Etiology — what causes it

Load-related changes within the patellar tendon, most commonly at the proximal insertion. Contributors include rapid increases in jump and cutting volume, deconditioning, training error, and inadequate eccentric capacity.

Epidemiology — who gets it

Common in volleyball, basketball, and jumping athletes (prevalence up to 45% in elite volleyball — Lian et al., AJSM). Peak age 18–30 in athletes; can occur later in recreational populations.

Clinical signs

Tenderness at the inferior pole of the patella, pain with single-leg decline squat (VISA-P functional test), preserved range, no instability or effusion. Quadriceps strength asymmetry common.

Symptoms

Anterior knee pain at the inferior pole of the patella, worse with jumping, cutting, deep squats, and after activity. Often progressive after a training volume increase. Stiffness in the morning or after sitting.

Best evidence for chiropractic treatment

Heavy slow resistance loading (Kongsgaard et al., Scand J Med Sci Sports; Beyer et al., AJSM 2015) outperforms eccentric-only and traditional approaches in multiple RCTs. Progressive loading through a 12-week phase-based protocol — isometric → heavy slow resistance → energy storage — is the modern standard. Manual therapy and modalities are adjuncts at best.

Subtypes

  • Proximal patellar tendinopathy. Most common; inferior pole of patella.
  • Distal patellar tendinopathy. Tibial tuberosity insertion.
  • Quad tendinopathy. Superior pole of patella; often in older athletes.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Patellar tendinopathy is a capacity issue. Heavy slow resistance loading over 12 weeks drives recovery — rest alone makes it worse.