Jumper's Knee: Why That Pain Below Your Kneecap Won't Settle
- Javier Diaz
- Jun 16
- 6 min read
What Is Patellar Tendinopathy (Jumper's Knee)?
You go up for a rebound, land, and feel a sharp pinch right below your kneecap. Or you push off hard on the pickleball court and there it is again, a focused ache at the front of the knee that lingers after you stop. If that sounds familiar, you are likely dealing with patellar tendinopathy, better known as jumper's knee, and it is one of the more stubborn knee problems we treat at Pursuit Physiotherapy in Burlington.
Patellar tendinopathy is an overload injury of the patellar tendon, the thick band that connects the bottom of your kneecap to your shin bone. Every time your quadriceps contract to straighten the knee, that tendon takes the load. When the demand from jumping, sprinting, or rapid changes of direction outpaces what the tendon can handle, it gets irritated and sensitized, usually right at the lower tip of the kneecap.
One quick but important distinction: jumper's knee is not the same as runner's knee. Runner's knee, or patellofemoral pain syndrome, comes from the joint behind and around the kneecap. Jumper's knee is a problem with the tendon just below it. They can feel similar, but they are different conditions with different treatment, which is exactly why a proper diagnosis matters.
What Causes Jumper's Knee?
Like most tendon problems, patellar tendinopathy is a load management story. The tendon is asked to do more than it is currently built for. A few common patterns show up in our Burlington clinic:
Jumping and landing sports - Basketball, volleyball, and track jump events are classic culprits. The tendon stores and releases energy with every jump and landing, and that adds up fast.
A spike in training - Ramping up volume, intensity, or adding plyometrics too quickly is a frequent trigger, especially in summer when leagues and pickup games get busy.
Deceleration and change of direction - Sports like pickleball, tennis, and soccer load the tendon hard when you stop and cut, not just when you jump.
Underprepared strength - When the quadriceps and the rest of the leg are not strong enough for the demand, the tendon absorbs more than its share.
It tends to affect active people, and younger jumping athletes most of all, though we see plenty of recreational athletes across Burlington, Oakville, and Waterdown who picked it up after a busy stretch of basketball, volleyball, or summer sports.
Signs and Symptoms to Watch For
Patellar tendinopathy has a fairly recognizable pattern. You might have it if you notice:
Focused pain right at the bottom of the kneecap, where the tendon attaches, rather than spread across the whole knee
Pain that switches on with loading (jumping, landing, deep squats, stairs, hills) and often eases once the load is removed
A warm-up effect, where the knee feels better as you get going, then worse afterward or the next morning
Stiffness and tenderness at the lower kneecap first thing in the morning
A gradual onset that builds over weeks rather than a single injury moment
If your pain is behind or around the kneecap, aches after long sitting, or flares mostly going down stairs, it may be patellofemoral pain instead. Sorting out which one you have is one of the first things we do during an assessment, because the rehab differs.
What the Research Says About Treating Patellar Tendinopathy
The strongest evidence for jumper's knee points squarely at progressive strength work, not rest. A well-known study in the American Journal of Sports Medicine looked at heavy slow resistance training in men with chronic patellar tendinopathy, and the results are worth knowing.
Over 12 weeks of heavy slow resistance training, participants improved their tendon pain and function scores by roughly 27 percent (VISA-P scores climbed from about 57 to 82), with a 36 percent drop in pain ratings. The training also increased quadriceps size and changed the tendon structure itself. Importantly, the program allowed discomfort during exercise as long as it did not linger afterward. Kongsgaard M, et al. (2010). Fibril Morphology and Tendon Mechanical Properties in Patellar Tendinopathy: Effects of Heavy Slow Resistance Training. Am J Sports Med, 38(4), 749-756.
A few practical takeaways from this and the broader research:
Loading beats resting. Tendons get stronger when you load them in a controlled, progressive way. Complete rest tends to make them more sensitive, not less.
Some pain during exercise is okay. Discomfort up to a tolerable level during loading is acceptable, as long as it settles and does not flare for the next day.
Education matters as much as the exercises. Understanding that loading is safe is a big driver of sticking with the program, which is what actually moves the needle.
This is a marathon, not a sprint. Meaningful change took months, which is normal for tendons.
How Physiotherapy Treats Patellar Tendinopathy in Burlington
The research is clear that the biggest driver of recovery is individualized, progressive loading, not a passive treatment or a long layoff. That is exactly the kind of care we focus on at our Burlington physiotherapy clinic.
Getting the Diagnosis Right
First we confirm it actually is the patellar tendon and not patellofemoral pain, fat pad irritation, or a problem referred from the hip. These can feel similar but need different plans. A thorough one-on-one assessment, including how the tendon responds to specific loads, tells us what we are dealing with.
Load Management That Keeps You in the Game
You rarely need to stop everything. The goal is to bring training down to a level the tendon can tolerate, then build from there. That often means temporarily cutting back on jumping and deep knee loading while we rebuild capacity, using a pain-monitoring approach so you know what is safe.
Progressive Strengthening
This is where the tendon rebuilds. A typical progression we use looks like this:
Isometrics first - Holding the quad under a steady load to settle pain and start loading the tendon.
Heavy slow resistance next - Slow, controlled strength work like squats and leg press, loaded carefully so the tendon adapts without flaring. This is the approach the research above supports.
Energy storage and jumping last - Reintroducing hops, landings, and sport-specific work once the tendon is ready, since jumping is the highest load of all.
For athletes, we combine this with exercise prescription built around your sport and, where helpful, hands-on manual therapy to manage symptoms along the way. If you are working back toward competition, our sports injury rehabilitation approach maps out the return-to-play steps so you do not rush the last and riskiest phase.
What to Expect at Your First Appointment
Every assessment at Pursuit is a full 60 minutes, one-on-one with Javier, a registered physiotherapist and McMaster University acupuncture instructor. No assistants, no being passed around, no doubling up of patients. We take the time to understand your history, test the tendon properly, rule out the conditions that mimic jumper's knee, and build a plan you actually understand. You leave the first visit knowing what is going on and what the next few weeks look like.
Self-Management Tips You Can Start Today
While a tailored program is the real fix, here are sensible steps that help most people with patellar tendon pain:
Do not rest completely. Total rest tends to make tendons more sensitive. Keep moving at a tolerable level.
Cut the highest-load activities for now. Pull back on jumping, deep squats, and downhill or hill running while the tendon settles.
Try isometric holds. Slow, sustained quad holds (such as a wall sit or a held leg extension) can ease tendon pain and start loading it safely.
Use the 24-hour rule. Some discomfort during exercise is fine, but if pain spikes and stays up the next day, you did too much. Scale back and rebuild.
Be patient and consistent. Tendons respond over months. Steady, progressive loading beats hard sporadic efforts every time.
When to See a Physiotherapist
If pain at the bottom of your kneecap has stuck around for more than a few weeks, keeps interrupting your sport, or is not improving with rest, it is worth getting it assessed. Tendon problems that drag on tend to take longer to settle, and the longer you push through, the more the tendon and the surrounding muscles decondition. We see patients from Burlington, Millcroft, Oakville, Waterdown, Hamilton, and Milton, and the ones who come in early almost always have a smoother recovery than those who tough it out for months.
Ready to get to the root of it?
If jumper's knee is keeping you off the court or the road, book a one-on-one assessment at Pursuit Physiotherapy and let us build you a plan that fits your sport and your goals.
#201-4125 Upper Middle Road, Burlington | (905) 331-8993
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