Patellar tendonitis (jumper's knee): symptoms, treatment and recovery time

Kingston and Richmond NHS Foundation Trust says the pain is caused by the tendon not coping with the weight or load being put on it, so strengthening exercises are recommended, along with simple steps to reduce strain on the knee: stopping or reducing higher impact activities such as running or jumping, and trying to lose weight if you are overweight.

NHS Lanarkshire says patellar tendon pain generally does not get better by itself if you continue to put the tendon under too much stress, and that physiotherapy exercises are recommended to strengthen the tendon and improve its stress tolerance. It advises staying active with low-impact activities such as cycling and swimming while you recover.

NHS Borders adds that you can ice the painful area for 10 to 15 minutes 2 to 3 times a day with a towel between the ice and the skin, ask a pharmacist about suitable pain relief, and consider a jumper's knee support to help offload the kneecap.

Leaflets differ in detail, so follow the programme from your own physiotherapist. Kingston and Richmond describes five phases: straightening the knee against a resistance band, double leg wall sit, single leg wall sit, squatting, and single leg squatting. The early holds are 15 to 45 seconds repeated 3 to 5 times, three times a day, and you can move to the next phase when pain or discomfort settles within 24 hours. Stop if they significantly increase pain.

NHS Borders says to work at a pain level no higher than 2 on its scale, and that load is needed to aid recovery but overload may worsen pain. NHS Lanarkshire says that during activity pain should be less than 3 out of 10 and settle within a 24-hour period.

Swansea Bay says isometric exercises have been found to give up to 45 minutes of pain relief, and that slow, heavy resistance exercises are best at improving function and pain.

NHS Lanarkshire says symptoms normally appear gradually but can also develop after a bump to the knee. Swansea Bay says pain is usually the first symptom, initially only as you begin activity or just after, but that over time, if not managed, it may interfere with daily movements such as walking, stairs or getting up from a chair.

• Pain over the patellar tendon below the kneecap (Kingston and Richmond, NHS Borders).

• Pain that increases on squatting, and going down hills and stairs (NHS Borders).

• A gradual increase in pain, and pain or stiffness after rest or after strenuous activity (Kingston and Richmond).

• Tenderness on the front of the knee, and the tendon may feel thickened (NHS Lanarkshire).

• Swelling beneath or on top of the kneecap (NHS Borders), and sometimes morning stiffness (NHS Lanarkshire).

The patellar tendon is a continuation of the thigh muscles (quadriceps) that attaches the muscles and kneecap to the top of the shin bone, according to Kingston and Richmond. NHS Lanarkshire says that in patellar tendinopathy the tendon struggles to cope with the pressure put upon it, resulting in micro injuries and changes to its structure, which causes pain.

Swansea Bay notes the condition is sometimes known as tendonitis or tendinitis, but the leaflets mostly use the term tendinopathy, which describes a tendon that is struggling rather than only inflamed.

Kingston and Richmond says the tendon is injured when it cannot cope with the strain on it. NHS Lanarkshire says it is not fully clear why some people develop it, but it is normally due to several reasons.

• High volumes of weight-bearing exercise, such as running or jumping, and repetitive squatting or jumping (Kingston and Richmond, NHS Borders).

• A sudden increase in activity or training volume, or progressing too quickly (Kingston and Richmond, NHS Lanarkshire).

• Being overweight or unfit, or a sudden increase in body weight (Kingston and Richmond, NHS Lanarkshire).

• Weak quadriceps or buttock muscles, and tight leg muscles (NHS Borders, NHS Lanarkshire).

• Reduced ankle movement (Kingston and Richmond), inappropriate footwear and exercising on hard surfaces (NHS Lanarkshire).

NHS Lanarkshire says patellar tendinopathy can resolve, but this can take time. It says it can take 6 to 12 weeks of doing specific exercises to notice a difference, that a pain flare-up will in most cases settle within 6 weeks, and that an appropriate exercise programme can take more than 3 months to complete.

Swansea Bay says it can be very debilitating and cause long absences from sport if not managed appropriately, and that management is complex and individual.

NHS Lanarkshire suggests that if your symptoms have not improved within 6 to 12 weeks of following the advice, a referral to a physiotherapist may be beneficial. Several leaflets say to stop an exercise and seek advice if it worsens your symptoms. NHS Borders says you do not normally need a scan to diagnose it.

On the NHS, musculoskeletal physiotherapy is often available through self-referral or GP referral, and local services publish leaflets and exercise videos. Private physiotherapy is also widely available. Swansea Bay notes imaging has often proved unreliable, so diagnosis is usually by expert assessment in either setting.