top of page

Patellar tendinopathy

Updated: May 31, 2020

close up of knee on a bike

A very common overuse injury causing pain at the tendon below the patella (kneecap). Cyclists often continue with this pain for quite some time until it gradually causes to much pain to push down during the pedal stroke.

What causes Patellar tendinopathy?

Changes in loading (stress), or the tendons ability to deal with this loading causes changes within the structure of the tendon. This may initially cause some inflammation and pain. However it is the changes to the structure of the tendon and its ability to take forces being applied to it that ultimately lead to the drop in performance and pain we see with this condition.

Risk Factors

  • Sudden changes in training volume and intensity are commonly cited as the cause of the problem - e.g taking up riding for the first time or building up for a bigger event.

  • A new bike, a new position or bike fit,

  • Increase in cycling on hilly or mountainous terrain.

  • Pedaling with a very low cadence of high gear (this is known as over-gearing)

  • A history of pain in the front of your knee is also linked to a greater risk of developing patellar tendinopathy.

  • Relative quadriceps muscle weakness and also over reliance upon the knee to generate power when cycling

What are the symptoms?

  • Pain is always very well localised to the tendon and will be tender to the touch. The tendon is located between the lower point of the kneecap and the bony bump at the top/front of your shin bone (tibia).

anatomical illustration of a knee displaying the patella and patellar tendon
  • It is often most tender at the very top, at its attachment to the kneecap.

  • In very acute cases there may be some slight swelling or thickening to the tendon compared to the other side.

  • In cycling, riders will complain of pain during the down stroke (power phase) of pedaling. However, it is often worst at the beginning of the ride, before easing off (sometimes completely), and then coming back towards the end of the ride or afterwards.

How can I manage Patellar tendinopathy?

Settle Acute Symptoms

  • If there is minor swelling and pain when not cycling then it is worthwhile icing the area regularly through the day.

  • Tips for Icing: 20 mins at a time. Do not place ice directly on skin (use thin towel). Allow at least 1 hour between each application

  • You can consider the use of ibuprofen to help with both the pain and the possible presence of acute inflammation. **Please consult with your doctor before commencing any course of medication**

  • Taping the knee may also provide short term pain relief and allow acute symptoms to settle more quickly - it is best to see an experienced physio to help with this but here is a demonstration of the technique. Book a Physiotherapy consultation

Activity Modification

  • If you are unable to perform any cycling without pain then you must take a short period of total rest from the bike until acute symptoms settle.

  • The ideal setting to re-introduce cycling is either with your bike on a home trainer or on a wattbike (or other gym bike) that you know to be set up correctly for you. This is preferable as it allows you to time a specific session, stop early, use the resistance tolerated rather than what outdoor conditions may dictate.


  • A tendon’s job is to transfer force from our muscles to our bones and thus generate motion around a joint. As such, it is vital that we maintain and re-build the tendon’s capacity to do so as part of the rehabilitation.

  • As a general rule, it is acceptable to have some low level discomfort when starting out with strengthening (or loading) exercises but a suggested upper limit for this is 4/10 (in the tendon area) during the exercise. Following that it is expected that the symptoms settle back down completely in 24hrs or the loading is considered beyond the tendon’s current ability to adapt and thus recover.

  • There are numerous recommendations for how best to start this process and unfortunately there is no single approach that will work equally well for all people. As such it is at this point that it really helps to seek guidance from an a physio who is experienced with both cyclists and tendon rehabilitation.

Bike Fit

The most common fitting errors I encounter with clients who present with patellar tendinopathy are:

  • Saddle height too low

  • Saddle too far forward

  • Saddle angled downward at the front

  • There are of course many others and as I always say, care must be taken when changing the position of one contact point as it will have a knock-on effect on others.

  • You may have had a bike fit recently or in the years prior but the combination of the current injury and you position are not compatible and often a ‘modified’ or ‘short-term’ fit is required as part of the treatment approach.

Make a Bike Fit enquiry

Shockwave Therapy

  • There is a building evidence base for using shockwave therapy to help manage tendon pain, promote healing, and assist in rehabilitation. I am lucky enough to have access to one of these devices at the clinic where I work and find it is extremely beneficial.

Other Adjuncts

  • Massage, using foam rollers, acupuncture and other forms of myofascial release may assist in easing some muscle tension in the quads but they do not address the core problem. So, while they are not necessarily curing the problem they may form part of a comprehensive treatment regime.

  • Stretching and flexibility is rarely the main cause of developing patellar tendon problems. However, if you simply lie on your front and struggle to get your heel to touch your backside then some work on stretching out your quads may be helpful.

What else could it be?

If you are having issues with your knee and want to get in touch about booking a consultation or a bike fit then please email us:



bottom of page