Patellar Tendonitis? Why the Back May Be the Real Cause
Key insights: 60-second read
- Patellar tendonitis is traditionally seen as an overuse injury - but this doesn't explain why only one side is affected, or why the tendon fails during normal use.
- Clinically, I'm finding a strong connection to the lower back - dysfunction in the mid-to-low back can alter how the knee is loaded.
- Two key exercises can address this hidden cause - foam roller back mobility and the couch stretch target the areas that influence knee function.
- Local + telehealth support available - personalised physio assessment in Port Macquarie or via video consult.
We traditionally look at Patellar Tendonitis as an overuse injury. However, I'm finding there might be more going on behind the scenes.
Clinically, I find that Patellar Tendonitis might be back-related, which may account for the many variables not currently explained by overuse alone.
Why is the patella tendon the area that fails? Why is often just the one side that becomes sore and not both? Why do we blame overuse when using our tissue is what it's designed for?
These questions have led me to reassess our current thinking around the cause of Patellar Tendonitis. It has also allowed me to take a step back and explore what its broader cause might actually be. And this is what's led me to the back.
Through assessment, treatment, and re-assessment of countless patient's knee tendonitis, I've been able to uncover some really interesting, and potentially thought-provoking things. Things that have fundamentally changed how I view and treat Jumper's Knee. Now, instead of just focusing on the knee itself, I've found it vital to focus on things that affect and influence the function of the knee.
On this page
Video: The Hidden Back Connection to Patellar Tendonitis
In today's video, I discuss this very connection I'm finding between the back and knee tendonitis and go through two exercises to help sort this out.
Why "Overuse" Doesn't Tell the Whole Story
The traditional model suggests that Patellar Tendonitis (Jumper's Knee) is simply an overuse injury - too much jumping, running, or loading without enough recovery. But this explanation leaves several important questions unanswered:
- Why the patellar tendon specifically? If overuse were the only factor, why does this particular tendon fail while others cope?
- Why is it often one-sided? Overuse typically affects both sides equally, yet many people have pain in only one knee.
- Why do we blame overuse when using tissue is what it's designed for? Our bodies are meant to handle repetitive loading. When they don't, it suggests something else is wrong.
These questions point to a deeper issue. The patellar tendon isn't failing because it's being used - it's failing because it's being used in a compromised mechanical environment.
The Back Connection: What I'm Finding Clinically
The nerves that supply the muscles around the knee, and influence how the knee joint functions, originate in the lower lumbar spine. When there's stiffness, joint dysfunction, or muscle imbalance in this area, it can alter the signals getting to the leg.
This may manifest as:
- Altered quadriceps and hamstring coordination
- Changes in how the patella tracks during movement
- Increased load on the patellar tendon during activities like jumping and landing
The knee itself may be structurally fine, but the control of the knee is compromised. The patellar tendon becomes the victim of a problem originating further up the chain.
Two Essential Exercises for Patellar Tendonitis
The video demonstrates two key exercises that target the areas most commonly contributing to patellar tendon dysfunction.
1. Foam Roller Back Stretch
This exercise targets the mid-to-lower back - the area that houses the nerve roots influencing the knee.
- Place a foam roller under your mid-back, positioned horizontally.
- Gently arch back over the roller, moving slowly up and down your spine.
- Stop on any areas that feel particularly stiff or tight.
- Hold on these spots for 30-60 seconds, breathing deeply.
- The goal is to restore mobility to the spinal joints, not just massage muscle.
2. The Couch Stretch
Tight hip flexors can pull the pelvis forward, altering the mechanics of the entire leg and increasing load on the patellar tendon.
- Place one knee into the back corner of a couch or chair.
- Keep your torso upright and gently drive your hips forward.
- You'll feel a stretch through the front of the hip of the kneeling leg.
- Hold for 60-90 seconds, breathing deeply.
- Repeat on both sides, spending more time on the tighter side.
Related: A more in-depth look at Patellar Tendonitis (ft. Jaeger O'Meara)
Helpful equipment for this video
- Power Band - for the couch stretch and other mobility work
- Lacrosse Ball - for targeted back and hip work
- Foam Roller - for the back mobility exercise
Please note: These are affiliate links. I may earn a small commission if you purchase through them, at no extra cost to you.
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- Grant
Frequently Asked Questions
Can lower back problems really cause knee pain?
Yes, absolutely. The nerves that control the muscles around the knee originate in the lower back. Stiffness or dysfunction in these spinal segments can alter how the knee is loaded and controlled, even without causing back pain. This is why the knee can be the messenger for a problem further up.
Do I still need to do knee-specific exercises?
Addressing the back is a crucial piece, but it doesn't necessarily replace local knee rehab. The most effective approach is often to address the hidden back dysfunction while also doing appropriate loading and strengthening for the patellar tendon. A physiotherapist can help you create a comprehensive plan.
How long does it take to see results from these exercises?
Many people notice an immediate change in how their knee feels after the first session, especially if they've identified a significant back restriction. However, lasting change requires consistent effort over weeks to months. The key is to keep addressing the root causes while also improving your movement patterns.
One key insight
"In my opinion, no treatment for Patellar Tendonitis is complete without a thorough assessment of the mid-low back. If we only focus on the knee, we run the risk of missing the bigger picture entirely."
Struggling With Persistent Knee Pain?
If you'd like help uncovering the underlying cause of your patellar tendonitis - whether it's back-related or something else - a thorough assessment can help. Learn more about our knee pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you'd like help with your knee pain or any other persistent issue, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
