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Common Causes of Anterior Knee Pain: Patellar Tendonitis and Quadriceps Tendonitis

Anterior knee pain is a common ailment that can occur due to various reasons. In this blog post, we will primarily focus on two of the most prevalent causes of knee pain - patellar tendonitis and quadriceps tendonitis. These conditions can cause significant discomfort and impair your ability to perform physical activities. This article aims to provide a clear understanding of what patellar tendonitis and quadriceps tendonitis are, how to differentiate between them, the causes that lead to their development, and the best ways to treat and prevent them.

Understanding the difference between patellar tendonitis and quadriceps tendonitis.

Patellar tendonitis and quadriceps tendonitis both cause anterior knee pain and have similar pathologies, with repetitive stress and strain on the tendon leading to small microtrauma and inflammation. This inflammation then results in pain in the area of the tendon.

Patellar tendonitis and quadriceps tendonitis differ in terms of the location of the irritation. Patellar tendonitis occurs when there is inflammation in the tendon between the kneecap (patella) and the shinbone (tibia). On the other hand, quadriceps tendonitis is the inflammation of the quadriceps tendon that connects the quadriceps muscles to the patella.

Common Symptoms of patellar tendonitis and quadriceps tendonitis:

Both patellar tendonitis and quadriceps tendonitis exhibit similar symptoms, with pain being the most prominent one. Typically, the pain is concentrated just above or below the kneecap, and is often described as aching, sharp, or throbbing. While it may start as mild discomfort, it may progress to more severe pain with activity.

Pain may increase during activities involving knee bending and straightening, such as jumping, running, or squatting. It can begin during warm-up and worsen with continued activity.

You may experience stiffness in the knee, particularly after periods of inactivity, like getting up from a chair or upon waking in the morning. This stiffness typically resolves with movement but can return after rest.

Swelling may or may not be present depending on the severity of tendon irritation.

The area just below the kneecap may be tender to the touch, and pressing on the patellar tendon can reproduce pain or discomfort.

In some cases, patellar and quadriceps tendonitis can lead to weakness in the quadriceps muscles, as the pain may discourage use of the leg.

If left untreated, patellar tendonitis can lead to a gradual worsening of symptoms. The pain may become more persistent and severe, making it challenging to participate in physical activities.

Common causes of anterior knee pain - patellar and quadriceps tendonitis:

Overuse: Both patellar and quadriceps tendonitis are frequently caused by overuse of the knee joint. Repetitive activities that strain the tendons can lead to small injuries and inflammation over time.

Muscle Imbalance: Muscle imbalances around the knee can contribute to these conditions. Weak quadriceps or tight hamstrings can affect how the knee functions, leading to increased stress on the tendons.

Poor Biomechanics: Incorrect movement patterns or poor body mechanics, such as improper jumping and landing techniques, can place extra stress on the tendons.

Age: Tendons naturally degenerate over time, and older individuals may be more prone to developing these conditions.

Treatment and Management

Treatment for patellar and quadriceps tendonitis is relatively similar. The biggest difference is the use of a potential brace. Read along to learn more about effective treatments.

The first step in treating patellar and quadriceps tendonitis is to give the affected tendons a break. Rest from activities that worsen the pain is crucial for recovery. The general guideline is to take two weeks of rest while doing concurrent treatment to start healing the tendon.

Applying ice to the affected area can help reduce inflammation and alleviate pain. Ice should be applied for 15-20 minutes after activity if you notice discomfort.

Physiotherapy can be effective and is often prescribed to strengthen the muscles around the knee and improve flexibility. Tendons respond best to gradual load and reduction in repetitive movement, which is why your physiotherapist may prescribe isometric exercises to start and progress to eccentric loading.

Here is a great video for progressive strengthening exercises for anterior knee pain.

Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage pain and inflammation. In cases where the pain has been progressively getting worse over 3-6 months despite physiotherapy treatment and other conservative methods, a corticosteroid injection may be beneficial.

There is some evidence to show that shockwave therapy can be helpful in chronic tendon injuries past 5-6 months. This may be worth bringing up with your physiotherapist if you've had symptoms for a while.

The biggest difference between quadriceps and patellar tendonitis is the usefulness of wearing a knee brace to reduce the stress on the affected tendon. Patellar tendonitis does occasionally respond well to wearing a patellar tendon brace during activity. A small padded brace is placed between the kneecap and shin bone with pressure on the patellar tendon. This pressure can reduce stress and strain on the tendon, effectively reducing pain. This doesn’t work as well for quadriceps tendonitis due to the location of the tendon.


Preventing patellar and quadriceps tendonitis can be difficult if your biomechanics are the culprit, but this can be improved with time and training with a physiotherapist. Here are some simple ways to prevent the condition if you are more prone to anterior knee pain:

Warm-Up and Stretch: Always warm up before exercising and stretch your quadriceps and hamstrings to maintain flexibility.

Proper Technique: Be mindful of your technique with jumping, squatting, and running. This can take time and require strengthening and physiotherapy. However, having awareness and bringing attention to the problem is the first step.

Gradual Progression: Gradually increase the intensity and duration of your workouts to avoid sudden, excessive strain on your knees.

Strength Training: Build strong quadriceps and hamstrings through strength training exercises to support knee stability.

Patellar and quadriceps tendonitis can cause significant anterior knee pain, making everyday activities and sports uncomfortable. Understanding the causes, treatment options, and prevention strategies is crucial for managing these conditions effectively. If you experience persistent knee pain, it's essential to consult with a healthcare professional for a proper diagnosis and treatment plan. With the right approach, you can alleviate pain, prevent further injury, and regain your active lifestyle.

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