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Pain just below the kneecap, where the patellar tendon joins it, that builds up with jumping and running. It is common enough in basketball and volleyball to be called jumper's knee. Despite the name, it is rarely true inflammation, and it responds to the right load rather than to rest.
Several problems cause pain at the front of the knee, and patellar tendonitis pain is only one of them. Where exactly it hurts, and who it happens to, usually separates them — and the last of these needs seeing promptly.
| Patellar tendon jumper's knee | Behind the kneecap kneecap pain | Bump below the knee Osgood–Schlatter | Torn tendon rupture | |
|---|---|---|---|---|
| Where it hurts | Just below the kneecap | Around or behind the kneecap | A tender bump on the top of the shin | Below the kneecap, suddenly |
| Who it happens to | Jumping and running sports | Runners, and people who sit a lot | Growing teenagers in sport | Usually a single heavy landing or stumble |
| How it came on | Gradually | Gradually | Gradually, during a growth spurt | Suddenly, with a pop |
| What makes it worse | Jumping, squatting, the start of activity | Stairs, squatting, sitting with bent knees | Kneeling on it, running and jumping | Cannot straighten the leg |
| How soon to be seen | Within a few weeks | Within a few weeks | Within a few weeks | Within a day or two |
A sudden pop, then a knee you cannot straighten, is not tendonitis. It may be a torn patellar tendon, and that is best repaired early, before the tendon end pulls back. Call the clinic and come in within a day or two. It is uncommon, but it is the one that should not wait.
The patellar tendon runs from the bottom of the kneecap to the top of the shin. It carries the pull of the thigh muscle, and every time you land from a jump it takes a load several times your body weight — most of all where it meets the kneecap.
What a picture cannot show is why it hurts. The old name, tendonitis, suggests inflammation, but a painful patellar tendon is mostly one that has been loaded faster than it could adapt. Its structure changes, and it becomes sore under load. That is why rest helps only while you are resting, and why the treatment that works is a gradual, deliberate increase in load.
It also explains why it so often starts during a busy season, after more training, harder floors or a sudden jump in matches. The tendon simply has not had time to catch up.
Treatment is built around loading the tendon properly rather than resting it. It takes weeks rather than days, and most people return to their sport.
Cut back the jumping and sprinting that provoke it, rather than stopping everything. Some discomfort during activity is acceptable as long as it has settled by the next morning; pain that is worse the day after is the signal to ease off further.
Holding the thigh muscle in a steady contraction often eases the pain in the short term. From there, slow, heavy strengthening builds the tendon up over about twelve weeks, before jumping is brought back gradually. This is the best-supported treatment, and it is kept up rather than stopped once the pain eases.
For a tendon that has not settled with a proper exercise programme, shockwave therapy has reasonable evidence behind it and is offered here. It works alongside the exercise, not instead of it.
Patellar tendonitis surgery is uncommon, and kept for the few tendons that stay painful after months of proper loading. A torn tendon is different: it is usually repaired surgically, and recovery then runs over several months.
Patellar tendonitis here is seen by Dr Kelvin Tan Guoping, an orthopaedic surgeon whose subspecialty is hip and knee, and whose practice includes trauma and sports surgery. He is a Fellow of the Royal College of Surgeons of Edinburgh, holds a Master of Medicine in orthopaedics, and is an Adjunct Assistant Professor at NUS. He consults in English, Mandarin, Teochew and Hokkien.
Yes. Jumper's knee is the everyday name, because it is so common in basketball, volleyball and other jumping sports. Doctors increasingly call it patellar tendinopathy, because the tendon is overloaded rather than inflamed.
Usually not completely. Cutting back the jumping and building the tendon up with the right exercises works better than stopping altogether. Pain that is worse the next morning is the sign to ease off more.
A strap worn just below the kneecap eases the pain for some people during sport. It can be useful while the tendon recovers, but it does not treat the cause; the loading programme does that.
Rarely. A complete tear usually happens with a single heavy landing or stumble, often in a tendon that was already weakened. That is one reason a sudden pop, or being unable to straighten the knee, should be seen promptly.
Usually months rather than weeks. A loading programme takes around twelve weeks to show its effect, and a return to full jumping can take longer. It improves most reliably when the exercise is kept up.
No. Bring any ultrasound or MRI reports, and be ready to say what changed in your training before it started.
Knee pain · Shockwave therapy · Knee bursitis · ACL injuries
Be ready to say what changed in your training before it started. That usually explains the injury, and points to the fix.
