Patellar Tendinopathy
An overuse injury affecting the patellar tendon, which connects the kneecap to the shinbone. Pain usually develops gradually and is common in athletes exposed to frequent jumping, sprinting, acceleration, and rapid changes of direction.
- •Mild pain at the front of the knee, usually just below the kneecap
- •Pain mainly occurs during jumping, running, or other explosive activities
- •Tenderness over the patellar tendon
- •Pain may decrease after stopping the activity
- •Little or no impact on daily activities
- •Strength and range of motion are largely preserved
- •Temporarily reduce activities that clearly aggravate the pain
- •In particular, reduce the amount of jumping, sprinting, and deep squatting
- •Maintain physical activity that can be performed with little or no pain
- •Cycling or other low-impact activity can be used to maintain fitness
- •Begin progressive strengthening of the quadriceps and leg muscles
- •Avoid prolonged complete rest from all activity
Begin with controlled tendon loading that is tolerated
Isometric quadriceps exercises may be used to reduce pain and activate the muscle
Progress to dynamic quadriceps strengthening
Gradually increase loading through exercises such as squats and leg presses
Progress to faster strengthening exercises when tolerated
Gradually introduce jumping and landing
Progressively increase running, acceleration, and changes of direction
- Pain is minimal and stable during daily activities
- Able to perform strengthening without significant worsening afterwards
- Able to run without significant pain
- Able to perform jumps and landings with good control
- Able to accelerate and decelerate without significant increase in pain
- Able to perform changes of direction
- Able to participate in football-specific drills with gradually increasing intensity
- Symptoms are not increased the following day
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Patellar Tendinopathy
An overuse injury affecting the patellar tendon, which connects the kneecap to the shinbone. Pain usually develops gradually and is common in athletes exposed to frequent jumping, sprinting, acceleration, and rapid changes of direction.
Mild — 6–12 veckor
Symptoms
- Mild pain at the front of the knee, usually just below the kneecap
- Pain mainly occurs during jumping, running, or other explosive activities
- Tenderness over the patellar tendon
- Pain may decrease after stopping the activity
- Little or no impact on daily activities
- Strength and range of motion are largely preserved
Acute Treatment
- Temporarily reduce activities that clearly aggravate the pain
- In particular, reduce the amount of jumping, sprinting, and deep squatting
- Maintain physical activity that can be performed with little or no pain
- Cycling or other low-impact activity can be used to maintain fitness
- Begin progressive strengthening of the quadriceps and leg muscles
- Avoid prolonged complete rest from all activity
Rehabilitation
Begin with controlled tendon loading that is tolerated
Isometric quadriceps exercises may be used to reduce pain and activate the muscle
Progress to dynamic quadriceps strengthening
Gradually increase loading through exercises such as squats and leg presses
Progress to faster strengthening exercises when tolerated
Gradually introduce jumping and landing
Progressively increase running, acceleration, and changes of direction
Return to Play
- ☐ Pain is minimal and stable during daily activities
- ☐ Able to perform strengthening without significant worsening afterwards
- ☐ Able to run without significant pain
- ☐ Able to perform jumps and landings with good control
- ☐ Able to accelerate and decelerate without significant increase in pain
- ☐ Able to perform changes of direction
- ☐ Able to participate in football-specific drills with gradually increasing intensity
- ☐ Symptoms are not increased the following day
Moderate — 12–24 veckor
Symptoms
- Clear pain at the front of the knee, usually around the patellar tendon
- Pain during jumping, running, sprinting, and acceleration
- Pain during squatting or stair climbing
- Clear tenderness over the patellar tendon
- Stiffness or pain after activity
- Symptoms may affect sporting performance
- Pain may persist after activity has stopped
Acute Treatment
- Significantly reduce load on the patellar tendon
- Temporarily reduce or pause jumping, sprinting, deep squatting, and other aggravating activities
- Maintain alternative exercise that is tolerated by the knee
- Use a structured progressive loading plan
- Isometric exercises may be used initially if dynamic loading is painful
- Physiotherapy assessment is recommended for persistent or significant symptoms
Rehabilitation
Begin with loading that keeps symptoms under control
Progressive quadriceps strengthening is the foundation of rehabilitation
Gradually increase load through exercises such as leg presses, squats, and other quadriceps exercises
Heavy slow resistance training can be used as part of progressive strengthening
Introduce explosive training as strength improves
Progress to jumping, landing, and plyometric exercises
Then progressively introduce running, sprinting, acceleration, and changes of direction
Gradually integrate football-specific activities
Return to Play
- ☐ Pain is low and stable during daily activities
- ☐ Full or near-full knee range of motion
- ☐ Good quadriceps strength without significant increase in pain
- ☐ Able to complete progressive strengthening without worsening the following day
- ☐ Able to run at higher speeds without significant symptom increase
- ☐ Able to perform repeated jumps and landings
- ☐ Able to accelerate and decelerate without significant pain
- ☐ Able to perform rapid changes of direction
- ☐ Able to participate in high-intensity football-specific training
- ☐ Able to increase training load without clear day-to-day deterioration
Severe — 3–6+ månader
Symptoms
- Severe or persistent pain at the front of the knee
- Pain that clearly limits sport and physical activity
- Pain during daily activities such as climbing stairs or standing up
- Marked tenderness over the patellar tendon
- Significant pain during jumping and landing
- Markedly reduced ability to run or jump
- Symptoms persist despite reduced loading and structured rehabilitation
- In rare cases, a very severe condition may involve significant tendon damage
Acute Treatment
- Reduce or pause activities that clearly aggravate the pain
- Avoid repeated jumping, sprinting, and heavy loading that worsens symptoms
- Maintain alternative physical activity that is tolerated
- Do not push aggressively through significant pain
- Medical or physiotherapy assessment is recommended for severe or persistent symptoms
- Sudden severe pain or suspected tendon rupture requires prompt medical assessment
Rehabilitation
Individualized load management is central
Progressive quadriceps strengthening under physiotherapy guidance may be required
Increase loading gradually according to function and symptoms
Progress from isometric and slow strengthening to heavier loading
Introduce explosive training and plyometrics as strength improves
Gradually return to jumping, running, sprinting, and changes of direction
Football-specific loading is reintroduced progressively
Rehabilitation may need to continue after return to sport to maintain tendon load capacity
Return to Play
- ☐ Pain is low and stable even with higher loads
- ☐ Full knee range of motion
- ☐ Good or restored quadriceps strength
- ☐ Able to perform heavy strengthening without significant worsening
- ☐ Able to perform repeated jumps and landings with good control
- ☐ Able to run at high speed without significant symptoms
- ☐ Able to repeatedly accelerate and decelerate
- ☐ Able to perform rapid changes of direction
- ☐ Able to perform football-specific explosive activities
- ☐ Able to complete full-intensity training without significant worsening afterwards
- ☐ Able to tolerate training load consistently across multiple sessions
When to Seek Medical Care
- Seek medical care if knee pain is severe or clearly limits daily activities
- See a physiotherapist or other healthcare professional if symptoms persist despite reduced loading and structured rehabilitation
- Seek care if pain progressively worsens despite reducing training load
- Seek care for significant weakness or substantial difficulty extending the knee
- Seek prompt medical care after sudden severe pain, a clear 'pop,' or suspected patellar tendon rupture
- In children and adolescents, persistent or significant pain below the kneecap should be assessed because other conditions can cause similar symptoms