain is rarely experienced in a resting state.
Other signs and symptoms, such as pain with prolonged sitting or during crouching may be present.
When touching the tendon you may feel pain and swelling.

Diagnosis of patellar tendinopathy

A diagnosis of patellar tendinopathy can be made on history and examination. Imaging is rarely needed, unless there is uncertainty over the diagnosis.

Self management of patellar tendinopathy

Weight loss

If you are overweight you are putting extra load through your knee. This will be contributing to your condition, therefore losing weight will improve your symptoms.

There are useful tools to find out if your weight is contributing to your arthritis and advice on losing weight on the NHS website:

BMI calculator Weight loss plan Exercise advice

Stopping smoking

Smoking is a well-recognised risk factor in the development of tendinopathy, it is therefore important to try and stop. The NHS website has some useful resources:

Stop smoking

Activity management

Reduce your levels of activity to a point where you feel no pain. Maintain this level of activity and the tendon may settle in as little as 5–10 days. However, it may take several weeks to fully settle. For mild cases you may be able to continue some normal activities as long as you’re able to keep it relatively pain free. Once symptoms have settled ensure your return to activities is gradual

Diabetes/raised cholesterol

If you suffer with these conditions it is important to ensure they are well controlled. Speak to your healthcare professional for advice on improving your control.

Exercises

When starting an exercise for the first time it is important to ‘start low and go slow’. This means start with gentle exercises concentrating on the movement and slowly progress through weight bearing to resistance exercises.

It is important to note that exercise with arthritis/degenerative meniscus is completely safe and will not make your condition worse.

Pain killers can be used to help you do the exercises. Talk to your doctor for more specific advice regarding pain killers.

There are many other options which can improve your pain including appropriate footwear and weight loss (if you are overweight).

Exercise 1: clam (lateral hip rotation in side lying)

Lying on your left side with your hips and knees bent
Lift your right knee up and rotate your hip
Forming a gap between your knees
Repeat

Exercise 2: deep squat

Start in a standing position, with your feet shoulder width apart
Raise your arms up as you bend your knees into a squat position
Return to the standing position

Exercise 3: single leg mini squat

Stand on one leg with the other leg stretched out in front of you
Your heel should be slightly off the ground
Slowly bend the knee going into a single leg squat position
ALL of your weight should be on this leg
Return to the starting position

Exercise 4: bridge

Lie face up on the floor, with your knees bent and feet flat on the ground
Keep your arms at your side with your palms down
Lift your hips off the ground until your knees, hips and shoulders form a straight line
Squeeze your buttocks
Hold your bridged position for a couple of seconds before easing back down

Exercise 5: hip abduction in standing

Stand sideways
Make sure you are supported
Keep your knee straight
Take your leg out to the side
Repeat

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

More exercises