Why Your Knee Pain Won’t Go Away: The Truth About Patellar Tendinopathy and What to Do About It
We’ve all been there…
You’re deep in a training block, gearing up for your next race. Then—out of nowhere—a slight ache creeps into your knee. You brush it off. Runners push through pain, right?
But it lingers.
First, it comes and goes. Then, it sticks around. You take a week off. Pop some ibuprofen. Hope it settles.
You return to training. But the pain? Still there.
Eventually, you visit a doctor. The diagnosis: Patellar Tendinitis.
Your reaction? What the F...?!
🤔 So… How Did This Happen?
Patellar tendinopathy doesn’t strike randomly. It builds silently from a mix of factors like:
⏱️ Sudden training spikes
😴 Poor sleep and recovery habits
🍽️ Suboptimal nutrition
🏃 Inadequate strength or tissue preparation
🦵 Faulty biomechanics or limited joint mobility
It’s not just about “doing too much”—it’s about doing more than your body is ready for.
🧬 The Tendon Continuum: What Science Now Tells Us
Modern research no longer views tendinitis as just inflammation. Tendon pathology is now seen as a continuum with three stages:
1. Reactive Tendinopathy
Triggered by acute overload or trauma
Often affects younger, active individuals
Involves tendon thickening as a protective response
2. Tendon Dysrepair
Chronic overload leads to collagen disorganization
Seen across all ages
Reversible with proper load management and strength training
3. Degenerative Tendinopathy
Occurs in older athletes or high-level competitors
Cellular breakdown and poor healing capacity
97% of ruptured tendons show degeneration
These phases have been well-described in the literature and should guide how we rehab tendon pain responsibly¹.
✅ Here’s the Good News
You don’t need to stop running.
At Resolve PT and Performance, we help runners train through tendon pain—safely and effectively.
The key? Load management and smart guidelines:
“It’s OK to run with pain—as long as the pain is stable and returns to baseline within 24–48 hours.”¹
🛠️ Our 3-Step Approach to Patellar Tendinopathy
1. Restore Your Mobility
Limited hip, knee, or ankle range of motion can increase tendon stress. We assess your movement to identify and fix joint restrictions.
2. Progressive Strength Loading
Tendons love tension. Controlled, progressive resistance promotes healing and tissue regeneration².
Progression Example:
Start: 4 sets of 15 reps @ max voluntary contraction
Progress: 4 sets of 5–6 reps @ high intensity (8/10 effort)
3. Targeted Exercises for Patellar Tendinopathy
These are evidence-based and built into your individualized program:
Knee Extensions – 80–90% max voluntary contraction
Goblet or Zercher Squats – RPE 8/10
Knee Isometrics – 5 x 30s @ 60% contraction for pain modulation²
🔁 What’s Next?
We’ll be diving deeper into tendon pain in upcoming posts, including:
Return-to-run progressions
Achilles tendinopathy strategies
Long-term tendon health and performance tips
🏃 Ready to Train Smarter—Not Just Harder?
If knee pain is holding you back, it’s time for a smarter plan.
Our performance-based rehab helps runners stay active, rebuild strength, and train with confidence.
📲 Click here to schedule your consult or download our free guide:
“5 Reasons You’re Still in Pain—and How to Fix It”
📚 References
Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. J Orthop Sports Phys Ther. 2015;45(11):887-898. doi:10.2519/jospt.2015.5987
2. Breda SJ, Oei EHG, Zwerver J, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021;55(9):501-509. doi:10.1136/bjsports-2020-103403
