Patellar Tendinopathy in Runners: Why Your Knee Hurts and What Actually Helps
If you’re a runner dealing with pain right at the front of your knee (especially pain that shows up during hills, speed work, or after harder training weeks) there’s a good chance you’ve been told you have “runner’s knee.”
But for many runners, what’s actually going on is patellar tendinopathy.
At our clinic here in the Atlanta area, this is one of the most common knee issues we see in runners and also one of the most misunderstood. The good news? When you understand why it’s happening, it becomes much easier to fix.
Let’s break it down in a way that actually makes sense.
First Things First: What Is Patellar Tendinopathy?
Your patellar tendon connects your kneecap (patella) to your shin bone (tibia). Every time you run, jump, or go downhill, this tendon helps absorb and transfer force from your quadriceps to your lower leg.
Patellar tendinopathy happens when that tendon is asked to handle more load than it’s currently prepared for, repeatedly. As with all tendinopathy injuries in runners, this isn’t usually inflammation; it’s a load tolerance problem. Read more on tendinopathy here.
That’s why runners often say:
“It hurts during the run, but warms up”
“It’s worse the day after hard workouts”
“Flat runs are okay, but hills kill it”
“Speed work sets it off immediately”
Sound familiar?
Why Runners Develop Patellar Tendinopathy
Patellar tendinopathy doesn’t come out of nowhere. In runners, it usually shows up when training demands change faster than the body can adapt. When we talk to runners that come into our clinic, we can usually pinpoint when exactly in their training they may have increased their risk for patellar tendinopathy. The most common triggers we see in Atlanta runners include:
1. Sudden Training Changes
Increasing mileage too quickly
Adding speed work or track sessions
Introducing hills (particularly running more downhill)
Small changes add up quickly so it’s really important to make calculated and gradual increases in your running volume or intensity during a training block.
2. Quad-Dominant Running Patterns
If your quads are doing most of the work and your glutes and/or hamstrings aren’t contributing enough, the patellar tendon ends up taking on extra stress. This is very common in runners who:
Sit a lot during the day
Have limited hip extension
Lack single-leg strength or control
3. Strength Deficits (Not Flexibility Issues)
Despite what many runners are told, patellar tendinopathy is rarely caused by “tight quads.” Much more often, it’s related to:
Reduced quad strength
Poor load tolerance
Weak hip and glute support
Stretching alone won’t fix that. You want to progressively overload the patellar tendon to help it be ready to match the demands of running all of those Atlanta hills (looking at you Midtown Atlanta and Piedmont Park).
4. Running Mechanics
Things like:
Overstriding
Excessive knee bend at landing
Poor control during downhill running
can all increase stress through the patellar tendon. This is where a running gait analysis can be incredibly helpful to give Atlanta runners insight into how to best address their running form.
What Patellar Tendinopathy Feels Like
Most runners describe:
Pain right below the kneecap
Tenderness when pressing on the tendon
Pain with stairs, hills or squats
Stiffness after sitting or first thing in the morning
Importantly, pain often improves with rest but comes right back when running resumes. That cycle is a big clue you’re dealing with a tendon issue.
Why Rest, Ice, and Stretching Usually Aren’t Enough
This is where frustration sets in. Many runners are told to:
Rest until pain goes away
Ice after runs
Stretch their quads
And while those things may calm symptoms temporarily, they don’t address the core issue: the tendon’s ability to handle load. Without rebuilding strength and capacity, the pain almost always returns once training resumes.
What Actually Helps Patellar Tendinopathy in Runners
The most effective approach combines smart load management, progressive strengthening and running-specific adjustments.
Here’s what that looks like in real life.
1. Modify Training (Not Shut It Down Completely)
In most cases, runners don’t need to stop running entirely. In fact, we prioritize keeping runners running when they come to us at Tempo PT & Performance.
Instead, we often:
Reduce hill volume
Temporarily limit speed work
Adjust weekly mileage
Space out harder efforts
The goal is to keep the tendon active and loaded, but within a tolerable range.
2. Progressive Strength Loading (This Is the Big One)
Tendons respond best to progressive, intentional loading, not avoidance. While your instinct may be to take time off completely, just know that will actually set you back more in the long run. If you only remember one thing from this blog, it’s that tendons need load!
For patellar tendinopathy, this usually includes:
Isometric quad exercises early on (to reduce pain)
Slow, controlled quad strengthening
Single-leg strength work
Gradual return to plyometric demands
This isn’t random exercise; the dosage and progression matter.
3. Address Hip and Glute Strength
Strong hips help offload the knee. When hips do their job, the knee doesn’t have to overwork. We focus heavily on:
Glute medius and max strength
Single-leg control
Pelvic stability
4. Improve Running Mechanics
Sometimes small changes make a big difference:
Slightly increasing cadence
Reducing overstriding
Improving downhill control
These adjustments reduce peak load on the patellar tendon, especially during harder runs. Our 3D running analysis uses a sensor that can read just how much force your body is having to control with each stride which is extremely important information to have when dealing with tendon injuries in runners.
How Long Does Patellar Tendinopathy Take to Heal?
This is a common (and fair) question.
Most runners see meaningful improvement within 6–12 weeks when they follow a structured plan. Chronic cases may take longer, especially if the issue has been present for months or years. Some runners can see a reduction in pain in as short as just a few weeks but pain is not the only sign we look for to determine if something is “fixed”.
The key factor isn’t time alone; it’s consistency with the right loading strategy.
When Should You See a Physical Therapist?
If you’re a runner in the Atlanta area and:
Your knee pain has lasted more than 2–3 weeks
It keeps coming back every training cycle
You’ve tried resting without lasting success
Hills or speed work are no longer tolerable
It’s time for a running-specific physical therapy evaluation.
At Tempo Physical Therapy & Performance, we specialize in running physical therapy in Atlanta, including stubborn tendon injuries like patellar tendinopathy.
Our approach includes:
Strength and movement assessment
Running gait analysis
Tendon-specific loading plans
Clear guidance on how to keep training safely
The Bottom Line
Patellar tendinopathy doesn’t mean your running days are over. It means your tendon needs a smarter, more intentional approach to load.
If you’re tired of guessing and ready for real answers, we’re here to help. Book a free consultation with us to learn how you can get back to pain free running.
📍 Serving runners across Atlanta, Sandy Springs, Buckhead, Brookhaven, Roswell, Alpharetta, Smyrna and surrounding areas.
