Massage therapy · Kitchener–WaterlooPatellar Tendinopathy

Patellar Tendinopathy Anatomy

The quadriceps are the main bulky muscle group at the front of the thigh. They come down the leg from the hip and attach into the patella. Below the patella, the attachment continues as the patellar tendon (in some texts known as the ligamentum patellae). It is a very thick, strong and fibrous band of tissue. However, if it is placed under repeated strain that it cannot adapt to (very often from sport), the tendon undergoes changes in its structure. Research shows these are mainly degenerative (wear-type) changes with very little inflammation (Breda et al., 2021).

How to Treat Patellar Tendinopathy

Tips

• Cut down on the sports and activities that place repeated heavy load on the tendon while it settles, but keep active in other ways.
• Slowly increase the intensity and frequency of your exercise programme when you are starting out, so the tendon can get used to the load. Increasing training too quickly is a common cause (Royal United Hospitals Bath NHS Foundation Trust, 2021).
• Sitting for a long time with your knee bent can make the tendon stiff (Royal United Hospitals Bath NHS Foundation Trust, 2021). In tight seats, such as theatre or airline seats, try to get an aisle seat so you can stretch your leg out.
• Perform strengthening exercises and quadriceps muscle stretching on a regular basis.
• Vary your training, as a lack of variation in training is a common training error (Oxford University Hospitals NHS Foundation Trust, 2019).

Patellar tendon pain responds best to the right amount of load: not complete rest, and not pushing through pain. My aim is to settle the tendon down, then build its capacity back up step by step so it copes with squatting, running and jumping again.

I start by assessing how your knee, hip and ankle move, testing your leg strength, and watching how you squat, step down and land. I'll also ask about your training, because a recent jump in load is often the trigger.

Load Management

• Cutting back jumping, sprinting and deep or heavy squatting for a while, and keeping fit with swimming or cycling
• Using the next day as our guide: if your knee is more painful the day after exercise, we make things easier; if it's stable or improving, we build on it
• If you lift, adjusting squat depth, load and volume rather than stopping altogether

Strength and Loading

• We start with pain-free holds, such as a wall sit or a held leg extension
• Then slow, controlled squats, split squats and leg presses, adding load gradually
• Strength work for the hips, hamstrings and calves so the whole leg shares the load
• A home programme between visits, then gym-based progressions, hopping and landing drills, and a graded return to your sport

Hands-On Treatment

1. Oxford University Hospitals NHS Foundation Trust (2019) Patellar tendinopathy: advice and management. Patient information leaflet. Available at: https://www.ouh.nhs.uk/media/bhwhrkds/49019ptendinopathy.pdf (Accessed: 7 October 2026).
2. Royal United Hospitals Bath NHS Foundation Trust (2021) Patellar tendinopathy advice leaflet (jumper's knee). Patient information leaflet. Available at: https://www.ruh.nhs.uk/patients/services/physiotherapy/documents/Patellar_Tendinopathy.pdf (Accessed: 7 October 2026).
3. Schwartz, A., Watson, J.N. and Hutchinson, M.R. (2015) 'Patellar tendinopathy', Sports Health, 7(5), pp. 415–420. doi: 10.1177/1941738114568775. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4547110/ (Accessed: 7 October 2026).
4. Breda, S.J. et al. (2021) 'Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial', British Journal of Sports Medicine, 55(9), pp. 501–509. doi: 10.1136/bjsports-2020-103403. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8070614/ (Accessed: 7 October 2026).