The Truth About Knee Pain (Patellar Tendonitis & ACL Issues)

Knee pain can stop training fast — whether it shows up as sharp pain below the kneecap, lingering soreness with jumping, or a feeling that the knee just isn’t stable anymore.At Live Active: Spine & Sport in Birmingham, I see knee pain every week, and the pattern is almost always the same:

The knee hurts, but the problem didn’t start at the knee.

Patellar tendonitis (“jumper’s knee”) and ACL-related issues are rarely random injuries. They are usually the result of how force is being absorbed, transferred, and controlled throughout the body.

Symptoms

Common knee-related symptoms I see include:

• Pain just below the kneecap, especially with stairs, squatting, or jumping

• Stiffness or aching around the front of the knee after activity

• Knee pain that flares during running, cutting, or deceleration

• A sense of instability or lack of confidence in the knee

• Pain that improves with rest but returns as soon as training resumes

• Lingering knee symptoms even after an ACL repair or “successful” rehab

If you’ve been told to just rest, ice, or “push through it,” there’s a better explanation.

What’s Really Happening

The knee sits between two major force managers:the hips above and the feet/ankles below.

When those systems aren’t doing their job, the knee becomes the dumping ground.

The most common contributors I see are:

• Poor hip control or mobilityWhen the glutes aren’t controlling motion, the knee absorbs excessive load during landing, cutting, and deceleration.

• Limited ankle and foot mobilityIf the foot and ankle can’t load and unload efficiently, stress transfers straight to the knee, increasing strain on the patellar tendon and ACL.

• Lack of three-dimensional strengthLife and sport don’t happen in straight lines. If your training only prepares the knee for forward/backward motion, it will struggle when rotation and side-to-side demands show up.

Patellar tendonitis and ACL issues are often a chain reaction, not an isolated failure.

What Failed

Most knee rehab approaches fail for predictable reasons:

1. Treating the knee as the problem

Ice, rest, injections, or isolated quad work may reduce symptoms temporarily, but they don’t address why the knee is overloaded.

2. Too much rest, not enough intelligent loading

Complete rest weakens tendons. Tendons require daily, graded load to recover and adapt.

3. Ignoring hip and ankle contribution

If the hip and foot aren’t included in the plan, the knee continues to compensate.

4. Returning to sport without rebuilding spring capacity

Jumping, cutting, and sprinting place the highest loads on the patellar tendon and ACL. Skipping proper reloading leaves the knee vulnerable.

Why Your Approach Is Different

At Live Active: Spine & Sport in Birmingham, I don’t just ask, “Where does it hurt?”I ask, “Where is your body failing to share the load?”

My approach focuses on restoring how the entire system works together:

• I assess hip, knee, ankle, and foot motion in all planes

• I evaluate balance, control, and how force is accepted and redirected

• I rebuild tendon capacity using graded loading, not guesswork

• I progress athletes back to jumping, cutting, and sport-specific demands safely

The order matters:

1. Reduce pain and inhibition

2. Restore strength and load tolerance

3. Rebuild spring and explosive capacity

4. Reinforce proper movement patterns

This approach doesn’t just calm symptoms — it builds resilient knees.

What This Looks Like in Practice

Depending on your presentation, care may include:

• Isometric loading to reduce pain and re-engage the quadriceps

• Slow, controlled strength work to rebuild tendon capacity

• Single-leg training to correct side-to-side asymmetries

• Foot and ankle mobility to unload the knee

• Progressive jumping and deceleration drills when appropriate

Every step is based on how your knee responds — not a one-size-fits-all protocol.

Ready to Fix Knee Pain at the Source?

If knee pain is limiting your training, sport, or daily activity — or if you’re trying to protect a knee after an ACL injury — a deeper movement-based approach matters.

👉 [Book Your Knee Evaluation in Birmingham]

Let’s identify what’s overloading your knee, rebuild confidence in movement, and get you back to doing what you love — pain free and strong.