Anterior Knee Pain in a Runner: Overcoming Patellar Tendinopathy and Returning to the Half Marathon

Introduction
Anterior knee pain is one of the most common reasons runners end up in the physio clinic. But when that pain turns out to be patellar tendinopathy — often referred to as “runner’s knee” — the solution is not rest or stretching alone. In this success story, we outline how McFerran Physio helped a 33-year-old female runner go from limping in pain to completing the Bristol Half Marathon pain-free through a progressive, evidence-based rehab program.

Patient Overview
This 33-year-old woman was fit, active, and had no medical issues. She regularly ran 5Ks, 10Ks, and half marathons. But for nearly six weeks, she was experiencing:

• Severe anterior knee pain during and after running.
• Morning pain and stiffness following a run.
• Significant limp and inability to run or train.

Despite a short rest period, her symptoms returned as soon as she resumed running.

Clinical Assessment

Initial Findings

• No swelling, redness, or deformity.
• Full knee range of motion.
• Pain on resisted quadriceps contraction, but not with hamstring resistance.
• Tenderness around the kneecap and patellar tendon.
• Pain with single-leg squats, especially on the affected side.
• No issues with hip mobility, but functional hip tasks (squats or lunges) increased her knee pain.

Based on these findings, a clear pattern emerged: patellar tendinopathy, a load-related pathology of the patellar tendon that connects the quadriceps to the shin.

Diagnosis & Education

We explained to the patient that patellar tendinopathy:

• Is not due to inflammation, despite older terms like “tendinitis”.
• Patellar tendinopathy is characterised by structural changes within the tendon, including the ingrowth of disorganised collagen fibres, new blood vessels, and nerve tissue — a process known as
• Strengthening the tendon and quadriceps is the most effective long-term treatment.

She was eager to get back to running, but understood the importance of a structured and progressive rehab journey.

Rehabilitation Plan

Phase 1: Isometric Strengthening

She could barely lift 5kg on the knee extension machine with the affected leg, while her unaffected leg could lift 25–30kg. Due to pain, we began with:

• Isometric knee extension holds.
• Short, pain-modulated sets to build tolerance and reduce discomfort.
• Education on pain levels (target: ≤ 3/10 during exercises).

Phase 2: Isotonic Strength Training

Once isometric tolerance improved, we introduced:

• Two-leg concentric / one-leg eccentric knee extensions.
• Leg press and split squats.
• Box squats for posterior chain support.
• Progress to one-leg concentric / eccentric knee extensions

The goal was to match strength to the unaffected side and eliminate morning pain — our green lights for return to run prep.

Phase 3: Plyometrics and Running Preparation

When she reached ~80% of the strength of her good leg and morning symptoms had resolved, we progressed to:

• Landing mechanics drills.
• Jumping and force absorption exercises.
• Straight-line running drills, followed by gradual increases in:
  • Duration
  • Frequency
  • Intensity

She continued with strength training 2–3x/week during this phase.

Return to Running & Outcome
Over the course of 10 weeks, with sessions every two weeks and a detailed home programme, she progressed steadily:

• No flare-ups during training.
• Gained confidence through objective strength gains.
• Returned to consistent running.
• Completed the Bristol Half Marathon pain-free.

Why It Worked: The McFerran Physio Difference

This case is a great example of how sports physiotherapy at McFerran Physio is more than just massage or stretching. Our approach is built around:

• Accurate diagnosis based on functional testing.
• Patient education to build confidence and buy-in.
• Progressive rehab from isometrics to full sport return.
• Use of our fully equipped gym to assess and track performance.

For any runners dealing with knee pain, particularly patellar tendinopathy, this story is a reminder that evidence-led treatment works — and we can help you return to doing what you love.

Ready to get back on the road?
Book your appointment today and start your journey back to pain-free running.