The two most common causes of anterior knee pain in grapplers are patellar tendinopathy (often called "jumper's knee") and patellofemoral pain syndrome (PFPS). While these conditions share similar symptoms and often coexist, they have distinct causes and require slightly different treatment approaches.

Understanding which condition you're dealing with—or if you have both—is critical for effective rehabilitation. This comprehensive guide covers:

• Differences between patellar tendinopathy and PFPS

• How these injuries develop in BJJ athletes

• Evidence-based self-assessment techniques

• Progressive rehabilitation protocols

• Prevention strategies specific to grapplers

• When imaging and medical evaluation are needed

Understanding Anterior Knee Pain: Two Different Problems

The Confusion

Many athletes—and even some healthcare providers—use terms like "knee pain," "jumper's knee," and "runner's knee" interchangeably. However, patellar tendinopathy and PFPS are distinct conditions with different underlying mechanisms:

Patellar Tendinopathy (Jumper's Knee)

What It Is:

• Overload injury to the patellar tendon

• Tendon connects kneecap (patella) to shin bone (tibia)

• Caused by repetitive loading (jumping, landing, explosive movements)

• Structural changes within tendon tissue (degeneration, not inflammation)

Location of Pain:

• Very specific: inferior pole of patella (bottom of kneecap)

• Where tendon attaches to kneecap

• Small, focal area of tenderness

Key Characteristics:

• Gradual onset over weeks/months

• Worse with explosive loading (takedowns, sprawls, shooting)

• "Warm-up phenomenon" (pain at start, improves during training, returns after)

• Pain with stairs (especially descending)

• Morning stiffness

Patellofemoral Pain Syndrome (PFPS / Runner's Knee)

What It Is:

• Pain around or behind the kneecap

• Caused by abnormal tracking of patella in femoral groove

• Related to muscle imbalances, hip weakness, biomechanics

• No structural tendon damage

Location of Pain:

• Diffuse: around kneecap, sometimes behind it

• Harder to pinpoint with one finger

• May be medial (inside) or lateral (outside) knee

Key Characteristics:

• Pain with prolonged sitting ("movie theater sign")

• Pain descending stairs or hills

• Pain with deep squatting

• Pain after training (not during as much)

• Crepitus (grinding/creaking sensation)

Can You Have Both?

Yes—and it's common in BJJ athletes.

• PFPS causes altered mechanics → increases patellar tendon stress

• Patellar tendinopathy changes movement patterns → worsens PFPS

• Treatment must address both conditions simultaneously

How Anterior Knee Pain Develops in BJJ

Patellar Tendinopathy Mechanisms

1. Repetitive Explosive Movements

• Takedown entries: Explosive level changes (penetration step)

• Sprawling: Rapid deceleration and eccentric loading

• Shooting: Drive from knees requires high tendon force

• Guard jumping/pulling: Impact absorption through tendon

• Explosive re-guarding: Standing back up from bottom

2. High Training Volume Without Adequate Recovery

• Multiple training sessions per day

• Training 5-7 days per week

• Adding strength training without reducing mat time

• Competition prep with increased intensity

• Not enough recovery between hard sessions

3. Sudden Training Changes

• Increased frequency or intensity too quickly

• New training focus (wrestling, takedowns)

• Competition camp ramp-up

• Returning from time off too aggressively

• Adding plyometric work without proper progression

4. Poor Movement Mechanics

• Landing on straight legs (no shock absorption)

• Knee valgus during takedowns (knee caving inward)

• Excessive anterior knee translation during squatting

• Weak glutes causing quad dominance

PFPS Mechanisms

1. Hip Weakness (Most Common Cause)

• Weak hip abductors (gluteus medius)

• Weak hip external rotators

• Results in knee valgus (knee caving inward)

• Increases lateral pressure on patella

• Alters tracking in femoral groove

2. Quadriceps Imbalance

• Weak VMO (vastus medialis oblique - inner quad)

• Dominant vastus lateralis (outer quad)

• Pulls patella laterally (outside)

• Creates uneven pressure distribution

3. Biomechanical Factors

• Flat feet/overpronation

• Poor ankle mobility

• Excessive femoral anteversion (hip rotation)

• Q-angle abnormalities

• Tight lateral structures (IT band, lateral retinaculum)

4. Training-Related Factors

• Prolonged kneeling positions (closed guard, turtle)

• Deep squatting during wrestling/scrambles

• Heel hooks creating rotational stress

• Passing positions requiring sustained knee flexion

Self-Assessment: Which Condition Do You Have?

Patellar Tendinopathy Tests

1. Patellar Tendon Palpation (Most Reliable)

How to Perform:

1. Sit with knee straight

2. Use one finger to press firmly on patellar tendon

3. Focus on inferior pole of patella (bottom of kneecap)

4. Press along entire tendon down to tibial tubercle

Positive Test:

• Very specific, focal tenderness at inferior pole of patella

• Sharp pain with direct pressure

• More tender than other knee

Sensitivity: 70-80%

2. Single-Leg Decline Squat (Victorian Institute of Sport Assessment)

How to Perform:

1. Stand on 25° decline board (or stair edge)

2. Stand on injured leg only

3. Slowly squat down to 60° knee flexion

4. Return to start position

5. Repeat 5-10 times

Positive Test:

• Pain at inferior pole of patella during or after

• Pain rating >3/10

• More painful than other knee

Sensitivity: ~80%
Most useful functional test for patellar tendinopathy

3. Hop Testing

How to Perform:

1. Single-leg hops on injured leg

2. 10 continuous hops

3. Compare to uninjured side

Positive Test:

• Sharp patellar tendon pain during/after hopping

• Reduced hop distance/height compared to other leg

• Inability to complete 10 hops

PFPS Tests

1. Patellar Grind Test (Clarke's Sign)

How to Perform:

1. Lie on back with knee straight

2. Tighten quad muscle maximally

3. Press down on top of patella while maintaining quad contraction

4. Try to slide patella up/down

Positive Test:

• Pain around or behind kneecap

• Pain with compression

• Crepitus (grinding sensation)

⚠️ Note: Many false positives, use with other tests

2. Patellar Tilt Test

How to Perform:

1. Lie on back with knee straight and relaxed

2. Try to lift lateral (outside) edge of patella

3. Compare to other knee

Positive Test:

• Patella doesn't tilt (tight lateral structures)

• Less than 10° of tilt

• Significantly tighter than other knee

3. Single-Leg Squat Assessment (Most Important)

How to Perform:

1. Stand on injured leg

2. Perform slow single-leg squat to 60° knee flexion

3. Have someone video from front

4. Watch knee position

Positive Test:

• Knee caves inward (valgus collapse)

• Knee travels excessively over toe

• Hip drops on opposite side

• Trunk leans excessively

This test reveals underlying biomechanical dysfunction

Severity Grading & Prognosis

Patellar Tendinopathy Stages (Blazina Classification)

Stage 1: Reactive Tendinopathy

• Pain only after training

• No impact on performance

• "Warm-up phenomenon" present

• Prognosis: Excellent with early intervention

• Timeline: 6-12 weeks to resolve

Stage 2: Tendon Disrepair

• Pain at start and after training

• Mild impact on performance

• May train through discomfort

• Prognosis: Good with appropriate loading

• Timeline: 3-6 months for full recovery

Stage 3: Degenerative Tendinopathy

• Pain during and after training

• Significant impact on performance

• Difficulty with daily activities

• Prognosis: Guarded, requires extensive rehab

• Timeline: 6-12 months, may require surgery

Stage 4: Tendon Rupture

• Complete tear (rare in patellar tendon)

• Immediate surgery required

• 9-12 months recovery

PFPS Severity

Mild:

• Pain only with prolonged sitting or stairs

• No impact on training

• Timeline: 4-8 weeks

Moderate:

• Pain with deep squatting, kneeling, some positions

• Can train with modifications

• Timeline: 8-16 weeks

Severe:

• Pain with most training activities

• Pain with walking, daily activities

• Timeline: 4-6 months

Patellar Tendinopathy: Treatment Protocol

Stage 1: Load Management & Isometrics (Weeks 0-2)

Goals: Reduce pain, begin tendon loading, avoid tendon irritation

Load Management Principles:

• Reduce training volume by 50%

• Eliminate explosive movements temporarily:

  • No takedowns (shooting, sprawling)

  • No jumping/guard pulls

  • No explosive stand-ups

• Focus on:

  • Technical drilling (slow, controlled)

  • Upper body work

  • Light positional sparring (avoiding movements above)

Isometric Exercise Protocol (Critical for Early Pain Relief):

Heavy Slow Resistance Isometrics:

1. Isometric Leg Extension Hold

   • Sit on edge of chair/bench

   • Extend knee to full extension

   • Hold weight on ankle (or against resistance)

   • Target load: moderate to heavy

   • Hold 45-60 seconds

   • Rest 2-3 minutes

   • 4-5 sets

   • Perform 2x per day

Why This Works:

• Immediate pain reduction (60-80% of athletes report relief)

• Analgesic effect on nervous system

• Begins tendon remodeling

• No eccentric loading yet (not ready)

Additional Exercises:

• Spanish Squat Isometric Hold

  • Band around knees, leaning back

  • Knee angle 60°

  • Hold 45 sec x 5 sets

• Wall Sit Holds

  • Back to wall

  • Knee angle 60-90°

  • 45 sec x 4 sets

Pain Monitoring:

• Keep pain <4/10 during exercise

• Pain should reduce within 24 hours

• If pain increases next day, reduce load

Stage 2: Progressive Eccentric Loading (Weeks 2-8)

Goals: Build tendon capacity, improve load tolerance, prepare for sport demands

Eccentric Squat Protocol (Evidence-Based Standard):

Weeks 2-4: Double-Leg Eccentric Squats

1. Stand with feet shoulder-width

2. Slowly lower to 90° knee flexion (3-5 second descent)

3. Rise back up using both legs

4. Key: Slow on the way down, normal speed up

5. Sets/Reps: 3 sets x 15 reps

6. Frequency: Daily (7 days/week)

7. Progress load weekly (bodyweight → vest → barbell)

Weeks 4-6: Single-Leg Eccentric Squats (Decline Board)

1. Stand on 25° decline board

2. Injured leg only

3. Slowly lower to 90° (3-5 seconds)

4. Use other leg to assist back up

5. 3 sets x 15 reps

6. Daily

7. Progress load as able

Heavy Slow Resistance (HSR) Protocol (Alternative/Addition):

• Leg press or squat

• 4 sets x 8-12 reps

• 3-second eccentric, 3-second concentric

• Heavy load (6-8 RPE)

• 3x per week (not daily)

Progressive Plyometrics (Weeks 6-8):

• Week 6: Double-leg pogo hops (2 sets x 20)

• Week 7: Single-leg pogo hops (2 sets x 15)

• Week 8: Depth drops from low height (2 sets x 8)

Pain Rules:

• Training pain acceptable up to 5/10

• Must settle within 24 hours

• If pain >5/10 or doesn't settle, reduce load

Stage 3: Return to Sport Loading (Weeks 8-16)

Goals: Sport-specific capacity, reactive strength, confident return to training

Energy Storage & Release Training (Weeks 8-12):

Reactive Strength Drills:

1. Countermovement Jumps: 3 sets x 8 reps

2. Broad Jumps: 3 sets x 6 reps

3. Depth Jumps (Low Height): 3 sets x 5 reps

4. Single-Leg Hops: 3 sets x 10 each leg

5. Split Squat Jumps: 3 sets x 6 each leg

Frequency: 2-3x per week (not daily)

Mat-Specific Drills (Weeks 10-12):

1. Sprawl Progressions:

   • Week 10: Slow controlled sprawls (10 reps)

   • Week 11: Moderate speed sprawls (15 reps)

   • Week 12: Full-speed sprawls (20 reps)

2. Shot Progressions:

   • Week 10: Stationary penetration steps

   • Week 11: Walking shots (no contact)

   • Week 12: Full-speed shots (light resistance)

3. Guard Pull/Jump Progressions:

   • Week 10: Step-through guard pulls only

   • Week 11: Small jump guard pulls

   • Week 12: Full guard jumps (with crash pads initially)

Training Progression (Weeks 12-16):

• Week 12: Drilling only (no live training)

• Week 13: Positional sparring (avoid positions that load tendon maximally)

• Week 14: Light live rolling (50-60% intensity)

• Week 15: Moderate intensity rolling (70-80%)

• Week 16: Full training return

Return-to-Training Criteria:

• Pain <3/10 with all plyometric tests

• Single-leg decline squat pain-free

• Hop testing >90% of uninjured leg

• No pain during daily activities

• Confident with explosive movements

• Passed functional testing (if available)

PFPS: Treatment Protocol

Phase 1: Pain Management & Hip Strengthening (Weeks 0-4)

Goals: Reduce pain, strengthen hip musculature, improve patellar tracking

Load Management:

• Avoid prolonged kneeling positions

• Modify deep squatting (stay above 60° knee flexion)

• Reduce training volume if needed

• Use knee sleeves for proprioception

Hip Strengthening (PRIMARY FOCUS - 5-6x per week):

Essential Hip Exercises:

1. Clamshells with Band

   • Side-lying, knees bent 90°

   • Band above knees

   • Lift top knee while keeping feet together

   • 3 sets x 20 reps each side

   • Target: Hip abductors

2. Side-Lying Hip Abduction

   • Lie on side, bottom leg bent, top leg straight

   • Lift top leg up (don't let it roll forward)

   • 3 sets x 15 reps each side

   • Target: Gluteus medius

3. Monster Walks (Band Around Knees)

   • Mini squat position

   • Step forward, sideways, backward

   • Keep knees pushed out against band

   • 3 sets x 20 steps each direction

   • Target: Hip abductors, glutes

4. Single-Leg Hip Thrust

   • Back on bench, one foot on ground

   • Lift hips up, squeeze glute at top

   • 3 sets x 12 reps each leg

   • Target: Gluteus maximus

5. Copenhagen Planks

   • Side plank with top leg on bench

   • Hold 30 seconds

   • 3 sets each side

   • Target: Hip adductors (inner thigh)

VMO (Inner Quad) Strengthening:

1. Terminal Knee Extensions with Band

   • Band around back of knee

   • Straighten knee fully, squeeze quad

   • Hold 3 seconds at full extension

   • 3 sets x 20 reps

   • Critical for VMO activation

2. Short Arc Quads

   • Towel roll under knee

   • Straighten knee to lift heel off ground

   • Hold 5 seconds

   • 3 sets x 15 reps

3. Split Squats (Spanish Squat Setup)

   • Band around knees, lean back slightly

   • Slow lower into lunge

   • 3 sets x 12 reps each leg

   • Emphasizes VMO without excessive patellofemoral pressure

Taping (Optional but Helpful):

• McConnell taping to medialize patella

• Kinesiology tape for support and proprioception

• Refer to Knee Taping Techniques for PFPS post

Phase 2: Progressive Loading & Motor Control (Weeks 4-8)

Goals: Build strength, improve movement patterns, reduce compensations

Strengthening Progression:

Weeks 4-6:

1. Double-Leg Squats (0-90°)

   • Focus on knee tracking over toes (not caving in)

   • 3 sets x 12-15 reps

   • Gradually add load

2. Step-Ups (Low Step)

   • Drive through heel

   • Control knee position (no valgus)

   • 3 sets x 10 each leg

3. Leg Press (Feet Wide, Toes Out)

   • Reduces patellofemoral stress

   • 3 sets x 12-15 reps

   • Moderate weight

Weeks 6-8:

1. Single-Leg Squats (Mini)

   • Focus on perfect form

   • Hip/knee/ankle alignment

   • 3 sets x 8 each leg

2. Bulgarian Split Squats

   • Back foot elevated

   • 3 sets x 10 each leg

3. Lateral Lunges

   • Targets hip abductors functionally

   • 3 sets x 10 each direction

Motor Control Training (Critical for PFPS):

Mirror Feedback Training:

1. Stand in front of mirror

2. Perform single-leg mini squats

3. Watch knee position

4. Self-correct any valgus collapse

5. 3 sets x 10 reps daily

Single-Leg Balance Progression:

• Eyes open: 3 sets x 30 sec

• Eyes closed: 3 sets x 30 sec

• On unstable surface: 3 sets x 30 sec

• With perturbations: 3 sets x 30 sec

Phase 3: Return to Training (Weeks 8-12)

Goals: Sport-specific conditioning, maintain strength gains, return to full training

Functional Training:

1. Lateral Shuffles: 3 sets x 30 sec

2. Carioca Drills: 3 sets x 20 yards

3. Cutting Drills: Progressive speed, focus on landing mechanics

4. Jump Training: Box jumps, broad jumps (land with good mechanics)

Mat Progression:

• Week 8: Drilling only, focus on positions previously painful

• Week 9: Light positional sparring (communicate with partners)

• Week 10: Moderate intensity rolling (70%)

• Week 11: Full intensity rolling

• Week 12: Competition training if applicable

Return-to-Training Criteria:

• Pain <3/10 with deep squatting

• Single-leg squat with good knee alignment (no valgus)

• Hip strength >80% of uninjured side

• No "movie theater sign" (pain with prolonged sitting)

• Confident with all BJJ positions

Combined Treatment: Patellar Tendinopathy + PFPS

If You Have Both (Common):

Weeks 0-4:

• Focus on PFPS hip strengthening (daily)

• Add patellar tendinopathy isometrics (2x daily)

• Reduce training volume significantly

Weeks 4-8:

• Continue hip strengthening (5x per week)

• Begin eccentric loading for tendon (daily)

• Motor control training (daily)

Weeks 8-12:

• Maintain hip strength (3x per week)

• Progress to reactive strength training

• Return-to-sport loading

Key Point: Address both conditions simultaneously—they feed into each other.

Advanced Treatment Options

When Conservative Treatment Isn't Working

If symptoms persist after 12 weeks of proper rehabilitation:

1. Extracorporeal Shockwave Therapy (ESWT)

• High-energy sound waves to stimulate healing

• Evidence: Moderate support for patellar tendinopathy

• Usually 3-6 sessions over 6 weeks

• May reduce pain, unclear if improves function long-term

2. Platelet-Rich Plasma (PRP) Injection

• Your own blood, concentrated platelets injected into tendon

• Evidence: Mixed results, some studies show benefit

• Expensive, not covered by insurance

• Consider if 6+ months of failed rehab

3. Corticosteroid Injection

• ❌ NOT recommended for patellar tendinopathy

• Short-term pain relief only

• Risk of tendon weakening/rupture

• May be appropriate for PFPS if severe inflammation

4. Surgical Options (Last Resort)

• Patellar tendon debridement: Remove degenerative tissue

• Lateral retinaculum release: For severe PFPS with tight lateral structures

• Usually only after 12+ months failed conservative treatment

• Success rates: 60-80% (not guaranteed)

• Recovery: 6-9 months return to sport

Prevention Strategies

Can You Prevent Anterior Knee Pain?

Yes—Significantly Reduce Risk:

1. Progressive Training Load

• Don't increase volume >10% per week

• Monitor explosive movements separately

• Build takedown/wrestling capacity gradually

• Plan rest weeks into training cycle

2. Off-Mat Strength Training (2-3x per week)

• Must include:

  • Hip strengthening (glute med, glute max, hip external rotators)

  • Quad strengthening (especially VMO)

  • Hamstring strengthening

  • Single-leg exercises

• Maintain year-round, not just when injured

3. Eccentric Exercise (Injury Prevention)

• Even without pain, 1-2x per week eccentric squats

• Builds tendon resilience

• Reduces injury risk by 50%+ (evidence-based)

4. Movement Quality

• Practice landing mechanics (soft landings)

• Single-leg squat with mirror feedback

• Address knee valgus patterns

• Improve ankle/hip mobility

5. Recovery Management

• Adequate sleep (7-9 hours)

• Nutrition (protein for tissue repair)

• Active recovery days

• Listen to early warning signs (don't ignore minor pain)

6. Equipment

• Knee sleeves for proprioception

• Quality mats (reduce impact)

• Consider decline boards for home eccentric training

When to See a Healthcare Provider

Seek Evaluation If:

⚠️ Immediate Evaluation Needed:

• Sudden onset severe pain

• Inability to weight bear

• Visible swelling or deformity

• Suspected patellar tendon rupture (can't straighten knee, gap in tendon)

📅 Schedule Appointment Within 1-2 Weeks:

• Pain not improving after 4 weeks of appropriate self-management

• Pain interfering with daily activities

• Symptoms progressively worsening

• Uncertain about diagnosis

• Want imaging or injection options

What to Expect

Initial Assessment:

• Detailed training and injury history

• Physical examination (palpation, strength testing, movement analysis)

• Functional tests (single-leg squat, hop testing, decline squat)

Imaging:

• Patellar Tendinopathy:

  • Ultrasound (first-line): Shows tendon thickening, tears, vascularity

  • MRI: If diagnosis unclear or considering surgery

• PFPS:

  • X-ray: Assess patellar alignment, rule out arthritis

  • MRI: If concern for cartilage damage or other pathology

Treatment Planning:

• Physical therapy prescription (sport-specific)

• Load management guidelines

• Discussion of injection options if appropriate

• Return-to-sport timeline

FAQ: Anterior Knee Pain in BJJ

Q: What's the difference between patellar tendinopathy and patellar tendinitis? A: Terminology update: "Tendinitis" implies inflammation (suffix "-itis"). Research shows patellar tendon overload causes degenerative changes, not inflammation. Correct term is "tendinopathy" (tendon pathology). Treatment focuses on progressive loading, not anti-inflammatories.

Q: Should I stop training completely? A: No, unless severe pain (Stage 3 tendinopathy). Instead:

• Modify training (avoid explosive movements initially)

• Reduce volume by 30-50%

• Focus on technical drilling, upper body

• Gradually reintroduce loading through rehab exercises Complete rest weakens tendon and delays return.

Q: Can I just do the exercises and keep training normal? A: Usually not successful. Tendinopathy requires:

1. Reduced tendon stress (load management)

2. Progressive tendon loading (exercises) Both are necessary. Continuing to overload while doing rehab = spinning wheels.

Q: How long until I can train normally? A: Depends on severity:

• Mild (Stage 1): 6-12 weeks

• Moderate (Stage 2): 3-6 months

• Severe (Stage 3): 6-12 months Rushing return = chronic problem. Be patient.

Q: Do I need imaging (ultrasound/MRI)? A: Usually not initially. Diagnosis is clinical (symptoms + tests). Consider imaging if:

• Not improving after 12 weeks proper rehab

• Considering injection/surgery

• Diagnosis unclear

• Severe symptoms

Q: Why do my knees hurt when sitting for a long time? A: Classic "movie theater sign" for PFPS. Prolonged knee flexion → increased patellofemoral pressure → pain. Indicates PFPS, not tendinopathy. Treatment: hip strengthening, VMO activation, patellar taping.

Q: Should I wear a knee brace or sleeve? A: Sleeves: Yes, can help (proprioception, compression, warmth). Won't fix problem but may reduce symptoms. Braces: Not necessary for these conditions. Focus on strength training. Patellar tendon straps: May provide temporary relief for tendinopathy, but not a long-term solution.

Q: Can I take anti-inflammatories (ibuprofen)? A: Short-term for symptom management: OK (3-7 days). Long-term: NOT recommended (>2 weeks). Reasons:

• Patellar tendinopathy isn't inflammatory (won't help underlying issue)

• May impair tendon healing

• Doesn't address root cause Focus on loading-based rehab instead.

Q: Will my knee pain come back? A: Risk factors for recurrence:

• Returning to training too quickly

• Not maintaining hip/quad strength

• Ignoring early warning signs

• Poor training load management Prevention: Maintain strength training 2x per week long-term, manage training loads, address early symptoms.

Q: Can I strength train (squats, deadlifts) with anterior knee pain? A: Depends:

• Patellar tendinopathy: Yes, if using appropriate loads and pain is <5/10. Heavy slow resistance is part of treatment.

• PFPS: May need to modify depth (stay above 60° knee flexion initially), but strength training is essential for recovery. Listen to pain signals and follow protocol.

Q: Why didn't rest work? A: Tendons need load to heal, not rest. Complete rest:

• Weakens tendon (disuse atrophy)

• Doesn't improve load tolerance

• Symptoms return when training resumes Progressive loading is the gold standard treatment (evidence-based).

Key Takeaways

✅ Two distinct but related conditions:

• Patellar tendinopathy: Focal pain at inferior pole of patella, worse with explosive loading

• PFPS: Diffuse pain around kneecap, worse with prolonged sitting and squatting

• Can coexist—address both simultaneously

✅ Treatment is loading-based, not rest:

• Patellar tendinopathy: Isometrics → eccentrics → plyometrics

• PFPS: Hip strengthening + VMO activation + motor control

• Progressive, evidence-based protocols (6-12 weeks minimum)

✅ Load management is critical:

• Reduce training volume 30-50% initially

• Eliminate explosive movements temporarily

• Gradually reintroduce based on symptoms

✅ Prevention strategies work:

• Hip/quad strength training (2-3x per week)

• Eccentric exercises (even when healthy)

• Smart training load progression

• Early intervention for symptoms

✅ Be patient—rushing back causes chronic problems:

• Follow return-to-training criteria (not just time-based)

• Maintain strength training long-term

• Monitor training loads

• Don't ignore early warning signs

Need Help With Anterior Knee Pain?

At Grapplers PerformX, we specialize in helping BJJ athletes overcome patellar tendinopathy and PFPS using evidence-based protocols tailored to the demands of grappling.

Our PTs will:

• Accurately diagnose whether you have tendinopathy, PFPS, or both

• Create progressive loading program specific to your severity

• Guide training modifications to keep you on the mats

• Address underlying biomechanical issues

• Get you back to full training safely

Free Knee Pain Resources:

• Download our Knee Pain Rehab Guide →

• Watch: Anterior Knee Pain Self-Assessment →

• Read: Knee Taping Techniques for PFPS →

• Book a Free 15-Min Consultation →

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• 5 Ways to Help Painful Knees from BJJ →