Jumper’s Knee vs Runner’s Knee: Understanding the Difference and How to Manage Them

Written By Mostafa Khatab

Knee pain is one of the most common complaints among active individuals. Two conditions that often cause confusion (both among patients and health professionals) are Jumper’s Knee (Patellar Tendinopathy) and Runner’s Knee (Patellofemoral Pain Syndrome). Despite both affecting the front of the knee, their underlying causes, symptoms, and management strategies are quite different.

This article explores the pathophysiology, acute and long-term management, and how to distinguish between these two commonly misdiagnosed conditions.

What Is Patellar Tendinopathy (Jumper’s Knee)?

Patellar Tendinopathy, often referred to as Jumper’s Knee, is an overuse injury affecting the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). It typically develops in athletes involved in sports that require explosive loading, such as basketball, volleyball, or football.

Pathophysiology:

Contrary to earlier beliefs of inflammation, patellar tendinopathy is now recognised as a degenerative condition rather than a purely inflammatory one. Histological studies show disorganised collagen, increased ground substance, and neovascularisation, but a lack of inflammatory cells. The pain is thought to arise from nociceptive nerve fibres and biochemical irritation within the tendon.

What Is Patellofemoral Pain Syndrome (Runner’s Knee)?

Patellofemoral Pain Syndrome (PFPS), often called Runner’s Knee, is not a tendon problem but a mechanical dysfunction involving the patellofemoral joint - where the kneecap meets the femur. It is caused by abnormal patellar tracking, often due to muscle imbalance, biomechanical dysfunction, or increased load on the joint.

Pathophysiology:

The exact mechanism is multifactorial. Contributors include:

  • Malalignment of the patella

  • Weakness or delayed activation of the vastus medialis oblique (VMO)

  • Poor gluteal control

  • Tight lateral structures (e.g. ITB)

  • Altered foot mechanics, such as overpronation

This leads to increased joint stress, resulting in pain, irritation of subchondral bone, and occasionally synovial inflammation.

Key Differences:

Feature Patellar Tendinopathy Patellofemoral Pain Syndrome Location of Pain Inferior pole of patella Peri- or retro-patellar region Onset Gradual, due to repetitive jumping/loading Gradual or acute, often load-related Primary Tissue Involved Patellar tendon Patellofemoral joint surfaces Pain Provoked By Jumping, squatting, stairs Sitting, stairs, running, hills Population Jumping athletes Runners, sedentary, young females

Acute Management

Patellar Tendinopathy:

  • Relative rest from aggravating activity, but not complete rest

  • Isometric exercises (e.g. Spanish squats) to reduce pain and maintain strength

  • Avoid stretching the tendon in the acute phase

  • Load modification is critical - manage volume and intensity

Patellofemoral Pain Syndrome:

  • Activity modification: avoid prolonged sitting, stairs, and deep knee flexion

  • Ice and NSAIDs may help reduce inflammation

  • Taping (e.g. McConnell taping) to alter patellar tracking

  • Correct footwear or orthotics if indicated

Long-Term Rehabilitation

1. Load Management

Both conditions require a careful return-to-activity plan. While patellar tendinopathy responds to progressive tendon loading, PFPS demands a broader focus on movement mechanics.

2. Strengthening

  • Tendinopathy: Emphasis on eccentric and heavy slow resistance training (HSR) of the quadriceps and calf.

  • PFPS: Focus on gluteal strengthening, VMO activation, core control, and gradual quadriceps loading.

3. Manual Therapy and Adjuncts

  • Soft tissue release for surrounding tight structures (e.g. quads, ITB)

  • Patellar mobilisation or dry needling where appropriate

  • Shockwave therapy or cryotherapy in chronic tendinopathy cases

4. Gait and Biomechanics Correction

Addressing abnormal movement patterns is crucial in PFPS. Physiotherapists often assess and retrain:

  • Gait and running mechanics

  • Dynamic knee valgus

  • Foot posture and pronation

Return to Sport Considerations

Returning too early is one of the main reasons for recurrence in both conditions. Before resuming full sport, ensure:

  • Pain-free strength tests

  • Full range of motion

  • Satisfactory functional tests (e.g. single-leg hop, squat)

  • Progressive sport-specific drills

When to Refer to a Physio

If symptoms persist beyond 2 - 3 weeks or worsen with activity, it’s advisable to see a physiotherapist. At KINETIQ REHAB, we offer:

  • Comprehensive biomechanical assessments

  • Individualised rehab programs

  • WorkCover and NDIS physiotherapy

  • Ongoing support through all stages of rehab

Conclusion

Although Jumper’s Knee and Runner’s Knee may sound similar, their causes, symptoms, and treatment approaches are distinct. Accurate diagnosis and targeted management are essential for optimal recovery. With the right approach, both conditions are highly treatable, and long-term outcomes can be excellent.

References

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Rabello, L.M., van den Akker-Scheek, I., Kuipers, I.F. et al. Bilateral changes in tendon structure of patients diagnosed with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 28, 1631–1638 (2020). https://doi.org/10.1007/s00167-019-05495-2

Pearson SJ, Stadler S, Menz H, Morrissey D, Scott I, Munteanu S, Malliaras P. Immediate and Short-Term Effects of Short- and Long-Duration Isometric Contractions in Patellar Tendinopathy. Clin J Sport Med. 2020 Jul;30(4):335-340. doi: 10.1097/JSM.0000000000000625. PMID: 30095504.

Hart HF, Patterson BE, Crossley KM, et al. May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions—a systematic review and meta-analysis. British Journal of Sports Medicine 2022;56:521-530.

Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. The Journal of orthopaedic and sports physical therapy. 2015 Sep:1-33.

Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Núñez-Nagy S, Pecos-Martín D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. Journal of physical therapy science. 2015;27(7):2387-90.

Santos TR, Oliveira BA, Ocarino JM, Holt KG, Fonseca ST. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Brazilian journal of physical therapy. 2015 May;19:167-76.

Mostafa Khatab