How to Fix Pain Above Knee: 7 Steps for Effective Relief

Are you dealing with pain above the knee? Then I’m sure you’d like to know: What is that? How bad is it? Why do you have it? What can you do about it?

We’ll cover all those questions (and more) in this article. This way you don’t have to do any more research. And I’ll even give you 3 sample exercise programs (for the early, mid, and late stage of rehab). This way you can easily start your rehab RIGHT NOW.

I can reassure you that this approach works. What you’re about to learn isn’t based on my experience or opinion. I’m summarizing the current scientific evidence for you.

Uncertainty About What This Is and What to Do

Most people with pain above the knee believe in one or more of the following things:

• They have an inflammation of a muscle or tendon.
• A tight muscle causes the pain.
• A muscle imbalance causes the pain.

Do you know what this leads to?

Treatments like:

• Anti-inflammatory medication
• Rest
• Ice
• Massage
• Stretching

And this doesn’t cut it (and you know that).

Let’s do something about that now, alright?

I will walk you through 7 points you need to understand. At least if you want a long-term solution for your pain.

7 Steps to Get Rid Of Pain Above the Knee

1. What’s the Affected Structure?

So we know that you’re feeling pain at the top of your kneecap. But does it change with your activity level? So the more you do, the more it hurts?

Then it’s usually the quadriceps tendon that’s affected. The correct medical term for this is “quadriceps tendinopathy”.

Here’s a quick rundown on the anatomy:

The quadriceps consists of four muscles. The common end of these muscles is the quadriceps tendon. This then continues over the kneecap and becomes the patellar tendon. And finally, the patellar tendon attaches to the shinbone.

2. Pain Above Knee – What Caused the Problem?

The simple answer is:

You’ve done more than your quadriceps tendon can currently handle. So, the volume, intensity, or frequency of the load was so high that your tendon couldn’t recover from it.

What’s important is that inflammation is NOT the cause of your pain. And it’s quite possible that you don’t have any inflammation at all right now!

Why it’s so important to understand? I’ll cover this in point #3 now.

3. How to NOT Get Rid Of It?

Most treatment approaches look like this:

• Massaging the quadriceps
• Rest
• Cortisone injections
• Ultrasound therapy
• Shockwave therapy
• Stretching the quadriceps

The problem is, that those approaches don’t increase the load tolerance of your tendon.

And that’s the main reason why they don’t help long-term.

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4. What Does an Effective Rehab Look Like?

The first big step to getting a handle on the pain is understanding the cause. We already checked that off the list.

If we look at the graphic from earlier again, we can now talk about what options we have.

Either, we reduce the load, which would be the left side. Or we increase the capacity/load tolerance, which would be the right side.

In the very acute phase, with severe pain, I’d first opt for reducing the load.

That means: trying to reduce activities that provoke pain.

This most likely will be your main sport (like soccer, running, tennis etc.). And if possible/necessary also reduce or adapt things like climbing stairs.

At the same time, I want to emphasize that you don’t have to freak out about this.

You might believe that every time you trigger pain, you damage the tendon further.

That’s not correct. It’s okay to have some pain.

You don’t have to drop every painful movement possible.

As a guideline: reduce fast, high-load activities first. And then see what else you can EASILY reduce.

As soon as you’ve reached a tolerable pain level you should start loading the tendon again. That way we can address the right side of the graphic, the load tolerance/capacity.

And yes, it’s even okay to train with and into pain.

Karin Silbernagel is one of the leading tendon researchers in the world. She published a well-known study in 2007. It showed that there’s no downside to training with moderate pain (Silbernagel et al. 2007).

The question is, how much pain is okay?

And that varies from person to person. Generally, the pain should be under 5/10. Ideally under 3/10. It might be fine for you to train with a pain level of 4/10, while for someone else, anything over 2/10 is unthinkable.

You’ll need to try out what you feel comfortable with and whether the pain limits your daily life.

If you can handle your daily routine with a pain level of 4/10, then there’s no reason not to allow that level of pain. The key is that the pain should decrease over time. Keep an eye on that.

Another important point is to not only check your pain during training. With tendon issues, there’s often what’s called a warm-up effect. This means your pain decreases when you’re active.

You might notice your pain is worse if you haven’t moved for a while (like in the morning after waking up). That’s a classic example of the warm-up effect. So you should also check your pain 24 hours AFTER exercising.

I’ll give you an example:

Before training, your pain is at 3/10. After training, it’s at 1,5/10. The next morning after training, it’s at 6/10. That’s a sign you did a bit too much (even though you didn’t have pain during training).

In this case, you should do fewer exercises or use less weight in your next session.

Right – so increasing the load tolerance through exercise is important. But what exercises can and should you do? Let’s talk about that now.

5. What Exercises can you do?

To recap:

Rehab is about getting your pain to a manageable level. And then gradually loading the quadriceps tendon again.

So, the question isn’t really WHICH exercises you can do, because you can do ALL exercises. The question is more: WHEN can you do certain exercises?

A recent study by Song et al. (2023) looked at 35 exercises. They recorded the load on the quadriceps tendon, among others, during these exercises.

What can you see from the diagram? The load on the tendon is higher when you do single-leg compared to double-leg exercises. Which makes sense, of course. And the load increases the faster you perform the exercise.

So, the logical conclusion is to start with double-leg exercises. I would even begin with isometric exercises, like a wall sit.

Then, you can move on to slow dynamic movements that don’t use the full range of motion yet.

For example, you could do a box squat.

But please start at a slow pace. Sticking with the squat example: go down in 3 seconds, hold for 1 second at the bottom, and push up in 3 seconds. This slow pace reduces the load on the tendon.

Over time, you should increase the speed of the exercises. Think of pushing up explosively in squats for example.

Then you can and should incorporate more exercises focusing on one leg. Why is that so important? Because bilateral exercises make compensation much easier. The pain-free side will take on more load to offload the other side.

You could try lunges or single-leg leg extensions.

If you tolerate this at a fast pace, move on to landings.

Start with landings on both legs, then progress to landing on one leg.

After landings, you can work on jumps. Once again start with both legs first doing exercises like:

After that move on to single leg jumps like the rear foot elevated split squat jump.

Finally, you’d get into sport-specific training where you practice things like changing direction.

Don’t worry: I will show you some sample sessions with sets and reps for the early, mid, and late stage in the next section.

6. How Do You Create a Rehab Program?

If I were you, I’d pick 2 exercises that specifically target the quadriceps tendon. You can do these exercises 2-4 times a week.

Here are the general parameters to keep in mind:

• Start with isometric exercises if your pain is quite high at the moment.
• Go for 30-45 second holds.
• For the dynamic strength exercises: you can do 3 sets of 8-12 repetitions per exercise. Start with a slow tempo (3 seconds down, 3 seconds up). Increase the speed over time.
• For jumps or landings: start low with 3 sets of 4 repetitions. Gradually work your way up in the number of repetitions.

Example rehab sessions could look like this:

Early Stage:

• Isometric: Bilateral Wall-Sit 3×30-45s
• Dynamic: Step Down 3×12
• 2-4x per week

Mid Stage:

• Session 1:
• Dynamic: Box Squat 3×12
• Plyometric: Landing (PB) 3×4
• Session 2:
• Dynamic: Split Squat 3×12
• Plyometric: CMJ

Late Stage:

• Session 1:
• Dynamic: Spanish Squat 3×12
• Plyometric: Rear Foot Elevated Split Squat Jump 3×6
• Session 2:
• Dynamic: Rear Foot Elevated Split Squat 3×12
• Plyometric: Depth Jump

Feel free to use the following graphic, where I have summarized the sessions for you once again.

7. How Do You Measure Your Progress?

This one is big, so please pay attention here. We want to take two variables into account:

1. Your pain level
2. Your activity level

If your pain decreases over time while staying active, you’re making progress. But you are also making progress if your pain level stays more or less the same and your activity level increases.

Please don’t make the mistake many athletes do.

As mentioned in step 4: many athletes completely stop when they have pain. Because they’re afraid of making it worse by being active.

They wait until the pain is gone. And then they start exercising again, having an immediate pain flare-up.

That’s called the boom-bust-cycle of rehab by the way. And I give you advice on how to avoid this in my free pain e-book. To get it, simply type in your name and email.

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Not only are those flare-ups frustrating. This on-and-off approach reduces your activity level over time. Because in your rest periods, your tendon’s load tolerance decreases.

So don’t only focus on the pain level in your rehab. I’d even encourage you to focus more on the activity level.

Here’s an example:

I was working with a soccer referee. His pain hasn’t changed in the past two months. So he got a little bit frustrated about his pain level.

Before he started the coaching with me, he couldn’t take part in any matches. At this point, he was then able to referee at least one game a week and jog for 45 minutes once a week.

So I asked him:

“If you had to choose: either you can work regularly as a referee or your pain level goes down to zero? What would you choose”

The answer was so obvious to him that he just smiled.

This doesn’t mean that you always have to pick one side. It’s a mindset strategy. Focus on the process and the activity level, not the outcome and pain.

By the way: are you an athlete and your pain keeps you from getting back to the sport that you love? Click on this link to learn more about the “Pain Coaching” we offer . My team and I may be able to help you with that with our intensive 1:1 online coaching approach.

Conclusion & Next Steps

To sum up: it’s smart to stay active and understand that pain shouldn’t be your main focus.

If you want to get rid of a quadriceps tendinopathy, you need to start loading the tendon (and it’s okay to nudge into pain). Focus on the process and an increase in your activity level.

I now want you to pick one of the three sample programs that I provided for you. If you want to: adjust them to your needs. And then get started right away.

Also: are you still doing stabilizing exercises for your knee on an unstable surface? You’re wasting your time. Check out this article now for answers.

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