Tendon pain below the kneecap from jumping
Written by Coach Moose. Not yet reviewed by a physiotherapist. · Published 6 November 2026
It's a pinpoint ache just under the kneecap. It's stiff first thing, warms up nicely, and then bites you the next day after box jumps, double-unders or a big volume of wall balls.
A clinician may call this patellar tendinopathy, but other things can hurt in the same spot. A physio can tell you what you're dealing with.
The short version
- Exercise loading is the first-line approach in the research.12
- Heavy, slow work and a staged loading program both have trial support.234
- Isometrics may ease pain for some people, but results are inconsistent.56
- Expect this to take months. The Dutch guideline suggests at least 12 weeks of progressive loading.2
What the research says
A 2021 review of 37 trials and 1,332 people put exercise loading first, and found heavy slow resistance at least as good as eccentric training, based on a single study.1 The Dutch guideline prefers heavy slow resistance, while rating the tendon exercise evidence as very low certainty.2
A small trial of 39 men compared injections, eccentric decline squats and heavy slow resistance over 12 weeks. All groups improved, but the injection group got worse by six months.3
In a 2021 trial of 76 people, mostly young men, a staged tendon-loading program beat eccentric training by about 9 points on a 100-point tendon score at 24 weeks. There was no difference at 12 weeks. Return to sport was 43% versus 27%, a difference that wasn't statistically significant.4 The study was funded in part by the NBA and GE Healthcare.
What about isometrics?
A very small 2015 study of six volleyball players found big, immediate pain relief from isometric holds.5 A larger 2020 crossover study of 21 people found a small drop that was gone by 45 minutes, and isometrics were no better than dynamic exercise.6 Holds can be a useful tool, but don't expect magic.
What the 2021 trial's program looked like
This is the program from the study, for reference.4 It's a good example of how gradual this is. People moved up after a week with pain at 3 out of 10 or lower.
| Stage | Exercise | Dose in the study |
|---|---|---|
| 1 | Isometric holds at 60 degrees knee bend | Daily, 5 x 45 seconds at 70% of maximum effort |
| 2 | Isotonic strength work | Alternate days, 4 x 15 progressing to 4 x 6 |
| 3 | Plyometrics | Every third day, 3 x 10 up to 6 x 10 |
| 4 | Sport-specific work | Building back to sport |
A physio can set this up for you. In class, here's how we'd apply the same idea.
What to do in class
| If the workout says | Try this first | Bring it back when |
|---|---|---|
| Box jumps | Step-ups | Small hops feel fine the next day |
| Double-unders | Singles or bike | Hops feel fine |
| Wall balls | Lighter, lower volume | Squats are settled |
| Running | Bike or rower, then run-walk | No flare the next morning |
| Squats | Slow tempo, heavier as tolerated | Keep this one in |
Four phases back
Coaching starting points, not study doses.
| Phase | Do this | Gate |
|---|---|---|
| 1. Calm it down | Reduce jumps and fast loading, keep strength work, try wall-sit holds 4 x 30 seconds | Morning stiffness is settling |
| 2. Get it moving | Leg press or box squat, slow, 3 x 12 to 15 | Next-day pain stays steady |
| 3. Build it back | Heavier slow squats or leg press, 3 to 4 x 6 to 8, every second or third day | Load climbs with no next-day flare |
| 4. Make it ready | Small hops, then box jumps, then double-unders, one at a time | Jumps cause no next-day flare |
Coach note
Tendons reward patience. Keep a record of how your knee feels the morning after, and add one thing at a time. For more on how tendons adapt, read our tendon guide.
Quick answers
Should I stop jumping completely?
Usually you cut back and bring jumps back gradually. Talk to your physio about what's right for you.
How long will this take?
Expect months. Trials in this area ran for 12 to 24 weeks.
Will a knee strap help?
We don't have good evidence to share on that yet. If it helps you train, ask your physio.
Are injections a good idea?
That's a conversation for your doctor. In one small trial, the injection group did well early and got worse by six months.3
Want a hand building back to jumps?
Tell us what's going on. We'll help you work out your next step, including whether to see a physio first.
Talk to a coachAbout the author. Dai Manuel, known around the gym as Coach Moose, has 30 years of coaching experience across strength, conditioning and lifestyle coaching, and is a co-owner of CrossFit BC in Vancouver.
This article is general education, not a diagnosis or treatment plan. If you're unsure what's going on, or it isn't improving, see a physiotherapist or physician.
References
- Challoumas D, et al. Management of patellar tendinopathy. BMJ Open Sport Exerc Med. 2021;7:e001110.
- Ophey M, et al. Dutch multidisciplinary guideline on anterior knee pain. Knee Surg Sports Traumatol Arthrosc. 2025;33(2):457-69.
- Kongsgaard M, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790-802.
- Breda SJ, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy. Br J Sports Med. 2021.
- Rio E, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277-83.
- Holden S, et al. Isometric exercise and pain in patellar tendinopathy. J Sci Med Sport. 2020;23(3):208-14.