Jumper’s knee: why the tendon below your kneecap hurts and how to load it back to health

Jumper’s knee is pain in the tendon that runs from the bottom of your kneecap to your shin. Clinicians call it patellar tendinopathy. The pain sits right at the lower tip of the kneecap and depends on load: it flares with jumping, landing, squatting and other activities that store and release energy in the tendon [1].

It is a different problem from runner’s knee, which is pain around or behind the kneecap. The difference matters, because the rehab is not the same.

Who gets it

It is most common in sports with lots of jumping:

• Elite volleyball44.6%
• Elite basketball31.9%
• Non-elite volleyball14.4%
• All elite athletes14.2%
• All non-elite athletes8.5%
• Non-elite soccer2.5%

Sources: Lian et al., 2005, 613 Norwegian elite athletes [2]; Zwerver et al., 2011, 891 Dutch non-elite athletes [3].

In both studies it was more common in men than in women [2] [3]. It also affects more than sport: in a study of 77 active athletes, 55% said it hurt their sports performance, and 36% reported lower productivity at work [4].

How long does it last?

Often a long time, especially if it goes untreated. Elite athletes with current symptoms had been living with them for 32 months on average [2], and non-elite athletes for a median of 12 months [3]. In an older study of male athletes followed for 15 years, 9 of 17 with jumper’s knee had quit their sport because of it, compared with 1 of 14 athletes without it [5].

The more recent picture is better. In a group of athletes who received structured physical therapy in a trial, 76% felt recovered about 5 years later, and 71% had returned to the sport they wanted to play [6]. Almost a quarter still did not feel recovered [6].

The Dutch guideline recommends at least 12 weeks of progressive strengthening before judging whether it is working [1]. In one trial, fewer than half the patients were back to their previous level of sport after 24 weeks [7]. Plan on months, not weeks.

What works: progressive loading

Strengthening comes first. The Dutch guideline recommends exercise therapy as the first treatment, in four stages [1]:

1. Calming the pain: education and advice on how much load to put on the tendon
2. Building strength: progressive quadriceps strengthening for at least 12 weeks, with heavy slow resistance preferred
3. Adding spring: jumping and landing drills, depending on your sport
4. Keeping it: continuing strength work after you are back

The evidence is not as strong as you might hope. A 2025 Cochrane review found only 7 small trials, all in athletes, and rated the certainty of the evidence as low to very low [10]. Still, the trials that compare approaches point in a useful direction:

Treatment	Trial	What it found
Progressive tendon loading vs. eccentric squats	76 athletes [7]	Bigger gain on a 0 to 100 tendon score at 24 weeks (28 vs. 18 points); back to previous sport level 43% vs. 27%, a difference that was not statistically significant
Heavy slow resistance or eccentric squats vs. a steroid injection	39 men [8]	All three improved at 12 weeks, but the injection group got worse by 6 months while the exercise groups kept their gains
Eccentric squats while still competing	29 volleyball players [9]	No improvement over 12 weeks
Surgery vs. eccentric squats	40 knees [19]	No difference at 12 months

In the first trial, the progressive program allowed pain up to 3 out of 10 during exercise, moving through stages from holds to strength work, jumping and sport-specific training. It was also less painful to do than the eccentric program, which pushed into pain of at least 5 out of 10 [7]. Both groups were told to reduce painful loading for at least 4 weeks [7]. Not every review agrees on which exercise is best: a large network analysis still named eccentric loading as the first-line choice [11].

Managing your load matters. Doing eccentric squats while still playing a full volleyball season did not help [9]. That does not mean you must stop all sport. It means a therapist should help you adjust how much jumping you do while the tendon gets stronger [1] [7].

What about isometric holds? A widely shared 2015 study found that holding a squat-like position gave dramatic pain relief, but it included only 6 volleyball players [12]. Later trials did not confirm a special pain-relieving effect [13], and a review of 10 trials found isometrics were no better than other strengthening exercises [14]. They can still be a useful, well-tolerated way to start loading [1].

Injections, shockwave and surgery

A word of caution before looking at these: people with jumper’s knee who receive placebo treatments in trials also improve a lot over time, by 27 points on the 0 to 100 tendon score at 6 to 12 months [18]. That is why treatments need to be tested against a placebo, and why a success story on its own proves little.

• Steroid injections: they gave good short-term but poor long-term results in the trial above [8]. Orthopedic surgeons link them to tendon weakness and a higher chance of rupture, so they usually avoid injecting around this tendon [21].
• Platelet-rich plasma (PRP): in a trial of 57 athletes who all did rehab, neither of two types of PRP beat a saline injection at any point up to a year [16]. One review favored repeated PRP injections, but it was based mostly on poor-quality studies [17]. The Dutch guideline recommends against injection therapy [1].
• Shockwave therapy: in 62 athletes treated during their season, it did no better than a sham treatment [15], and a network analysis recommended against it [11].
• Surgery: a Cochrane review found no clinically important benefit of surgery over eccentric exercise, based on low-certainty evidence [20]. The Dutch guideline reserves it for people with disabling symptoms after at least 6 months of non-surgical care [1].
• Straps, tape and similar add-ons: the Dutch guideline suggests considering them only if 12 weeks of exercise has not made a meaningful difference, with a patellar strap as the first choice because it is cheap and easy to use [1].
• Pain medicine: the same guideline advises caution, with acetaminophen first and an anti-inflammatory gel second, only for severe pain [1].
• Imaging: it adds little and is only needed if the diagnosis is uncertain or 12 weeks of exercise have not helped [1].

What you can do now

• Cut back on the jumping and landing that clearly provoke the pain, rather than stopping all activity [1] [7]
• Start a strengthening program and give it at least 12 weeks [1]
• Keep exercise pain low, around 3 out of 10 at most, as in the progressive loading trial [7]
• Use an ice pack wrapped in a towel for up to 20 minutes every 2 to 3 hours if it helps with pain [22]
• See a clinician if your knee pain does not improve within a few weeks [22]

Get urgent care for a possible tendon tear. Warning signs include a tearing or popping sensation followed by pain and swelling, not being able to straighten your knee, a dent at the bottom of the kneecap, the kneecap riding up into the thigh, or the knee buckling [21]. If surgery is needed, people do better when the repair is done soon after the injury [21].

Also get medical care promptly if you cannot bear weight on the knee, it looks deformed, or you have fever, redness, warmth or a lot of swelling [23].

The takeaway

• Jumper’s knee is pain at the lower tip of the kneecap, and it is most common in jumping sports.
• It often lingers for months or years when it is not treated well, but most people do well with structured rehab.
• Progressive strengthening for at least 12 weeks is the first treatment, with your jumping load adjusted along the way.
• Steroid injections, PRP, shockwave and surgery have not been shown to beat exercise or placebo.
• A pop with trouble straightening your knee needs urgent care.

You can start physical therapy in Utah without a referral. If the bottom of your kneecap hurts when you jump or squat, an evaluation can confirm the cause and build a loading plan around your sport.