Patellar tendonitis: the pain below your kneecap keeps coming back after rest, because a knee tendon heals slowly, and rest alone does not make it stronger.
Doctors also call it jumper's knee. It can last for months or even years, but the right exercises help it heal, and a doctor can add peptide therapy (medicines made from small proteins) to your rehab, which may support the repair.
If your knee hurts just below the kneecap, the tendon there is often the cause, and rest alone usually does not fix it.
- Patellar tendonitis (also called jumper's knee or patellar tendinopathy) is damage to the tendon that joins your kneecap to your shin bone. It hurts most when you jump, land, squat, run downhill or climb stairs.
- It heals slowly because a tendon gets much less blood than a muscle, and the inside of an adult tendon barely replaces old tissue with new.
- Rest makes the pain fade, but the pain usually comes back as soon as you run or jump again, because resting does not make the tendon stronger.
- The treatment with the best evidence is a strength programme that makes the tendon carry a little more weight every week.
- A cortisone injection can ease the pain for a few weeks, but in a study on knee tendon pain, people's pain was worse again by 6 months.
- Some people also ask a doctor about peptide therapy: small proteins that may help your body's own repair process. In South Africa it needs a doctor's prescription.
Your knee hurts because every jump and landing pulls on your patellar tendon below the kneecap, and the tendon gets damaged faster than it can repair itself.
Your patellar tendon is a strong band that joins the bottom of your kneecap to your shin bone. Patellar tendonitis means this tendon is damaged and sore. It usually hurts right at the bottom tip of the kneecap, and the pain gets worse the harder your thigh muscle works.
Your thigh muscle pulls on the tendon every time you land.
The patellar tendon passes the pull of your thigh muscle to your shin bone, so you can straighten your leg, jump and land. A healthy tendon handles this and repairs small strain between workouts.
Too much load, too often, causes tiny tears.
More jumping, more running, heavier squats or harder ground than your tendon is used to causes small tears. When they build up faster than your body repairs them, the tendon gets weaker and starts to hurt.
The tendon repairs itself slowly, so the damage builds up.
Blood brings the cells and materials your body uses for repair, and a tendon gets much less blood than a muscle. So a tendon heals far slower than a pulled muscle.
After about age 17, the inside of your tendon barely replaces old tissue with new.
It was built while you were growing, and it stays mostly the same tissue for the rest of your life. Your muscles, by contrast, replace old tissue with new all the time. Scientists could date the tissue because nuclear bomb tests in the 1950s and 60s left a trace of radioactive carbon in the tissue people built at that time.
Heinemeier et al., FASEB Journal, 2013 (a study of the Achilles tendon)
40 in every 100 club runners in Ekurhuleni, Gauteng, had pain at the front of the knee when they were checked.
Patellar tendonitis is one of the two most common causes of this kind of knee pain in runners.
Kunene et al., South African Journal of Physiotherapy, 2018 (183 runners)
The more your sport makes you jump and land, the more likely you are to get jumper's knee.
How many people had jumper's knee when they were checked (Nutarelli et al., 2023, a review of 28 studies; rugby: Durcan et al., 2014).
More than half the athletes with jumper's knee in one study had to give up their sport because of their knee.
The study followed them for 15 years. Among the athletes who never had jumper's knee, only 1 in 14 gave up their sport.
Kettunen et al., American Journal of Sports Medicine, 2002. Nine of the 17 athletes with jumper's knee stopped, and 1 of 14 without it.
Is knee pain stopping you from running, jumping or training? Answer a 60-second quiz, then a registered doctor phones you to talk through your options.
Claim Your Peptide Therapy ConsultationRest, ice and a knee strap make the pain fade for a while, but the pain usually comes back, because none of them make the tendon stronger.
You have probably tried some of these. Each one eases the pain for a while, but none of them fix the reason it keeps coming back.
Resting it
What it does: the pain fades, because the tendon is not being loaded.
What it does not do: make the tendon stronger. When you go back to running or jumping, the same load hits the same weak tendon, and the pain comes back.
Ice, painkillers and a knee strap
What they do: ease the pain for a few hours, so you can get through a session.
What they do not do: repair the tendon. They ease the pain, but the damaged tendon is still there.
A cortisone injection
What it does: the pain often drops quickly.
What it does not do: heal the tendon. In a study on knee tendon pain, people who had cortisone felt better at 12 weeks but worse again at 6 months. Doctors also warn that repeated cortisone injections can weaken a tendon.
To stop the pain coming back, your tendon has to get stronger, and a strength programme that adds a little more weight every week has the best evidence for that.
A physiotherapist adds a little more weight for your knee each week, while the pain slowly goes down.
In a 2021 study, a programme that added weight on the tendon step by step worked better after 24 weeks than the usual exercises where you only slowly lower yourself into a squat. In another study, people on heavy, slow strength training kept their improvement at 6 months, while people who had cortisone got worse again. A physiotherapist can set this up for you.
Tensing your thigh muscle and holding it without moving, like pushing your leg against a machine five times for 45 seconds each, cut the pain straight away, and it stayed down for at least 45 minutes. That study was small (6 volleyball players), but it gives you a way to train with less pain.
The hard part is time. Most people need 6 to 12 weeks of exercises before they notice a difference, and 3 months or more to finish the programme. That is why many people give up, or go back to jumping too early and start again from zero.
Your tendon heals slowly, so a doctor may add a peptide to your rehab, a tiny protein that may help your body's own repair process, alongside your exercises, not instead of them.
A peptide is a tiny piece of protein. Your body makes thousands of them, and each one gives a signal to the cells it fits. This is how a prescribed peptide gets to your damaged tendon.
It travels through your blood
Once it is in your body, the peptide is carried by your blood to every part of your body.
It fits the cells it was made for
It only fits into a "lock" on certain cells, like a key fits one lock, so only those cells get its signal.
Those cells respond to the signal
With some peptides, this may help send repair cells to the damaged part of the tendon.
There are two peptides a doctor may talk to you about, and only your doctor decides which one, if any, suits you.
BPC-157
BPC-157 is a chain of 15 amino acids (protein building blocks), copied from part of a protein found in human stomach juice. It may help your body grow new small blood vessels and move repair cells into damaged tissue. In animal studies this helped damaged tendons heal, and a poor blood supply is one of the reasons a tendon heals so slowly.
Learn More About BPC-157Ask About BPC-157
TB4
TB4 is thymosin beta-4, a repair protein your body already makes. It may help repair cells move to where they are needed in the body. Some doctors prescribe it together with BPC-157.
Learn More About TB4Ask About TB4Not a steroid
A cortisone injection is a steroid that eases pain for a while. A peptide is a small protein that may help your body's own repair process, so it works in a different way.
Not a replacement for rehab
The strength programme is still the main treatment for patellar tendonitis. A peptide may help the repair happen while you do your exercises.
Not for tested athletes
BPC-157 and TB4 are on the World Anti-Doping Agency's banned list. If you are tested for doping in your sport, these are not for you.
Want to know if peptide therapy could support your knee rehab? Answer a 60-second quiz, then a registered doctor phones you.
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You can get peptide therapy the legal way. It starts with a 60-second quiz and one call with a registered doctor.
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The legal way to get these peptides in South Africa is a prescription from a registered doctor, made up by a licensed pharmacy. Clarve gives you both.
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Get straight answers to what people with patellar tendonitis ask us most.
How long does patellar tendonitis take to heal?
With a good strength programme, most people notice a difference after 6 to 12 weeks, and the full programme often takes 3 months or more. Without the right exercises it can drag on for years: elite athletes in one study had had symptoms for 32 months on average.
Can patellar tendonitis heal on its own?
Rest alone usually makes the pain fade without making the tendon stronger, so the pain tends to come back when you load it again. An 11-year study of volleyball players found it does not go away by itself, and about 1 in 5 of the players who had it gave up competitive volleyball because of it.
Should I keep training with patellar tendonitis?
Usually yes, at a level your knee can handle. Physios often suggest keeping the pain under 3 out of 10 while you exercise, and making sure it settles within a day, and swapping jumping for cycling or swimming for a while. Ask a physio to set your limits.
Is walking bad for patellar tendonitis?
Walking on flat ground puts much less load on the tendon than running, jumping or stairs, so many people can keep walking. Use the same rule as for exercise: keep the pain under 3 out of 10, and ask a physio if it keeps hurting.
Do you ever need surgery for patellar tendonitis?
Rarely. Surgery is usually only considered when several months of a proper strength programme have not helped. Most people never need it.
Should I get a cortisone injection?
It can ease the pain in the short term. But in a study on knee tendon pain, the people who had cortisone were worse again by 6 months, while people on a strength programme kept their improvement. Talk it through with your doctor first.
Has peptide therapy been tested on people's tendons?
Not in a finished study yet. The tendon research on BPC-157 comes from animal and lab studies, where healing tendons in rats grew back stronger, and a study in people with torn hamstring muscles is under way. That is why, if a doctor prescribes it, it is as support alongside your rehab, after checking your health first.
Is peptide therapy legal in South Africa?
Yes, when a registered doctor prescribes it and a licensed pharmacy makes it. Clarve's doctors are registered with the HPCSA, and our own licensed pharmacy in Johannesburg makes every prescription.
Can I use BPC-157 or TB4 if I play competitive sport?
Not if you are tested for doping. Both are on the World Anti-Doping Agency's banned list.
How much does it cost?
The doctor consult is a once-off R99. If the doctor prescribes a therapy, you get the exact price before you pay anything more. Our prices are market-related, so you are not paying a lot more for doing it the legal way.
- Kunene, Ramklass, Taukobong. Front-of-knee pain in club runners in Ekurhuleni, Gauteng. South African Journal of Physiotherapy, 2018 (PMID 30349876).
- Nutarelli et al. How common patellar tendinopathy is in athletes and the general population, a review of 28 studies. Orthopaedic Journal of Sports Medicine, 2023 (PMC10280536).
- Durcan et al. Patellar tendinopathy in elite academy rugby players in Ireland. Journal of Science and Medicine in Sport, 2014 (PMID 23838071).
- Lian, Engebretsen, Bahr. Prevalence of jumper's knee among elite athletes from different sports. American Journal of Sports Medicine, 2005.
- Kettunen et al. Long-term prognosis for jumper's knee in male athletes: a 15-year follow-up. American Journal of Sports Medicine, 2002.
- Visnes et al. Long-term prognosis of patellar tendinopathy in young elite volleyball players: an 11-year follow-up. American Journal of Sports Medicine, 2024.
- Heinemeier et al. Lack of tissue renewal in human adult Achilles tendon is revealed by nuclear bomb 14C. FASEB Journal, 2013.
- Tempfer, Traweger. Tendon vasculature in health and disease. Frontiers in Physiology, 2015.
- Malliaras et al. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. Journal of Orthopaedic and Sports Physical Therapy, 2015.
- Breda et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy. British Journal of Sports Medicine, 2021.
- Kongsgaard et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scandinavian Journal of Medicine and Science in Sports, 2009.
- Rio et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 2015.
- Coombes, Bisset, Vicenzino. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy. The Lancet, 2010.
- Masiello et al. Platelet-rich plasma in tendinopathies: a systematic review and meta-analysis. Blood Transfusion, 2023.
- NHS Lanarkshire physiotherapy. Patellar tendinopathy exercise guide.
- Staresinic et al. Gastric pentadecapeptide BPC 157 accelerates healing of transected rat Achilles tendon. Journal of Orthopaedic Research, 2003.
- Chang et al. The promoting effect of pentadecapeptide BPC 157 on tendon healing. Journal of Applied Physiology, 2011.
- USADA. BPC-157 and thymosin beta-4 on the WADA Prohibited List.
Last checked 21 September 2026. This article is general information, not medical advice. Only a doctor can tell you what is right for you.
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