Question 1

I'm a basketball player and have had pain below my kneecap for 3 months that's not getting better with rest. My physio keeps telling me to do eccentric exercises but they hurt and I don't understand why I'm supposed to do exercises that make it worse. Should I just stop playing until it heals?

Accepted Answer

The confusion about eccentric exercises is very common—they're counterintuitive but are the most effective treatment for patellar tendinopathy. Here's why: WHY REST DOESN'T WORK: Patellar tendinopathy is NOT an acute injury that heals with rest—it's chronic degeneration of tendon tissue from repeated overload. The tendon has failed to adapt to training loads and has developed abnormal collagen structure, poor blood flow, and degenerative changes. Simply resting doesn't stimulate the tendon to remodel and strengthen—in fact, complete rest can weaken tendons further. Studies show athletes who just rest have recurrence of symptoms as soon as they return to sport. WHY ECCENTRIC EXERCISES HURT (BUT WORK): Eccentric exercises (like single-leg decline squats) involve loading the tendon while it's lengthening—this creates high mechanical stress that stimulates tendon cells (tenocytes) to produce new collagen and remodel the degenerative tissue. Research shows eccentric loading triggers: increased collagen synthesis, improved tendon structure on ultrasound, reduced pain chemicals (substance P), neovascularization regression (abnormal blood vessels disappear). The exercises SHOULD cause mild discomfort (3-5/10 pain during exercise is acceptable and even beneficial—this is 'therapeutic pain' signaling tissue remodeling). However, severe pain (more than 5/10) or pain lasting more than 24 hours after exercise is too much and means load needs reducing. EXPECTED TIMELINE: Weeks 1-4—symptoms may worsen initially (loading degenerative tendon). Frustrating but normal. Weeks 6-8—start noticing improvement in pain and function. Weeks 12-16—significant improvement, returning to sport. Studies show 70-80% of athletes achieve good results with 12 weeks of eccentric exercises vs 30-40% with rest alone. SHOULD YOU STOP PLAYING: Complete cessation not necessary for Stage 1-2 tendinopathy (pain after but not during sport). Modify training: reduce jumping volume 50%, avoid sessions causing pain more than 3/10 during or lasting more than 24 hours after, continue eccentric program 3x weekly. For Stage 3 (pain during sport affecting performance), may need 6-12 weeks break from competition while doing eccentric program, then gradual return. BOTTOM LINE: Trust the eccentric program even though it's uncomfortable. If you're not seeing improvement after 8 weeks of CONSISTENT exercises (missing sessions reduces effectiveness), see sports medicine doctor to review program and consider other options (PRP, shockwave therapy).

Question 2

My jumper's knee has been chronic for 18 months and I've tried everything—rest, physio, shockwave therapy, even PRP injections. My surgeon is now recommending surgery to 'clean out' the damaged tendon. What does this involve and what are realistic expectations for getting back to volleyball?

Accepted Answer

After 18 months of failed conservative management, surgical debridement is reasonable to consider. However, it's important to understand what surgery can and can't do: WHAT SURGERY INVOLVES: Arthroscopic or open debridement—surgeon removes degenerative tendon tissue (appears brown/yellow, frayed vs healthy white glossy tendon) using arthroscopic shaver or sharp dissection. Goal: excise diseased tissue back to healthy tissue, sometimes scrape underlying bone to stimulate healing response. Takes 45-60 minutes under general anaesthetic. Day surgery or overnight. Post-op: knee brace 1-2 weeks, partial weight-bearing 2-4 weeks, progressive rehabilitation 3-6 months. REALISTIC EXPECTATIONS: Success rate: 70-80% achieve good-to-excellent pain relief and return to sport after surgery. However, 20-30% have persistent pain or reduced performance despite surgery. Better outcomes if: focal area of degeneration (vs diffuse tendon involvement), younger athlete (under 30), high level of pre-injury function, compliant with post-op rehab. RETURN TO VOLLEYBALL TIMELINE: Weeks 0-6—protected weight-bearing, gentle ROM exercises. Weeks 6-12—progressive strengthening (including eccentric exercises—yes, still necessary post-surgery). Weeks 12-16—sport-specific training (jumping progression, landing drills). Months 4-6—gradual return to full training and competition. Most athletes not back to pre-injury level until 6-9 months post-surgery. Some never regain 100% of previous jumping power. WHY SURGERY FAILS 20-30% OF TIME: Surgery removes degenerative tissue but doesn't address WHY tendinopathy developed—biomechanical factors (landing mechanics, quadriceps strength imbalances, training load errors). If these aren't corrected, tendon can degenerate again. Also, extensive debridement weakens tendon—removing too much tissue increases risk of rupture or persistent pain. ALTERNATIVE TO CONSIDER BEFORE SURGERY: High-volume image-guided injection (HVIGI)—newer technique where large volume of saline/local anaesthetic injected into tendon under ultrasound guidance to strip away abnormal blood vessels and nerve fibers causing pain. Less invasive than surgery. Some studies show 70% improvement at 6 months. Not widely available in Australia, not Medicare covered ($500-1000). BOTTOM LINE: Surgery is reasonable after 18 months of failed conservative management, but set realistic expectations—70-80% success, 6-9 months return to sport, some risk of persistent symptoms. Ensure you've had comprehensive biomechanical assessment and plan to address training load/technique post-surgery to prevent recurrence. If surgeon hasn't discussed these factors, seek second opinion.

Medical Disclaimer

Jumper's Knee (Patellar Tendinitis)

📖What is Jumper's Knee (Patellar Tendinitis)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention