How is jumper's knee treated, and when can you return to sport?

What is jumper's knee?

The patellar tendon connects the kneecap to the shin bone and transfers force from the thigh muscles during jumping, landing and changing direction. Patellar tendinopathy causes pain just below the kneecap, usually brought on by loading activities such as jumping, landing, squatting and climbing stairs.

It is common in basketball, volleyball, football and athletics, particularly during periods of increased training or competition. Pain often warms up during activity and is worse afterwards or the next day.

How is it diagnosed?

Diagnosis is mainly based on the location of pain, tenderness at the lower edge of the kneecap and pain that increases with load, such as a single-leg decline squat. A clinical commentary on patellar tendinopathy describes how pain that increases with the amount of tendon load helps distinguish it from other causes of front-of-knee pain 1.

Ultrasound or MRI can show tendon changes, but such changes are also seen in athletes without pain, so imaging is interpreted together with symptoms.

What is load management?

Load management means reducing the activities that provoke tendon pain, particularly jumping and landing volume, to a level the tendon can tolerate, rather than stopping all activity. Pain during and in the 24 hours after activity is used as a guide 1.

Athletes may continue with modified training while completing a rehabilitation programme. Complete rest is not recommended because it reduces tendon capacity.

Which exercises help patellar tendinopathy?

Rehabilitation usually progresses through stages: isometric exercises such as holding a wall sit or leg extension to reduce pain, heavy slow strengthening exercises, then energy-storage exercises such as jumping and landing, and finally sport-specific training 1.

In a randomised trial of 39 men with patellar tendinopathy, 12 weeks of heavy slow resistance training, eccentric decline squats or corticosteroid injections all improved symptoms initially 2. At the half-year follow-up, improvements were maintained with both exercise programmes but deteriorated in the injection group, and satisfaction was highest with heavy slow resistance training 2.

When can I return to sport?

Return to sport is gradual and based on criteria rather than a fixed timeline. These include tolerating heavy strengthening and progressive jumping, landing and cutting drills without increasing pain the following day, and strength comparable to the other leg.

Many athletes need several months of rehabilitation, and longer-standing symptoms can take more time. Continuing strength work during the season helps reduce recurrence.

What other treatments are used?

Patellar straps may reduce pain during activity for some athletes. Shockwave therapy and other injection treatments have been used for persistent cases, with variable results. Surgery is rarely needed and is reserved for persistent symptoms after a long, well-conducted rehabilitation programme.

Addressing training load, landing technique and overall strength of the hips and legs is important alongside any treatment.

How can training load be managed during the season?

Athletes with patellar tendinopathy often cannot stop playing during the season. Reducing the total volume of jumping in training, spreading high-load sessions across the week, and replacing some jumping drills with lower-load conditioning can keep symptoms manageable.

Monitoring pain during a simple loading test, such as a single-leg decline squat, the morning after training helps show how the tendon is responding. If pain rises from one day to the next, the following session is adjusted. Maintaining strength exercises throughout the season reduces flare-ups.

When should knee pain be checked?

Seek assessment for knee pain after a fall or direct blow, sudden inability to straighten the knee, significant swelling, locking or giving way, or a hot swollen knee with fever.

In children and adolescents, pain below the kneecap may come from growth plate irritation, such as Osgood-Schlatter or Sinding-Larsen-Johansson conditions, which are managed differently.

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