Quadriceps tendinopathy

Also called: Quad tendon pain above the kneecap

Exercise is the main treatment Strength Stretch Massage

Pain just above the kneecap rather than below it, worst deep squatting and stairs. It is the same tendon problem as jumper's knee at the other end of the kneecap, and it responds to the same progressive heavy loading.

How common: Common in jumping athletes and heavy squatters; less recognized than patellar tendinopathy

Open the Knee Pain/Bulletproofing routine All problems

What it is

The quadriceps tendon runs from the thigh muscles into the top of the kneecap. Degenerative change at that attachment produces pain above the kneecap, which is less common than patellar tendinopathy below it but behaves in the same way.

It is more associated with heavy loaded knee extension than with jumping - deep squatting, weightlifting, and repeated stair or hill work. As with all tendinopathies the tissue change is degenerative, and the treatment is progressive loading rather than rest.

What it feels like

Pain just above the kneecap, at the top edge
Worst with deep squatting, stairs and getting up from low chairs
Warms up during activity and hurts more afterwards
Tender to press at the top of the kneecap
Aching after prolonged sitting with the knee bent

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Repeated high-load knee extension: Heavy squatting, leg pressing, weightlifting and repeated stair climbing all load the quadriceps tendon at its attachment. Volume beyond the tendon's capacity produces the degeneration.
A failed healing response: The same process as any tendinopathy: disorganised collagen, new vessel and nerve ingrowth, a thicker but weaker tendon. Rest reduces symptoms and does not restore capacity.
A rapid increase in loading: A new lifting programme, a jump in training volume, or a return after a layoff. Tendon adapts slowly and the mismatch is the mechanism.
Deep knee flexion under load: The tendon is loaded most at deep knee angles. Deep squatting under heavy load is the specific position most associated with it.
Quadriceps weakness relative to demand: Weak muscle transfers more of every load to the tendon. Strength is both the risk factor and the treatment.
Age: More common in people over forty than patellar tendinopathy is, reflecting declining tendon quality with age.
Metabolic factors: Diabetes, obesity and high cholesterol are associated with tendinopathy generally, through effects on collagen and tendon blood supply.
Fluoroquinolone antibiotics: Associated with tendinopathy and, rarely, rupture. Worth noting if symptoms started around a course of them.
Continuing to train through the warm-up effect: Because the pain eases during a session, lifters continue and the tendon deteriorates. It is the same trap as jumper's knee.

Who tends to get it

Weightlifters and anyone doing heavy loaded squatting
Athletes over forty, in whom it is more common than the patellar version
Anyone who has increased loading volume quickly
People with diabetes, obesity or high cholesterol
Anyone with weak quadriceps relative to the loads being attempted

What makes it worse, and what settles it

Makes it worse

Continuing heavy deep squatting through the pain
Complete rest, which loses tendon capacity
Deep loaded flexion during a reactive phase
Corticosteroid injection into the tendon, which risks rupture
Returning to full loading as soon as the pain eases

Settles it

Isometric quadriceps holds for short-term pain relief
Progressive heavy slow resistance training through a tolerable range
Temporarily reducing depth and load rather than stopping training
Gradually restoring deep-range loading once capacity has improved
Massage and soft tissue work on the quadriceps for symptomatic relief

What actually helps

The short version: Degenerative change in the quadriceps tendon at the upper patellar pole from repeated high-load knee extension

Strength work: Legs: Quads - heavy slow resistance; isometric holds for pain relief; Glutes: Max

Stretching: Legs: Quads; Hips: Flexors; Legs: Calves

Massage: Legs: Quads

Also worth doing: Reduce deep squat volume while irritable; isometrics before training for analgesia

What the evidence says: Same loading principles as patellar tendinopathy: heavy slow resistance, isometrics for analgesia, patience measured in months not weeks.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routineKnee Pain/Bulletproofing

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Open this routine in my Checklist

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Sudden inability to straighten the knee after a pop - possible tendon rupture, urgent

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Three to six months of progressive loading is a realistic timescale, and longer where it has been present for a year or more. The pain resolves before the tendon capacity does, so the loading programme should continue well past symptom resolution. Sudden severe pain above the kneecap with an inability to straighten the knee against gravity suggests a quadriceps tendon rupture, which is a surgical emergency and needs immediate assessment.

Prevalence basis: Sports medicine series

Others the same routine covers

These share the Knee Pain/Bulletproofing routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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