Patellar tendinopathy
Jumper’s knee
Pain below the kneecap that comes back after every break.
Jumper’s knee doesn’t heal through rest. It heals through the right loading — at the right time. We determine both.
Four weeks, five appointments, one team. You’re not left alone with your symptoms.
up to 45%
of professional volleyball players affected
>80%
return to sport with structured therapy
25°
decline-squat angle — the gold standard
Your APPOINTMENT at OMC
Four weeks, five appointments, one team.
Orthopedics and internal medicine in one integrated concept — for patients who value thorough diagnostics and structured treatment.
03
Final appointment: assessment and next steps
Personal review with Dr. Klein after four weeks. Three possible paths: pain-free — handover to the home maintenance program; improved but not yet complete — follow-up appointment in four weeks; insufficient improvement — further diagnostics or therapy escalation, such as a PRP injection or MRI.
02
Weeks 2–4: three supervised therapy sessions
Weekly appointments in the therapy room with the three-person therapy team. Multimodal treatment package (shockwave, magnetic field, cryo), exercise correction and progression, re-taping, progress review based on the pain diary. Daily internal case discussion — every patient stays in view.
01
First appointment: diagnosis and immediate start of treatment
History, clinical examination, and ultrasound. Immediately afterward: treatment begins in the therapy room — shockwave, magnetic field, cryotherapy, kinesiotape, exercise guidance from the team. You leave the practice with a plan, the pain diary, and four scheduled follow-up appointments.
Four weeks, five appointments, one team — a clear plan from day one.
In many cases, jumper’s knee can be treated alongside continued training — with reduced jump volume and consistent strength training. Those who start early and stick with the phase model have a good chance of playing the next season without limitation.
Increasing pain over the course of the season — despite unchanged training
Cumulative damage without adequate recovery; early symptoms are often ignored.
"Movie sign" — pain after sitting for a long time
Getting up from a bent-knee position hurts, then loosens after a few steps.
A tendency to swell at the lower edge of the kneecap after intense loading
A visible sign of irritation at the tendon-bone junction; typically appears after high jumping loads.
Start-up pain that briefly "walks off"
Painful for the first minutes — a marked increase after training.
Going down stairs, landing after a jump — painful
Especially during eccentric deceleration, less when walking uphill.
Stabbing pain right at the lower pole of the kneecap
Very precisely localizable — at the tendon insertion, not in the joint.
"I took two months off. When I started again, the pain was back just as strong after the third session."
This is a typical pattern. Rest reduces the pain — but it doesn’t heal the tendon. Tendinopathies usually require not complete rest but adapted, controlled loading — progressive and specifically targeted at the tendon structure.
Recognizing symptoms
Does this sound familiar?
Jumper’s knee has a very characteristic pain pattern: pinpoint, load-dependent, directly below the kneecap. Anyone who knows the symptoms recognizes them immediately.
Common pitfalls
Why it often doesn’t get better
Jumper’s knee often becomes chronic — not because it’s hard to treat, but because the wrong measures are used in the wrong order.
The patient is left alone with a set of exercises
An exercise sheet handed over on the way out is not a treatment plan. Without guidance, correction, and regular progress checks, half the exercises end up only half correct — and the tendon doesn’t respond. Tendon healing needs support, not just a recommendation. At OMC the therapy team supports you weekly.
Cortisone — frequently used, rarely effective
Cortisone relieves pain in the short term — but inhibits the tendon’s collagen synthesis. The study by Coombes et al. (JAMA 2013) shows significantly worse outcomes for tendinopathies one year after a cortisone injection than after conservative therapy. At the patellar tendon there is additionally an increased risk of tendon rupture. Anyone who trains again immediately after a cortisone shot loads a structurally weakened tendon.
Eccentric training without a decline board — the wrong exercise
Squats on level ground or stepping down from a step reduce the tension on the patellar tendon. That sounds safer — but it’s ineffective for tendon regeneration. The 25° decline board is decisive: it increases the eccentric load on the patellar tendon while reducing compressive load on the patellofemoral joint. Anyone doing this exercise without the incline is training the wrong target tissue.
Rest without targeted training — the most common mistake
Complete rest from sport reduces pain because the tendon is no longer loaded. But tendinopathies don’t heal through rest — they need progressive mechanical stimulus. Anyone who simply resumes as before after the break starts back into the same load with an even more degenerated tendon. The result is well known: the pain returns, often faster than before.
The OMC approach
What’s different at OMC.
Tendons don’t heal through isolated measures but through the right system: diagnostics, multimodal therapy, and support over four weeks — consistent and structured.
Internal-medicine perspective as routine
Vitamin D, thyroid, metabolism — those who know these factors treat not just the tendon but create the physiological basis for healing. Particularly relevant in athletes with multiple overuse injuries.
Isometric exercises as an immediate measure
Isometric knee-extensor holds (5 × 45 sec at 70% of maximal strength) reduce pain immediately — via cortical inhibition mechanisms. They bridge the phase until the training is fully effective.
Multimodal treatment package as standard
Shockwave, magnetic field therapy, and cryotherapy combined in every session — that is the OMC standard for every tendon patient. PRP is used specifically as an escalation when the standard package isn’t enough. The procedures are available directly at the practice.
Decline-squat protocol — correctly guided
25° incline, 3 × 15 repetitions daily, progressively loaded — the protocol established in the original studies (Purdam 2004, Young 2005). Correct execution is guided, because the specific eccentric loading of the patellar tendon only occurs with this geometry.
Specialist in
Internal
medicine
Assessment of thyroid function, vitamin D status, diabetes status, and medication history. Whatever blocks tendon regeneration from within is found and treated." und „Ultrasound, clinical differential diagnostics, ESWT, PRP injection, eccentric training protocol, ergonomics advice — all from a single source.
Specialist in
Orthopedics &
trauma surgery
Ultrasound, clinical differential diagnostics, ESWT, PRP injection, eccentric training protocol, ergonomics advice — all from a single source.
What we examine
Diagnostics at the OMC practice
With classic symptoms, the clinical diagnosis is usually clear — ultrasound and functional analysis confirm the findings and form the basis for the treatment plan.
01
History — sport, training volume, course
Sport, training frequency, changes in training volume (the most common trigger: an abrupt increase), playing surface (indoor floor, tartan), footwear, previous treatments, cortisone history.
Internal medicine: vitamin D status, thyroid, diabetes status, medication (fluoroquinolones as a risk factor).
> Training planning and load management is a building block of therapy
02
Clinical examination — patellar tendon tests under load
Pressure on the lower patellar pole with the knee extended (more sensitive, tendon relaxed) and with the knee flexed to 90° (tendon under tension). Pressure pain that clearly decreases on flexion is typical of patellar tendinopathy (Maffulli 2017). In addition: squat test, single-leg squat, pain reproduction under load. Differentiation from patellofemoral pain syndrome (diffuse retropatellar pain) and Hoffa’s syndrome (infrapatellar fat pad).
> Distinguishes the patellar tendon from other anterior knee pain
03
Ultrasound — tendon structure and confirmation of diagnosis
Thickening of the proximal patellar tendon at the lower patellar pole, hypoechoic areas (degeneration), neovascularization (source of pain, indicates active pathology), calcifications, tendon thickness compared side to side. Ultrasound confirms the diagnosis, rules out other pathologies, and serves for progress monitoring: has the tendon responded to therapy?
> The basis for targeted therapy rather than guesswork
The OMC advantage: structured therapy instead of isolated measures
Ultrasound confirms the diagnosis. The multimodal treatment package (shockwave + magnetic field therapy + cryotherapy) is the standard for every patient. PRP is used specifically when the standard therapy isn’t enough. That’s how therapy is decided, not guessed.
Treatment concept
Therapy approach.
Individual & multimodal
Jumper’s knee follows a clear phase model: from pain reduction through strength building to a sport-specific return. Four weeks, five appointments, one team at your side — each phase with clear goals.
Isometrics immediately, decline squat as the foundation
The two core exercises — in this order. Isometric knee extensors for immediate pain relief, decline squat for structural tendon regeneration.
Isometric holds: 5 × 45 sec at ~70% of maximal strength, daily; reduces pain immediately (cortical inhibition); bridges the gap until training takes effect
Decline-squat protocol (25° board): 3 × 15 reps daily, progressive over 8–12 weeks; gold standard for eccentric patellar-tendon loading
Reduce training load, but not to zero — halve jump volume, no change-of-direction training in the acute phase
Surface optimization: avoid harder floors; footwear with adequate cushioning
Kinesiotaping: temporary relief during the transition phase
Metabolism & cofactors
What blocks tendon regeneration from within — and what athletes often don’t get checked.
Vitamin D3 + K2 — deficiency directly associated with musculoskeletal overuse injuries
Normalize thyroid function — always assess in multiple tendinopathies
Weight optimization — reduces tensile load with every jump and landing
PRP · cortisone (contraindicated)
Platelet-rich autologous blood (PRP) — yes. Cortisone into the patellar tendon — no.
PRP ultrasound-guided — into the altered tissue; promotes collagen synthesis; no risk of rupture
Cortisone — not into the patellar tendon; inhibits collagen synthesis and increases the risk of rupture
Local anesthetic — as part of the PRP injection
ESWT · PRP · magnetic field · cryotherapy
The multimodal standard package at OMC — as a fixed combination in every therapy session.
Focused shockwave therapy (ESWT) — at the lower patellar pole; stimulates collagen reorganization and reduces neovascularization; typically 3–5 sessions; in studies the combination with eccentric training shows the best results.
Pulsed magnetic field therapy (PEMF) — adjunctive to ESWT; supports tissue regeneration.
Cryotherapy — local pain relief and reduced irritation after loading.
PRP — as an escalation when there is no response; ultrasound-guided into the degenerated area of the proximal patellar tendon; several RCTs show better medium-term results than cortisone.
Multimodal therapy + decline squat shows better results than isolated measures.
PRP is used specifically as an escalation when the standard package isn’t enough. The phase model is not a comfort — it is medicine. Skipping it risks recurrence.
Healing perspective
What you can realistically expect
The prognosis for jumper’s knee is good — with a structured, phased program, over 80% of patients return to sport. Patience is the most important variable: tendon regeneration takes months, not weeks.
"Tendon healing is not a single measure but a process. Those who commit to the program see a different knee pain after four weeks than before."
Dr. Roman Klein, MD, Ortho Motion Concept
Long chronic course before therapy
Prior cortisone treatment into the tendon
Returning to jumping sports too early
Bilateral occurrence (bilateral tendinopathy)
Early start of treatment
Consistent daily decline-squat program
Phase model not skipped
Systemic cofactors treated
→
clearance for sport by a standardized functional test — not by the calendar
3–6
months to full athletic load capacity with pronounced changes
>80%
return to sport with a conservative phased program
Frequently asked questions
What patients ask us
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May I keep training and playing?
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What exactly is the decline squat — and why do I need that special board?
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How long does treatment take until return to sport?
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What does PRP achieve in jumper’s knee?
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When do I need surgery?
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Could a vitamin D deficiency or my thyroid have contributed?
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What is the difference between the OMC Tendon Center and a standard orthopedic practice?
Your next step
Rest didn’t help.
Now comes the right kind of loading.
Book your first appointment now. You leave the practice with a clear diagnosis, a written four-week plan, and the start of your therapy. You don't come in for an examination — you enter a structured program with a team that won't leave you on your own.
Ultrasound-confirmed diagnosis
Decline-squat protocol correctly guided
Multimodal treatment package: shockwave, magnetic field, cryo available on site
Internal-medicine assessment of systemic cofactors included
Medical note
This content serves general medical information and does not replace individual medical advice or examination. For persistent, unclear, or worsening complaints, please consult a physician. Dr. Roman Klein, MD, Specialist in Orthopedics & Traumatology and Internal Medicine · Ortho Motion Concept · Europastraße 3 · 67433 Neustadt an der Weinstraße.