How do you assess and load-manage patellar tendinopathy?
Recognising patellar tendinopathy, telling it apart from patellofemoral pain, and building a progressive loading plan.
Subjective triage
- Localised pain at the inferior pole of the patella.
- Pain with energy-storage activities: jumping, landing, change of direction.
- Often warms up during activity, then worse later or the next day.
- Recent increase in jumping or training load.
Differential dilemma: vs patellofemoral pain
| Feature | Patellar tendinopathy | Patellofemoral pain |
|---|---|---|
| Pain location | Pinpoint, inferior pole | Diffuse, around or behind the patella |
| Provoking load | Jumping and landing | Stairs, squatting, prolonged sitting |
| Load response | Pain increases with tendon load (e.g. decline squat) | Less clearly dose-dependent |
| Typical patient | Jumping athletes | Runners, adolescents, mixed activity |
Red flags: recognise, screen, refer
Recognise
- Hot, swollen knee with fever
- Locking or giving way after trauma
- Unexplained bony pain or night pain
- Sudden loss of extension after a fall (possible tendon rupture)
Screen
Check for systemic signs, trauma history and other joint involvement.
Refer
Suspected infection, rupture or bony pathology needs urgent medical review.
The clinical reasoning chain
- 1
History
Volleyball player with inferior knee pain after a block of extra jump training.
- 2
Pattern
Localised pain linked to energy-storage load fits tendinopathy.
- 3
Objective finding
Inferior pole tenderness; pain rises with single-leg decline squat depth.
- 4
Diagnostic decision
Patellar tendinopathy: modify jump load, start isometric or heavy slow loading and progress.
Quick reference FAQ
Should patients stop all sport?
Usually not. Modify load so pain stays acceptable and settles by the next day, rather than complete rest.
How long does rehab take?
Recovery commonly takes several months. Set realistic expectations and progress through loading stages to return to jumping.
Is imaging needed?
Diagnosis is clinical. Imaging changes are common in pain-free athletes and rarely change management.