Patellar Tendinopathy Self-Assessment: Is Your Knee Pain Coming from the Tendon?

One of the most common questions I get is some version of: "How do I know if it's my tendon?" It's a fair question — knee pain has a lot of possible sources, and the treatment is very different depending on where the problem is coming from.

I want to walk you through a practical self-assessment you can do right now. This isn't a replacement for a proper clinical evaluation, but it will give you a much clearer picture of whether patellar tendinopathy is likely, and whether you need further investigation.

Work through each section honestly. At the end, I'll help you interpret what you find.

Step 1: Location check

Sit down and extend your leg slightly. Using one finger, press along the base of your kneecap — the bony bump at the bottom of your patella. The patellar tendon attaches here, at a point called the inferior pole.

Does this area feel tender to direct pressure? Is the tenderness pinpoint and localised — the kind you can cover with a fingertip — rather than diffuse across the knee?

Patellar tendinopathy pain is characteristically localised. If your pain is around the sides of the knee, under the kneecap, or spread across the joint, another structure is more likely involved.

"Tendon pain has an address. You can point to it with one finger. If you're pointing vaguely at your whole knee, something else may be going on."

Step 2: Activity pattern

Think about when your knee hurts. Work through these questions:

Does the pain come on with loading activities — squatting, jumping, going down stairs, lunging, or running? Does it ease when you sit down and rest? Does it sometimes feel stiff or achy for the first few minutes of activity, then improve with warm-up? Does it return or get worse after you stop exercising?

This pattern — load-dependent pain that warms up but returns with fatigue or after exercise — is classic for tendinopathy. Knee pain that is worse at rest, wakes you at night, or is constant tends to have a different cause.

Step 3: The decline squat test

This is the most useful clinical test for patellar tendinopathy that you can perform on yourself. It was developed specifically to isolate load on the patellar tendon, and it's sensitive enough to provoke symptoms even in people who can squat normally on flat ground.

You'll need something to create a small decline — a wedge, a thick book, or a doorstep works. Aim for about a 25° decline.

Stand with both feet on the decline, toes pointing forward. Slowly perform a single-leg squat on your symptomatic side, lowering yourself to about 60° of knee bend.

Does this reproduce your familiar knee pain at the base of the kneecap?

If yes — especially if the pain comes on at a relatively low load (one leg, moderate depth, slow speed) — that's a strong indicator of patellar tendinopathy. If you can perform this test without symptoms, or if what you feel is generalised knee discomfort rather than localised tendon pain, the picture is less clear.

Note your pain level out of 10. Under 3/10 is generally acceptable to work through. Above 5/10 suggests higher irritability that will influence how you approach early loading.

Step 4: Ruling out other causes

Patellar tendinopathy is not the only source of anterior knee pain. Before assuming it's the tendon, consider these alternatives:

Patellofemoral pain (runner's knee) — pain behind or around the kneecap, often worse with sustained sitting (the "theatre sign"), better with patellar tendinopathy tests. Tender at the sides of the kneecap rather than the base.

Osgood-Schlatter disease — common in adolescents, pain and swelling at the tibial tuberosity (the bony bump below the kneecap, lower than where the patellar tendon attaches at the top).

Fat pad impingement — pain at the inferior pole of the patella, but typically worse with hyperextension and eased with slight flexion. Can mimic tendinopathy closely; ultrasound or clinical assessment often needed to distinguish.

Meniscal or joint pathology — joint line tenderness (along the sides of the knee), locking, giving way, or swelling suggest intra-articular involvement. These aren't tendon symptoms.

Step 5: Irritability check

Knowing how irritable your tendon is helps determine how aggressively you can start loading. Answer these:

Is your pain constant, or does it only come on with activity? How long does pain take to settle after a provocative activity — minutes, hours, or longer? Have you had a recent spike in symptoms after increasing activity?

High irritability (constant pain, slow to settle, recent spike) means you need to start with lower loads and progress more conservatively. Low irritability means you can typically move through the early phases more quickly.

What your results mean

Likely patellar tendinopathy: Localised inferior pole tenderness, load-dependent pain pattern, positive decline squat test, no signs of joint pathology. You can begin a structured loading program with confidence. The goal is to find a starting load that's tolerable — typically 3–4/10 discomfort — and progress from there.

Possible patellar tendinopathy, unclear picture: Some features match but not all. This often means there's a mixed presentation — tendon involvement alongside another structure. A clinical assessment is worthwhile to clarify the primary driver.

Unlikely to be the tendon: Pain doesn't localise to the tendon, positive signs suggest joint or other soft tissue involvement, decline squat test negative. See a clinician for a proper differential — treating the wrong thing wastes time and can make some conditions worse.

What to do next

If this self-assessment points toward patellar tendinopathy, the next step is getting a clear loading plan in place. I've written a detailed guide to the treatment approach here.

If you want a structured program with the progressions built in, or if you'd benefit from a one-on-one assessment to confirm what's going on, I offer both — you can find details at the links below.