Physiotherapy Rehabilitation Protocol: Patellar Tendinitis (Jumper's Knee)

Overview

Anatomy & Pathology

Clinical Assessment

Rehabilitation Protocol Overview

Stage 1 - Isometric Loading (Pain Management Phase)

Key Exercises

1. Wall Squat (Double-Leg Isometric)

• Stand with back against wall, feet shoulder-width apart
• Slide down until knees are at 60-90° flexion (stay within pain-free range)
• Hold 45 seconds x 4-5 repetitions
• Rest 2 minutes between reps
• Frequency: 4-5 days/week

2. Spanish Squat / Leg Press Isometric

• Using a leg press or resistance band around a post
• Maintain knee at 60° flexion
• Hold 45 seconds x 4-5 reps
• Rest 2 minutes

3. Single-Leg Decline Squat (Isometric Hold)

• Stand on a 25° decline board on affected leg
• Lower to 60° knee flexion and hold
• Use only if double-leg isometrics are pain-free

• Warm up with 5-10 min low-resistance cycling
• Apply ice to front of knee for 10-15 minutes after session
• No ballistic or jumping activity

Stage 2 - Isotonic / Eccentric-Concentric Loading

Key Exercises

4. Slow-Speed Leg Press

• 3-4 seconds down (eccentric), 3-4 seconds up (concentric)
• Load: 70-80% of 1RM
• 4 sets x 8-12 reps
• 3 days/week (rest day between sessions - tendons need 48-72 hr recovery)

5. Single-Leg Decline Squat (Eccentric Focus)

• Stand on 25° decline board
• Perform eccentric (lowering) phase over 3-4 seconds on affected leg
• Use both legs to return to start
• Loaded with a backpack or weighted vest when pain allows
• 3 sets x 10-15 reps

6. Leg Extension Machine

• Full range of motion, slow controlled movement
• 3 sets x 10-12 reps at moderate load
• Avoid if pain exceeds 4/10 in terminal extension

7. Romanian Deadlift / Hamstring Strengthening

• Addresses posterior chain weakness which contributes to patellar overload
• 3 sets x 10-12 reps

8. Quadriceps Stretch (Stretching Component)

• Standing, pull heel toward buttock
• Hold 30 seconds x 3 reps each side
• Perform BEFORE strengthening exercises

9. Hamstring Stretch

• Lying: towel around foot, lift straight leg until stretch is felt
• Hold 30 seconds x 3 reps each side

10. Calf Stretch

• Stand with toes on wall edge, knee straight, lean forward
• Hold 30 seconds x 3 reps each side (Calf tightness increases tendon load during landing)

Stage 3 - Energy Storage / Plyometric Loading

Progression of Plyometric Exercises

Stage 4 - Sport-Specific Return to Play

Progressions

• Return to sport-specific drills (cutting, bounding, change of direction)
• Graduated increase in training volume (no more than 10% increase per week)
• Jump training: double-leg → single-leg → reactive/unexpected loading
• Sport return criteria: VISA-P ≥ 90, single-leg hop test ≥ 90% symmetry

Adjunct Physiotherapy Interventions

Red Flags - When to Refer

• Pain > 7/10 that does not settle within 24 hours
• Swelling, warmth, or redness (may indicate other pathology)
• No improvement after 12 weeks of consistent rehab
• Suspected partial or full tendon tear (urgent orthopaedic review)
• Night pain or systemic symptoms (rule out inflammatory arthropathy)

Outcome Measures

Summary Timeline

Evidence Base

• Challoumas et al. (2021), BMJ Open Sport & Exercise Medicine - systematic review and network meta-analysis showing progressive heavy slow resistance training as first-line intervention
• A 2026 UK Defence systematic review (PMID 39979017) confirmed progressive tendon loading as the most effective conservative management strategy for patellar and Achilles tendinopathy
• Pure eccentric (decline squat) protocols remain valid but 4-stage progressive loading shows broader clinical benefit across the tendon continuum

Note: This protocol is a general clinical guideline. All exercises should be supervised or prescribed by a licensed physiotherapist, individualized based on symptom severity, sport demands, and patient response to loading.