What is Patella Tendinopathy?

● Pain is usually located at the lower part of the patella.

● Pain is load-related: it appears or worsens when jumping, landing, running, or repeatedly squatting.

● It is not just inflammation; it involves changes in the structure and load-bearing capacity of the tendon.

● Common in jumping sports, but can also occur in people who suddenly increase the load on their knees. In short: the tendon is being asked to do more than it can tolerate or recover from.

What does “tendinopathy” mean?

Are there stages?

● Tendinopathy = a pathological condition of the tendon (it does not just mean inflammation).

● Common stages: 1. Early stage – pain only after activity, little interference with function. 2. Progressive stage – pain during and after activity, affecting performance. 3. Chronic / high-load stage – persistent pain, tendon less tolerant to load.

Key concept: the tendon’s load tolerance is reduced.

Is there Inflammation in the tendon?

● Usually, there is no classic inflammation.

● Degenerative changes dominate (disorganised collagen, increased ground substance).

● Modern rehabilitation focuses on progressive tendon loading, rather than just using anti-inflammatory treatments.

Why is the tendon swollen?

● Swelling or thickening is a response to repeated overload.

● The tendon produces more collagen and fluid to try to adapt to the load.

● Swelling indicates mechanical stress, not necessarily acute inflammation. 

Why does tendinopathy occur?

● Overload: sudden increases in training or jumping.

● High rate of loading: fast, high-energy movements.

● Inadequate training: insufficient progression or rest.

● Biomechanical factors: weak muscles, incorrect technique, limited mobility.

● Reduced tendon capacity: age, previous injuries, weak muscles.

● Cumulative micro-damage: repeated small deformations of the tendon.

In summary: load > tendon capacity.

Rest or exercise?

● Complete rest: generally less effective.

● Unmodified exercise: can worsen the condition.

● Ideal approach: manage the load, reduce activities that cause intense pain, and start a progressive rehabilitation programme.

● Use a pain-monitoring approach: mild to moderate pain is acceptable, but it should not worsen day by day or impair function.

How can physiotherapy help?

● Assessment and education on load, movement, and individual factors.

● Safe adjustment and progression of exercises.

● Prescription of specific exercises: isometric, concentric, eccentric, heavy slow resistance.

● Correction of movement technique (jumping, landing, squatting).

● Gradual return to sport or specific activities.

● Monitoring pain and tendon adaptation.

Exercises and load progression: Tier model for patellar tendinopathy

Central idea: the tendon needs to be loaded gradually, from safer exercises to high-load, high-velocity activities.

Example Goal Tier 1 –

Low load Isometric or light movements Partial squats, step-ups, quadriceps holds Relieve pain, initiate tendon adaptation

Tier 2 – Moderate load Concentric/Eccentric or moderate resistance Decline eccentric squats, controlled lunges Improve tendon strength, endurance, and control

Tier 3 – High load / High velocity Explosive, high-load exercises Single-leg jumps, plyometrics, fast deep squats.

Restore full tendon tolerance for sport and high-impact movements

Principles of the model:

● Start at the level the tendon can tolerate without excessive pain.

● Progress gradually as the tendon adapts.

● Consider load magnitude, speed, and time under tension. ● Always under the supervision of a physiotherapist.