The patellar tendon runs from the inferior pole of the patella (kneecap) to the tibial tuberosity (the bony prominence below the knee). It acts as the final link through which quadriceps force is transmitted to extend the knee, meaning it is exposed to very high tensile loads during running and jumping.
Tendinopathy refers to a failed healing response within the tendon. With excessive or repetitive loading, the collagen structure becomes disorganised, new blood vessels form within the tendon (neovascularisation), and accompanying nerve growth can contribute to pain. This is primarily a degenerative process rather than an inflammatory one.
What drives patellar tendinopathy:
Rapid increases in training load: The most common cause. The tendon is unable to adapt to sudden increases in jumping, sprinting, or overall training volume
High jumping and landing demands: Common in sports such as basketball, volleyball, athletics (jump events), football, and gymnastics
Quadriceps and hip strength deficits: Reduced capacity in these muscle groups increases relative load on the tendon
Training surface and footwear: Hard surfaces and inadequate footwear can increase impact forces
Rapid weight gain: Increases mechanical load through the tendon with each movement
The patellar tendon runs from the inferior pole of the patella (kneecap) to the tibial tuberosity (the bony prominence below the knee). It acts as the final link through which quadriceps force is transmitted to extend the knee, meaning it is exposed to very high tensile loads during running and jumping.
Tendinopathy refers to a failed healing response within the tendon. With excessive or repetitive loading, the collagen structure becomes disorganised, new blood vessels form within the tendon (neovascularisation), and accompanying nerve growth can contribute to pain. This is primarily a degenerative process rather than an inflammatory one.
What drives patellar tendinopathy:
Rapid increases in training load: The most common cause. The tendon is unable to adapt to sudden increases in jumping, sprinting, or overall training volume
High jumping and landing demands: Common in sports such as basketball, volleyball, athletics (jump events), football, and gymnastics
Quadriceps and hip strength deficits: Reduced capacity in these muscle groups increases relative load on the tendon
Training surface and footwear: Hard surfaces and inadequate footwear can increase impact forces
Rapid weight gain: Increases mechanical load through the tendon with each movement
LPAW’s clinical team includes 19 practitioners, many holding postgraduate qualifications from UCL, King’s College London, and Guy’s and St Thomas’. Lead clinician Mr Arjun Viswanath MSc, MCSP, MPPA – Co-Founder and Consultant Physiotherapist – brings 25+ years of NHS and private experience including BMI London Independent Hospital and Harley Street.
Every clinician joining LPAW completes a mandatory intensive shadowing placement with our Consultant Physiotherapist before seeing patients independently. This is not a standard practice at most clinics – it’s our way of maintaining clinical consistency across the team.
Progressive tendon loading is the cornerstone of patellar tendinopathy management. The current best-evidence approach is heavy slow resistance training, which uses controlled, slow-tempo loading to place sustained tensile stress on the tendon. This stimulates collagen synthesis and supports tendon remodelling over time.
The LPAW patellar tendinopathy programme follows a four-stage loading progression:
Stage 1 — Isometric loading
Sustained static quadriceps contractions (such as wall sits or leg press holds) performed daily. Isometric work can reduce pain in the short term and is useful both therapeutically and as a warm-up before activity. This stage is typically used when symptoms are reactive or irritable.
Stage 2 — Isotonic (heavy slow resistance) loading
Slow-tempo exercises such as squats, leg press, and split squats with progressive loading. A common prescription is 3 sets of 15 repetitions with a controlled 4-second concentric and 4-second eccentric phase, progressing towards heavier loads with lower repetitions (e.g. 6-rep sets).
Stage 3 — Energy storage loading
Introduction of plyometric and elastic loading tasks such as box jumps, depth drops, and progressive hopping. This phase targets the tendon’s ability to absorb and release energy and should only begin once the tendon tolerates previous loading without symptom reactivity.
Stage 4 — Sport-specific loading
Gradual return to full sporting demands, including jumping, sprinting, and court-based movements, progressed in a structured and criteria-based manner.
Load management is essential throughout all stages. Total jumping and sprinting volume should be reduced initially and then rebuilt gradually to prevent symptom flare-ups or reactive episodes.
[Physiotherapy] sessions include:
Shockwave therapy may be used for specific presentations of chronic back pain — particularly those involving myofascial trigger points or thoracolumbar fascial pain — though it is not the primary treatment for most back pain presentations.
Progressive tendon loading is the cornerstone of patellar tendinopathy management. The current best-evidence approach is heavy slow resistance training, which uses controlled, slow-tempo loading to place sustained tensile stress on the tendon. This stimulates collagen synthesis and supports tendon remodelling over time.
The LPAW patellar tendinopathy programme follows a four-stage loading progression:
Stage 1 — Isometric loading
Sustained static quadriceps contractions (such as wall sits or leg press holds) performed daily. Isometric work can reduce pain in the short term and is useful both therapeutically and as a warm-up before activity. This stage is typically used when symptoms are reactive or irritable.
Stage 2 — Isotonic (heavy slow resistance) loading
Slow-tempo exercises such as squats, leg press, and split squats with progressive loading. A common prescription is 3 sets of 15 repetitions with a controlled 4-second concentric and 4-second eccentric phase, progressing towards heavier loads with lower repetitions (e.g. 6-rep sets).
Stage 3 — Energy storage loading
Introduction of plyometric and elastic loading tasks such as box jumps, depth drops, and progressive hopping. This phase targets the tendon’s ability to absorb and release energy and should only begin once the tendon tolerates previous loading without symptom reactivity.
Stage 4 — Sport-specific loading
Gradual return to full sporting demands, including jumping, sprinting, and court-based movements, progressed in a structured and criteria-based manner.
Load management is essential throughout all stages. Total jumping and sprinting volume should be reduced initially and then rebuilt gradually to prevent symptom flare-ups or reactive episodes.
Shockwave therapy may be used for specific presentations of chronic back pain — particularly those involving myofascial trigger points or thoracolumbar fascial pain — though it is not the primary treatment for most back pain presentations.
What We Do
