Symptoms
Does this sound like you
- Pain in the tendon just below the kneecap
- Worst with jumping, landing, drops and moguls
- An ache on stairs and after a long sit with the knee bent
- A tendon that warms up during activity and hurts afterwards
- Stiffness the morning after a big day
- Tenderness when you press on the tendon
- A thickened tendon in longer-standing cases
Assessment
We start with your story: where on the tendon it hurts, how it behaves through a day of riding or skiing, and what changed in your training. A tendon that warms up as you go and then hurts afterwards is the usual pattern.
We press along the tendon to find the tender spot and check the kneecap and the joint, because pain around or behind the kneecap is a different problem. Single-leg squats and small hops show how the tendon responds to load and how much it can take right now. We test strength through the thigh, calf and hip, since a weak link there sends more load into the tendon, and we watch how you land.
Treatment
Complete rest is not part of the plan. A tendon loses capacity when it is unloaded, and the pain returns the first time you jump again. Instead we set a level of load the tendon accepts, with pain no more than a little worse during and after. That keeps you at work, study and sport while the tendon rebuilds. The loading runs in stages:
- Held contractions early: long, still holds of the thigh muscles, such as a wall sit, to calm the pain and keep the muscle working.
- Slow, heavy strength: squats, leg presses and step-downs with real weight, done slowly. This rebuilds the tendon's capacity and is the longest stage.
- Energy-storage work: hopping, bounding and landing drills that teach the tendon to store and release load again, once strength is back.
Shockwave therapy sits alongside the loading when the pain lingers. A handheld device sends focused sound waves (acoustic waves) through the skin into the tendon. It is one part of the plan, never the whole of it. See shockwave therapy.
A patellar strap or tape takes some people through the early stage with less pain, and hands-on treatment can ease a tight thigh and calf. Neither replaces the exercise. The later stages often run into strength and conditioning, which takes the gains on to what your sport or job asks of the tendon.
Getting back to sport
Jumping and landing come back in steps, not all at once. Small hops on two feet come first, then single-leg hops, drops from a box and longer sessions with less rest. You move on when the current step leaves the tendon no more than a little worse by the next morning.
The last steps match your sport: drops and rough trail for the bike park, moguls and landings on skis. A stiff landing with little give at the hip and knee sends more of the shock into the tendon, so we test landings before each step up. Technique analysis and the return-to-sport plan are part of sports physiotherapy.
The slow, heavy strength work stays in your week after you return, because a tendon keeps its capacity only while it is loaded.
When to come in
Book an assessment if pain below the kneecap keeps returning with jumping, drops or stairs, or is holding you back on the bike or the hill. Come in too if you have cut back and the tendon has not settled.
Go to the emergency department right away, or call 911, if any of these happen:
- a sudden pop below the kneecap, and you cannot straighten the knee or lift the leg
- the knee looks out of shape
- you cannot put weight on the leg, even for a few steps
- the knee is hot, red and swollen, and you have a fever
The people
Who treats it
Partner · PhysiotherapistSport physiotherapy and return to sport · Movement analysis and exercise programming · Complex orthopaedic and post-surgical rehabilitationVillage North · Whistler Athlete Centre
Partner · PhysiotherapistHand and upper-limb rehabilitation · Concussion and vestibular rehabilitation · Sports and spinal injuriesVillage North
Partner · PhysiotherapistComplex neck and back problems · Sports injuries · Concussion and vestibular rehabilitationVillage North
PhysiotherapistPelvic health and pelvic floor physiotherapy · Pre- and post-natal rehabilitation · Sports injuries and post-surgical rehabilitationVillage North · Whistler Athlete Centre
PhysiotherapistRunning injuries · Post-surgical rehabilitation, including ACL and rotator cuff · Concussion and vestibular rehabilitationVillage North
PhysiotherapistACL rehabilitation, with or without surgery · Concussion and vestibular rehabilitation · Running injuriesVillage North
PhysiotherapistSnow sports injuries · Acute sporting knee injuries · Strength and conditioningVillage North · Whistler Athlete Centre
PhysiotherapistPelvic health for men and women · Antenatal physiotherapy · Hip, pelvis and spinal injuriesVillage North · Whistler Athlete Centre
- By referral
Care
How we help
Physiotherapy
Assessment, hands-on treatment and a plan built around your sport, from physiotherapists whose patients compete on the World Cup with Canada's ski and snowboard teams.
Read more ServiceShockwave Therapy
Shockwave therapy is a non-invasive treatment that delivers focused acoustic waves to injured tissue. Physiotherapists use it for a range of tendon and soft-tissue conditions, alongside exercise.
Read more ServiceStrength and Conditioning
Exercise programming that builds strength and control in the later stages of rehabilitation, taking your recovery on to the demands of your sport or your job.
Read more ServiceSports Physiotherapy
Assessment and treatment of sports injuries by physiotherapists who hold a Sports Physiotherapy Diploma or title, with experience from junior to elite athletes.
Read more ServiceRegistered Massage Therapy (RMT)
Manual soft-tissue treatment for pain, muscle tension, spasm and trigger points: restoring mobility and promoting recovery.
Read moreFAQ
The questions we hear most
Should I stop training until the tendon stops hurting?
No. A tendon adapts to the load it is given, and loses that adaptation when the load stops. Waiting for the pain to go usually means starting again weaker. We swap the jumping and drops for loading the tendon can take, and keep the rest of your training as it is. Some pain during the exercises is acceptable, provided the tendon is no more than a little worse the next morning. If it cannot tolerate even gentle holds, we lower the load rather than remove it.
Is my tendon torn?
Rarely. Most jumper's knee is a tendon that has been overloaded and is struggling to keep up, not a tear. The patellar tendon is thick and strong, and a full tear is unusual without one big event. A sudden pop below the kneecap, with a knee you cannot straighten or a leg you cannot lift, is that event. It belongs in the emergency department, not in a physiotherapy booking.
Does shockwave hurt?
A little. Most people feel the pulses as a firm, rapid tapping over the tendon, and the area can be sore for a day or so afterwards. A session is short, and you can usually carry on with your day. We check first that it suits you, because it is not used over open growth plates, during pregnancy, or with some implants and medical conditions. Our shockwave therapy page explains more.
Can I keep riding or skiing with jumper's knee?
Usually. A tendon handles steady load well and sudden spikes badly, so the aim is to keep you riding or skiing at a level it accepts. That might mean fewer laps through the drops, groomed runs instead of moguls, and a lighter day after a big one. We set the level with you and raise it as the tendon's testing improves. If the pain is sharpening rather than settling, that is the sign to come in.
This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.