Dry Needling for Patellar Tendinopathy (Jumper’s Knee): Adjuvant Signals to a Progressive Eccentric Exercise Program

Patellar tendinopathy — also known as jumper’s knee — is an overuse injury of the patellar tendon at its inferior pole insertion, common in athletes of sports with repeated jumps (volleyball, basketball) and in populations with knee overload. The established first-line treatment is the progressive eccentric exercise program (modified Alfredson, Heavy Slow Resistance), with a solid evidence base. In patients with partial response, additional options include shock waves, PRP infiltration (controversy), dry needling, and — rarely — surgery. Dry needling at quadriceps trigger points has been investigated as an adjuvant to reduce pain and facilitate active rehabilitation.

What the Literature Shows

The evidence is more limited than for other tendinopathies (lateral epicondylitis, plantar fascia). The small available trials suggest that dry needling at quadriceps trigger points, when combined with a progressive eccentric exercise program, offers additional benefit compared to exercise alone — with improvement in VISA-P and VAS. The effect is modest in magnitude. There is no robust evidence that isolated dry needling can replace the eccentric exercise program as the primary treatment — that remains the foundation.

The Pillar of Treatment Remains Eccentric Exercise

The progressive eccentric exercise program — modified Alfredson or Heavy Slow Resistance — is the treatment with the highest level of evidence for patellar tendinopathy. Dry needling is adjuvant and never replaces this foundation. The indication occurs when there is an associated myofascial component in the quadriceps perpetuating the condition or when pain during progressive load limits adherence to the program.

Limitations

The literature is dominated by small trials with variability in protocols. There is no robust meta-analysis dedicated exclusively to patellar tendinopathy and dry needling — most of the findings derive from reviews on lower-limb tendinopathies as a whole. Trials with long follow-up (≥ 6 months) and data on specific outcomes for return to high-level sport are lacking.