The knee is consistently reported as the second-most injured site in padel, after the elbow[1]. But the dominant knee story in padel is not catastrophic ligament rupture. It is overuse — specifically patellar tendinopathy, the gradual, insidious breakdown of the tendon connecting your kneecap to your shinbone[2][3]. It is responsible for far more lost weeks of padel than ACL or meniscus tears combined.

This article is a conservative, research-grounded look at what actually happens to padel players' knees, why padel produces a specific pattern of damage, and the prevention principles that the sports-medicine literature consistently supports. It is not a treatment plan. If you have pain, see a sports physiotherapist.

Two stories

The tale of two knee injuries.

Knee injuries in padel sort into two clean categories, with very different mechanisms, frequencies, and consequences.

1. The overuse injury — patellar tendinopathy (the common one)

Patellar tendinopathy, sometimes called "jumper's knee," is a gradual degenerative change in the tendon that runs from the bottom of your kneecap to the top of your shinbone. It is the dominant knee injury in padel and shows up in 5–25% of athletes across sports involving repeated jumping, lunging, and rapid change of direction[4]. The symptoms are recognisable: localised pain at the lower edge of the kneecap, worse with deep knee bends and lunges, often beginning as a slight ache after play and progressing to pain that interferes with the game itself.

One large Swedish study of 274 padel players found the knee was the single most common site of overuse injury, ahead of the elbow[5]. A 2025 study of youth padel players reached the same conclusion: "overuse injuries, particularly to the knee, were most common"[2].

2. The acute injury — meniscus, ACL, MCL (the rare ones)

The dramatic injuries — ACL tears, MCL sprains, meniscus tears — also occur in padel, but at significantly lower rates than in sports like football, basketball, or skiing. The reason is structural to padel itself: the court is small, played in doubles, with walls that allow you to reposition rather than sprint, lunge, and decelerate at the limits of your control[6]. Padel involves change of direction, but the speeds and distances are smaller than in open-court sports. The mechanism that tears ACLs — high-speed deceleration with a planted foot — is far less common.

This does not mean acute knee injuries don't happen. Meniscus tears from awkward twists, MCL sprains from foot-planted pivots, and occasional ACL ruptures all occur. But statistically, the player who quietly develops chronic anterior knee pain over six months of unstructured padel is dramatically more common than the player who blows out a ligament in a single moment.

Most padel players worry about the dramatic, acute, surgical injury. The injury that actually takes them off the court is the gradual one — and they typically don't notice until it's already months in.

Why padel

Why padel does this to knees.

The mechanism is not jumping. Padel involves very little vertical jumping compared to volleyball or basketball, where patellar tendinopathy is most often studied. The mechanism in padel is repetitive sub-maximal knee flexion under load — the position your knees spend most of the match in.

Specifically, four features of padel load the patellar tendon in the exact way that produces tendinopathy:

1. The ready position. Good padel posture is a slight squat — knees bent, weight forward, ready to move. You spend most of a match in this position. It is a low-grade isometric load on the quadriceps and patellar tendon. Multiplied over hours of play, this is significant cumulative load.

2. The lateral movement. Every shift between forehand and backhand side, every approach to the net, every retreat for a lob — these are short, sharp lateral movements requiring rapid deceleration. The patellar tendon is the primary structure absorbing that deceleration.

3. The lunges. Defensive shots off the back glass, low volleys, balls that drop short — all require deep, often loaded knee flexion in positions the body is not strong in. Each lunge is a sub-maximal eccentric load on the patellar tendon.

4. The volume. Serious amateur padel players often play three to five times per week. Tendons need recovery time to adapt to load. Without it, microdamage accumulates faster than the tendon repairs, which is the basic recipe for tendinopathy[7].

Female players

A note on female padel players.

Knee injury patterns in padel differ by sex, though the evidence is mixed. One 2025 study of 305 padel players reported a 44.6% injury prevalence in women versus 8.2% in men, with women significantly more likely to sustain ligament and muscle strain injuries[8]. Other studies have found no significant difference[9]. The picture is complicated by confounding factors — women in the higher-prevalence study were more likely to play at competitive levels and accumulate playing hours.

What is well-established across sports is that female athletes tear ACLs at rates two to eight times higher than males[10], due to a combination of neuromuscular control patterns, knee geometry, and hormonal factors. This is one area where padel's structural protections (smaller court, doubles, walls) likely help — but where a thoughtful prevention program still matters more for female players than for male players.

Mechanisms

The four mechanisms behind every case.

Across the patellar tendinopathy literature, the same risk factors appear repeatedly. In padel specifically, four dominate.

1. Quadriceps weakness relative to load

The patellar tendon's job is to transmit force from the quadriceps to the shinbone. When the quadriceps cannot produce or absorb enough force, the tendon absorbs more than its share. Players whose strength has not kept pace with their playing volume are the players who develop patellar tendinopathy.

2. Posterior chain weakness

This one surprises people: padel knees often fail because the back of the body is weak. Strong hamstrings and glutes share the load of deceleration with the quadriceps. When they're weak, the quad and patellar tendon do all the work. A knee program that only trains the front of the leg is solving half the problem.

3. Poor change-of-direction mechanics

How you decelerate and cut matters as much as how strong you are. ACL prevention research consistently identifies knees-over-toes alignment, controlled landings, and hip-dominant deceleration as protective[11]. Players whose knees collapse inward on lateral movements load the tendon, the meniscus, and the ligaments all at once.

4. Volume increasing faster than recovery

The single most common pattern in patellar tendinopathy: a player increases their playing frequency or intensity faster than their tissues can adapt[7]. Going from twice a week to four times a week, or adding tournaments on top of regular play, are classic onset triggers.

Prevention

What the research says actually works.

Sports-medicine evidence for the prevention and management of patellar tendinopathy converges on four principles. They overlap somewhat with the elbow protocol — which is not a coincidence. Tendons across the body respond to similar loading principles.

Principle 1 — Heavy slow resistance and eccentric loading

The strongest body of evidence for treating and preventing patellar tendinopathy is for heavy slow resistance training and eccentric loading of the quadriceps[12][13]. The classic protocol — single-leg decline squats performed slowly — has decades of clinical research behind it. More recent evidence supports heavy slow resistance protocols as equally effective and sometimes better tolerated.

The mechanism: progressive tendon loading appears to promote remodelling, increasing the tendon's ability to handle exactly the loads that injured it. Tendons are stubborn — they take weeks to respond to training — but they do respond.

Principle 2 — Train the posterior chain

Hamstrings, glutes, and calves take load off the quadriceps and the patellar tendon during deceleration. Hip-dominant exercises (hinges, bridges, single-leg deadlifts) are not optional — they are part of the protection.

Principle 3 — Train the cut, not just the squat

Strength is necessary but not sufficient. Players who are strong but cut poorly still get hurt. ACL-prevention programs that train lateral deceleration mechanics, single-leg balance, and controlled landing have measurably reduced injury rates in cutting sports[14]. The same principles apply to the patellar tendon: how you absorb force is as important as how much force you can produce.

Principle 4 — Manage load progression

The most evidence-supported strategy for preventing overuse injuries is not exotic — it is not playing more than you have trained to play. A general rule used in tendon-loading research: change your training volume by no more than ~10% per week. A player who jumps from two padel sessions to five in a single month is asking for trouble, regardless of how strong they are.

Red flags

When to stop self-managing.

Knee pain that should send you to a sports physiotherapist immediately, not "after I see if it gets better":

The first four are red flags for acute structural damage and need imaging. The last two are signs that tendinopathy has crossed from "manageable with load adjustment" into "needs structured rehab."

A sports physiotherapy assessment is fast and useful. Self-diagnosis of knee pain from articles like this one is not a substitute.