Physiotherapy for Patellar Tendinopathy in Runners
Patellar tendinopathy, often known as “jumper’s knee,” is a common injury in runners. It causes pain at the front of the knee, just below the kneecap, and often affects runners who train frequently, increase their workload quickly, or return to running after a break.
The encouraging news is that this condition is treatable. With a structured approach focusing on gradual strengthening, load management, and the right running progression, most runners return to full training successfully. Physiotherapy provides a clear, evidence-informed pathway to rebuild tendon strength and confidence in the knee.
What Is Patellar Tendinopathy and Why Does It Occur?
The patellar tendon connects the kneecap to the shin bone. Its job is to transfer power from the quadriceps muscles during activities like running, jumping, squatting, and stepping up or down.
When this tendon experiences more load than it is prepared for, it can become irritated, painful, and sensitive. This doesn’t usually happen from a single event—it develops gradually over time and often appears after changes such as:
Increasing weekly running volume quickly
Adding speed sessions, track training, or intervals
Starting hill or stair sessions
Returning to running too fast after time off
Running more days per week without additional recovery
Weakness in the quadriceps, glutes, or calves
Reduced control or stability around the hip and knee
Rather than improving with total rest, patellar tendinopathy usually responds best to retraining the tendon with the correct type and amount of loading. That’s where physiotherapy becomes essential.
Common Signs and Symptoms for Runners
Runners with patellar tendinopathy often describe:
Pain at the front of the knee, just below the kneecap
Discomfort when running, particularly on hills or during high intensity sessions
Pain when squatting, lunging, or going downstairs
Stiffness first thing in the morning or after sitting for a long time
Pain that warms up with movement but returns afterward
Many runners find the knee feels OK at first but gets worse after a hard session. Others notice the pain slowly increasing over several weeks until it begins to interfere with routine training.
Is It Safe to Keep Running?
In many cases, yes. Many runners can continue training while rehabilitating their knee, provided the symptoms are monitored and load is adjusted.
Here are some general guidelines:
Pain during running should be mild and manageable
Pain should not spike sharply during activity
Knee soreness should settle within an hour
Symptoms should gradually improve over time
If pain becomes severe, lasts more than a day, or steadily worsens, the runner may need to reduce training temporarily. This doesn’t usually mean stopping completely—often just adjusting:
Training frequency
Distance
Intensity
Terrain (e.g., reducing hills)
Physiotherapists can help determine how much running is appropriate for each stage of rehab.
Why Physiotherapy Helps
Physiotherapy is one of the most effective approaches for managing patellar tendinopathy because it focuses on:
Strengthening the tendon
Improving the capacity of the surrounding muscles
Reducing pain
Correcting load errors such as too much too soon
Improving running technique when needed
Supporting a safe return to full performance
During assessment, a physiotherapist will look at:
Where the tendon is irritated
What movements cause pain
Running habits and weekly load
Muscle imbalances
Strength in the quads, calves, glutes, and hips
Running mechanics
From this, a personalised plan is created that targets the causes of the issue—not just the symptoms.
Managing Patellar Tendinopathy in Runners
Successful management usually includes four main components:
1. Modify Training (Not Stop It)
Total rest is often not needed and can sometimes make the tendon more sensitive.
Instead, the goal is to keep moving but stay within a manageable level of load. This may mean:
Reducing the number of weekly runs
Shortening sessions
Swapping some sessions for cross-training (e.g., cycling or deep-water running)
Removing speed or hill training temporarily
This gives the tendon space to recover while still staying active.
2. Strengthening the Tendon
Strength training is the foundation of rehabilitation. Tendons get stronger through gradually increasing load over time, and rehab progresses through stages.
Early Phase – Settle Symptoms and Start Rebuilding
Early exercises aim to reduce pain and begin stimulating the tendon safely. Examples include:
Wall sits
Spanish squats
Slow leg extensions
Isometric contractions (holding positions rather than moving)
These exercises help reduce pain and start the process of rebuilding strength.
Middle Phase – Controlled, Heavier Strength
Once the tendon can tolerate more load, exercises progress to include:
Squats
Leg press
Step-downs
Lunges
Slow knee-extension work
The focus is control, quality, and muscle endurance.
Later Phase – Power and Speed
Once strength improves and pain reduces, the program adds:
Hopping
Jumping
Bounding
Plyometric drills
Sport-specific progressions
This prepares the tendon for the demands of fast or explosive running.
3. Supporting Treatments
Some additional treatments can help in the early stages, especially when pain limits loading. These may include:
Soft tissue therapy
Joint mobilisation
Taping
Shockwave therapy
Dry needling
Blood flow restriction training (BFR)
These methods help control symptoms, but they are most effective when paired with a structured strengthening plan.
4. Review Running Technique
Sometimes small adjustments can make a big difference. Your physiotherapist may look at:
Cadence (steps per minute)
Stride length
Landing mechanics
Knee position during stance
Footwear suitability
For many runners, slightly increasing cadence (taking more steps per minute) reduces tendon load without changing running style dramatically.
How to Rehab Patellar Tendinopathy
A physiotherapist will tailor a structured program, but a typical rehab timeline might look like:
Phase 1: Pain Reduction and Activation
Goal: Reduce soreness and begin gently loading the tendon.
Focus areas:
Isometric exercises
Light, controlled knee strengthening
Maintaining some level of running or cross-training
Phase 2: Building Strength
Goal: Improve tendon and muscle capacity.
Exercises often include:
Leg press
Squats
Step-ups or step-downs
Slow, controlled knee-extension exercises
Glute and hip strengthening
This phase continues until the tendon becomes more tolerant of load.
Phase 3: Power and Running-Specific Work
Goal: Prepare for real-world running demands.
Exercises may involve:
Hopping drills
Small jumps and bounds
Plyometric training
Faster contraction movements
Training volume and speed return gradually once strength allows.
Phase 4: Return to Full Running
A typical return might involve:
Run–walk intervals
Short, easy runs
Gradual increase in volume
Reintroduction of hills
Later return to speed work
Some runners progress faster than others, but consistency matters more than speed.
How Long Does Recovery Take?
Recovery time varies depending on:
How long the tendon has been irritated
Running history
Strength levels
Training habits
Consistency with rehab
Some runners notice improvement within a few weeks. Others need several months to fully rebuild tendon strength and return to full performance.
The key is to stay consistent. Tendons respond best to steady, progressive loading—not rushed or sporadic efforts.
Can It Be Prevented?
While not every case can be avoided, runners can reduce their risk by:
Increasing running volume gradually
Keeping strength training in their routine
Including rest and recovery days
Not adding hills and speed simultaneously
Building strong quads, glutes, and calves
Maintaining regular mobility and movement habits
A strong, well-trained tendon is more resilient, adaptable, and better prepared to handle running load.
Final Thoughts
Patellar tendinopathy is common in runners, but it is highly treatable. With structured strengthening, sensible training adjustments, and guidance from a physiotherapist, most runners return to full training without lasting issues.
The most important points are:
Don’t rely on rest alone
Keep some level of running or activity when possible
Focus on controlled, progressive strengthening
Make changes gradually, not all at once
Stick with the plan long enough to make a difference
If knee pain is affecting your running, a physiotherapist can assess what’s contributing to the problem and guide a tailored program to get you running confidently again.
Disclaimer: Our articles are not designed to replace medical advice. If you have an injury or health concern, we recommend seeing a qualified health professional.
