Patellar tendon irritation is common in runners, especially during hills, speed work and load spikes. Here’s what causes it, what helps, and how to keep training without making it worse.
Bayley Forbes is an osteopath and strength & conditioning coach based in Ringwood, Victoria. He founded Summit Osteo & Performance to help people bridge the gap between treatment and performance — combining hands-on care with tailored movement and strength programs to support long-term recovery and better performance.
Patellar tendon pain — often called patellar tendinopathy or “jumper’s knee” — is a common irritation at the front of the knee just below the kneecap.
While often associated with jumping sports, it also affects runners, especially during:
Hills
Speed sessions
Interval blocks
Load spikes
Transitions back into running after time off
Patellar tendon pain is highly responsive to strength training and gradual load progression — but can worsen if the wrong strategies are used.
Here’s what contributes to it and what helps.
The patellar tendon transmits force from the quadriceps to the shin during running. It tolerates high loads well — but becomes sensitive when overloaded too quickly.
Key contributors include:
• Sudden increase in running volume
• Adding hills or speed too abruptly
• Weakness in quads, glutes or calves
• Overstriding
• Running with excessive forward lean
• Fatigue from increased training frequency
• Reduced recovery between sessions
Symptoms reflect sensitivity — not structural damage.
Runners often notice:
Pain below the kneecap
Discomfort when loading the knee (stairs, hills, squats)
Morning stiffness
Pain early in the run that may warm up
Pain returning after the run or the next morning
Discomfort when jumping or landing
Tendons respond predictably to load — too much = irritation, the right dose = improvement.
❌ Hills early in the week
Large increase in tendon load.
❌ Downhill running
Increases eccentric quad demand.
❌ Speed work / sprints
High tendon loads that exceed capacity.
❌ Deep knee flexion under fatigue
Front squats, deep lunges, etc., if poorly controlled.
❌ Training through high pain
Tendons don’t like large spikes above tolerance.
❌ Resting completely when mildly irritated
This reduces tendon capacity further and can worsen symptoms long term.
✔ Strength Progression (Most Important)
The patellar tendon responds best to progressive loading.
Key exercises:
Isometrics (early stage / when painful):
• Wall sit
• Single-leg leg press hold
• Spanish squat
These reduce pain and prepare the tendon for more load.
Heavy Slow Resistance (mid/late stage):
• Squats
• Split squats (important)
• Step-downs
• Leg press
• Hip thrusts
• Calf raises (both straight- and bent-knee)
Strength increases tendon capacity and long-term tolerance.
✔ Cadence Adjustment
A small increase in cadence reduces braking forces and knee load.
Aim for:
Increase of 5–10% from current baseline.
✔ Load Modification
Modify running, don’t stop unless necessary.
Adjust:
• Km per week
• Intensity
• Downhill exposure
• Hills temporarily
• Speed sessions
Symptoms usually improve within 2–4 weeks of good load management.
✔ Return-to-Run Progression
Gradually reintroduce speed and hills after symptoms stabilise.
Think:
flat → small inclines → longer inclines → moderate speed → faster efforts.
✔ Overstriding
Increases knee braking forces.
✔ Excessive forward lean
Loads quads more, increasing tendon demand.
✔ Narrow stance
May reduce stability and shift load forward.
✔ Low cadence
Amplifies peak knee load per stride.
Technique changes are subtle — not exaggerated.
Modify when:
✔ Pain warms up
✔ Pain stays mild (0–3/10)
✔ Doesn’t change your running mechanics
✔ Settles within 24 hours
Stop when:
❌ Pain increases during the session
❌ Running technique becomes altered
❌ Weakness or giving-way occurs
❌ Pain persists strongly into the next day
Most runners experience improvement within:
2–6 weeks with strength + load modification
8–12 weeks for full resolution in long-standing cases
Consistency matters far more than intensity.
The information in this article is general in nature and does not constitute personalised medical or health advice. Always consult a qualified healthcare professional for assessment and guidance tailored to your individual needs.
