If you have a sore, well-localized spot just below the kneecap that hurts when you jump, squat or push off, the likely cause is a tendon that has been asked to do more than it was ready for. The best-supported fix is slow, progressive loading of that tendon, and it takes months. Shockwave, PRP and laser have weaker or mixed evidence for this tendon, and corticosteroid injections are the one thing to steer clear of. Here is what each option can and cannot do.
What is jumpers knee (patellar tendonitis)?
Jumpers knee is the everyday name for patellar tendinopathy: pain in the tendon that connects your kneecap to your shinbone, usually at the lower tip of the kneecap. StatPearls describes it as a frequent cause of front-of-knee pain in athletes exposed to repetitive, high-load jumping and running, with tenderness at the tendon and pain that worsens when the knee extensors are loaded.
You will also hear "patellar tendonitis" and "patellar tendinitis." Those words suggest inflammation, but the same source calls it primarily a degenerative condition. That is why anti-inflammatory approaches do less than people expect.
It is common in jumping sports. A 2022 meta-analysis puts prevalence at up to 14% among elite athletes, rising with years of play. For pickleball, tennis and basketball in Naples, the pattern is the same: sudden stops, lunges and landings put repeated load through the tendon. Our pickleball injuries guide covers how those movements add up.
How do you know it is the patellar tendon, and what else could it be?
Two features define it, according to Malliaras and colleagues in JOSPT (2015): pain localized to the lower tip of the kneecap, and pain that rises with demand on the thigh muscles, especially in jumping and landing. Diagnosis stays clinical. Imaging can help sort out other causes, but the authors note that tendon changes can show up on scans of people with no pain, so a scan alone does not settle it.
StatPearls lists the look-alikes a clinician rules out: meniscal injury, patellofemoral pain syndrome, quadriceps problems, bursitis, fat pad pathology, chondromalacia and patellar tracking problems, plus Osgood-Schlatter disease in teenagers.
A quick way to sort yourself before the visit:
| What you notice | What it points toward |
|---|---|
| One tender spot at the lower tip of the kneecap, pain with jumping or a single-leg decline squat | Patellar tendinopathy |
| Aching behind or around the kneecap, with no single tender spot | Patellofemoral pain, a different problem |
| Catching, locking or giving way | A meniscal or other internal problem |
| Sudden pain and swelling after a landing or fall, with trouble straightening the knee | A tendon tear |
On that last row, the AAOS says a patellar tendon tear often brings a tearing or popping sensation, pain and swelling, and you may not be able to straighten your knee. It also says tendinitis weakens the tendon and can cause small tears. A sudden injury like that needs a doctor the same day, before any loading program.
What is the best patellar tendonitis treatment?
Progressive tendon loading, meaning exercise that is gradually made heavier and more demanding, is the first-line care in the studies. The evidence is good enough to act on and imperfect enough to stay humble about.
- In a randomized trial of 76 people (Breda, British Journal of Sports Medicine, 2021), a progressive tendon-loading program beat pain-provoking eccentric exercise after 24 weeks (28 versus 18 points on the VISA-P questionnaire). Return to sport was 43% versus 27%, a gap that was not statistically significant. Most participants had symptoms for about two years and had already failed other treatment.
- In a 39-man trial (Kongsgaard, 2009), heavy slow resistance (squat, leg press and hack squat done slowly, with heavy loads) and eccentric decline squats both held their gains at six months. Heavy slow resistance had the most satisfied patients.
- A systematic review of 15 studies (Lim and Wong, 2018) graded isometric holds as the most trustworthy for short-term pain relief, especially in season, with heavy slow resistance and eccentric work better suited to long-term pain and knee function.
- A 2024 network meta-analysis found eccentric training alone ranked lowest, and loading that included isometrics or moderate slow resistance did better.
One caution. The 2025 Cochrane review of exercise says it is very uncertain whether strengthening reduces pain compared with no treatment, because the trials are few and small, and all of them enrolled athletes. The practical reading: loading is the best-supported option we have, and the research still has gaps.
What does a loading progression look like?
Malliaras and colleagues describe a staged approach in their 2015 JOSPT commentary. It combines evidence with expert opinion, so treat the numbers as a framework to review with a physical therapist.
| Stage | Start when | Example dose |
|---|---|---|
| 1. Isometric holds | Pain is more than minimal during normal lifting | 5 holds of 45 seconds, 2 to 3 times a day, building toward 70% of maximum effort as pain allows (Malliaras, 2015) |
| 2. Heavy, slow lifting | Pain is minimal during lifting | 3 to 4 sets, working from a 15-rep load toward a 6-rep load, every second day |
| 3. Jumping and landing work | Strength is good and pain stays at 3 out of 10 or less, returning to baseline within 24 hours of a load test | Add volume, then intensity, to match your sport |
What should you avoid?
Avoid corticosteroid injections in or around the patellar tendon. In Kongsgaard's trial, injections gave good short-term relief and poor long-term results. The AAOS says steroid injections have been linked to a weaker tendon and a higher chance of rupture, so doctors typically avoid them here. A 2019 network meta-analysis found injection users scored 23 VISA points worse than controls.
Two softer cautions come from the Malliaras commentary: expecting recovery on a short timetable, and leaning mostly on passive treatments. Both are common traps. StatPearls also says anti-inflammatory pills offer only short-term relief for a condition that is mostly degenerative.
Does shockwave therapy work for jumpers knee?
Shockwave has low-to-moderate quality evidence of a negligible effect for this tendon. A 2023 meta-analysis reached that conclusion for pain and function against placebo. The best single trial, Zwerver and colleagues (2011), randomized 62 volleyball, basketball and handball players to three shockwave sessions or sham. Scores matched through 22 weeks. More shockwave patients felt better one week after treatment (65% versus 32%), and nothing else differed.
A 2021 review of 37 trials found shockwave no better than sham shockwave when both groups did eccentric exercise. In short: it is reasonable to ask whether shockwave suits you, and wrong to expect it to replace loading.
What about PRP injections?
The evidence is mixed. A 2022 review of platelet-rich plasma found no significantly greater benefit than other injections, a benefit over shockwave in one trial, and no difference in return to sport at six months. Its authors could not recommend for or against PRP. A 2019 network meta-analysis ranked leukocyte-rich PRP and dry needling highest on the VISA-P score, then warned the estimates could be biased and should not be overstated. The AAOS calls PRP promising for jumper's knee but says it is hard to claim it beats traditional care. If you are considering an injection, our what to expect after PRP guide covers aftercare.
Is laser therapy worth trying?
Evidence for laser on this specific tendon is thin. A 2022 meta-analysis in BMJ Open of low-level laser found less pain and disability in lower-limb tendinopathy and plantar fasciitis in the short and medium term, with some uncertainty about the size of the effect. Only two of its 18 trials involved patellar tendinopathy, and it studied low-level lasers rather than the higher-power Class IV devices. We found no patellar-specific trial of Class IV laser, so it belongs in the "possible add-on" category. See our laser therapy guide for the general picture.
Is surgery ever needed?
Rarely, and late. The Cochrane review of surgery (2019) rated the evidence low certainty and could not say whether surgery beats non-surgical care. A 2023 overview notes that surgery is the next recommended step when conservative care has failed after about six months. If you are not improving after months of consistent loading, ask a sports medicine physician or orthopedic surgeon to recheck the diagnosis.
When can you play again?
Return to sport is earned stage by stage and has no fixed date. Use this decision rule from the Malliaras framework: advance only when pain during the exercise stays at 3 out of 10 or lower and settles back to baseline within 24 hours. Strength matters too: Malliaras and colleagues (2015) suggest the ability to do 4 sets of 8 single-leg presses at around 150% of body weight for most jumping athletes. Once you are back, keep two strength sessions a week, and use isometric holds before or after play if the tendon is cranky.
Expect it to be slow. Breda's participants were measured at 24 weeks, and Malliaras's authors call rehab "slow and sometimes frustrating."
Where do studio services fit?
OutRecover is a recovery studio. It does not stand in for a physical therapist or physician. Nothing in the studio replaces the loading program above, and you should not skip it for any machine.
If you want to add something alongside loading, two services match this tendon. Focused shockwave is a handheld device that delivers pulses to the sore spot; given the evidence above, think of it as an optional extra with a modest ceiling. Class IV laser is a clinician-guided laser, with the thin evidence described above. Each has its own research summary: shockwave and Class IV laser.
The package that fits best is OutResolve, built for chronic tendon pain and listing jumper's knee among its uses, with laser and/or shockwave plus PEMF. OutPrime pairs oxygen, laser and shockwave around a PRP injection and lists patellar tendinopathy, so it suits you if you and your doctor have already decided on PRP. If you have had surgery, clear anything new with your surgeon first.
What to do next
- Book a diagnosis with a physical therapist or sports medicine doctor, especially if the pain did not build gradually.
- Start isometric holds if your pain is high, and work toward heavy slow lifting with their guidance.
- Skip steroid injections.
- If you want a studio add-on, call the studio or take the recovery quiz and ask which package fits.
Sources
- Lim HY, Wong SH. Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: a systematic review. Physiotherapy Research International, 2018. https://pubmed.ncbi.nlm.nih.gov/29972281
- Breda SJ, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. British Journal of Sports Medicine, 2021. https://pubmed.ncbi.nlm.nih.gov/33219115
- Kongsgaard M, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scandinavian Journal of Medicine & Science in Sports, 2009. https://pubmed.ncbi.nlm.nih.gov/19793213
- Li Y, et al. Mixed comparison of intervention with eccentric, isometric, and heavy slow resistance for VISA-P in adults with patellar tendinopathy: a systematic review and network meta-analysis. Heliyon, 2024. https://pubmed.ncbi.nlm.nih.gov/39559237
- Lopes AD, et al. Exercise for patellar tendinopathy. Cochrane Database of Systematic Reviews, 2025. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013078.pub2/abstract
- Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. Journal of Orthopaedic & Sports Physical Therapy, 2015. https://pubmed.ncbi.nlm.nih.gov/26390269
- Challoumas D, et al. Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ Open Sport & Exercise Medicine, 2021. https://pubmed.ncbi.nlm.nih.gov/34900334
- Zwerver J, et al. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial. American Journal of Sports Medicine, 2011. https://pubmed.ncbi.nlm.nih.gov/21285447
- Charles R, et al. The effectiveness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis. Frontiers in Immunology, 2023. https://pubmed.ncbi.nlm.nih.gov/37662911
- Barman A, et al. Platelet-rich plasma injection in the treatment of patellar tendinopathy: a systematic review and meta-analysis. Knee Surgery & Related Research, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9066802
- Chen PC, et al. Comparative effectiveness of different nonsurgical treatments for patellar tendinopathy: a systematic review and network meta-analysis. Arthroscopy, 2019. https://pubmed.ncbi.nlm.nih.gov/31699265
- Naterstad IF, et al. Efficacy of low-level laser therapy in patients with lower extremity tendinopathy or plantar fasciitis: systematic review and meta-analysis. BMJ Open, 2022. https://pubmed.ncbi.nlm.nih.gov/36171024
- Dan M, et al. Surgery for patellar tendinopathy (jumper's knee). Cochrane Database of Systematic Reviews, 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6756823
- American Academy of Orthopaedic Surgeons. Patellar tendon tear. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/patellar-tendon-tear
- American Academy of Orthopaedic Surgeons. Platelet-rich plasma (PRP). OrthoInfo. https://orthoinfo.aaos.org/en/treatment/platelet-rich-plasma-prp
- StatPearls. Patellar tendinopathy (jumper's knee). NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/sites/books/NBK532969
- Patellar tendinopathy: an overview of prevalence, risk factors, screening, diagnosis, treatment and prevention. PubMed Central, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10541843
