By: Dr. Marc Robinson, PT, DPT, Cert. MDT
Are you struggling with patellar tendonitis? In this article, I’m going to show you how to perform a sequence of exercises to strengthen the patellar tendon. The exercises described in this article should be directed by a physical therapist if you are recovering from patellar tendinitis. These exercises are one aspect of patellar tendonitis rehab; however, there are additional aspects of an effective rehab program.
Before I show the exercises, I'm going to discuss important information regarding patellar tendonitis. Tendonitis refers to active inflammation of the tendon. Many tendon injuries are not inflammatory; therefore, the term "tendonitis" can be misleading. "Tendinopathy" is a better word to describe general problems with the tendon because tendinopathies are inclusive of all tendon injuries.
The treatment plan for patellar tendinopathy will be specific to each person. For example, the repetitions, sets, frequency, and intensity among other factors may be changed depending on the severity of your injury or stage of healing. The treatment plan will also depend on your end goal.
For all these reasons, it is important to be assessed by a rehab professional who can help you transition from pain to optimal performance.
What Causes Patellar Tendinopathy?
Injuries of the patellar tendon occur with excessive strain to the patellar tendon due to improper training, traumatic events, or repetitive use. Some mechanisms of injury can be prevented, but others cannot.
Regardless of the injury, the patellar tendon needs to be strengthened. The best way to strengthen the tendon is through exercise and loading the tendon in a logical progression.
The patellar tendon responds well to specific exercises to target regeneration of the patellar tendon. Over time, the tendon will adapt and become stronger.
How to Rehabilitate Patellar Tendonitis?
As I mentioned before, your rehab should be guided by a rehab professional; however, there are principles of rehabilitation which I will share with you for educational purposes.
I will simplify the process into two broad phases, but there are additional phases and steps involved. I am using these two phases to illustrate two important principles with patellar tendonitis rehab.
Phase 1: Unload It.
In phase 1, remove excessive strain from the patellar tendon. Strain can be reduced by stretching restricted muscles, strengthening weak muscles, improving biomechanics, increasing motor control, taping the patellar tendon to offload pressure, taping the patella to improve tracking, rest, or modifying activities.
In the initial stages of patellar tendonitis, the patellar tendon needs to rest. The goal is to decrease inflammation, pain, and swelling by modifying activity levels, protecting the tendon and promoting gentle active movement.
Phase 2: Load It.
In phase 2, it's time to increase the load on the patellar tendon to promote growth, repair, and regeneration. Progressively loading the tendon rebuilds and strengthens the collagen fibers of the tendon.
A damaged tendon often looks like a frayed rope. Loading the tendon with exercises will help to reorganize the frayed fibers. The patellar tendon will gradually become resilient to load and the demands you place on it.
How to Load the Patellar Tendon
In this video, I show an example of progressively loading the patellar tendon with eccentric squats.
The video shows three levels of difficulty from the front and side view. There are more progressions than what is shown, but these exercises should give you an idea how squats can be used to change the amount of load placed on the patellar tendon.
Watch the video then I will discuss the three levels in more detail.
Body weight is evenly distributed. For example, 50% of body weight is on the right leg and 50% of body weight is on the left leg.
The squat should be performed slow and controlled; however, there should be an emphasis on descending slowly. The lowering phase of the squat focuses on the eccentric contraction. Eccentric contractions have been shown by research to promote tendon repair.
But research also shows that both concentric and eccentric contractions are important for tendon repair. What does this mean for you? Focus on contracting the quadriceps muscles throughout the squat because it will help the tendon to heal.
Shift your body weight to the injured side. For example, if the right tendon is injured, then shift 60% body weight onto the right side and 30% on the left side. The percentage of body weight can increase as you get stronger.
The other leg can be placed in front of you or to the side to make the weight shift easier. If you want to be precise, you can place your other foot on a scale to measure the amount of body weight.
Shift your full body weight onto the injured side and slowly lower yourself using the injured leg. The other leg should be held up in the air. Focus on slowly lowering your bodyweight during the descent of the squat. On the way up, you can use both feet.
A verbal instruction for this exercise is “Up with two, down with one.” The goal is to place more load on the patellar tendon during the eccentric phase of the muscle contraction (descent of squat) to promote tendon repair.
Once you can tolerate these exercises with the proper number of reps and sets, then you can start squats on a decline slant board (if you have access to one). The slant board adds more load to the patellar tendon. In this video, I'm replicating a decline slant board by placing my heels on a plate to create a heel lift.
How Many Repetitions and Sets are Recommended?
The number of reps and sets depend on an assessment from a rehab professional like a physical therapist.
Typically, 3 sets of 15 repetitions, 2 times per day are performed for patellar tendinopathy; however, this may significantly vary from person to person. Performing the incorrect dosage of exercise can lead to injury or delayed tendon healing.
As you can see from the videos, these exercises put a lot of stress on the tendon and too much stress too soon can cause harm. You can successfully manage patellar tendinopathy on your own, but you should seek guidance from a rehab professional who can guide the program for you. Proper guidance will save you time, money and get you back to the things you love faster! Fill out a quick 2-minute application if you want me to create a customized program for you. I'll review the application within 24 hours and let you know if we are a good fit. If you are tired of getting knee pain and repetitive injuries, I can help you break this cycle of injury. Click Here.
A Word of Caution
The exercises to promote patellar tendon repair - specifically, the decline slant board squats - can place a significant strain on the kneecap. If you have a history of patellofemoral pain, also known as runner's knee, you should use caution when performing these exercises. If you are not accustomed to performing these types of exercises, then it's better to consult with a rehab professional first.
Patellar tendonitis - more accurately known as patellar tendinopathy - can recover with progressively loading the patellar tendon. Over time, the patellar tendon will adapt, repair and get stronger. You will get the best outcome if you seek guidance from a rehab professional. But I know some of you do-it-yourself-ers are looking for exercises you can start right now. I suggest strengthening your hips muscles with mini-loop bands. The majority of my clients in the clinic have weakness in the hips which typically lead to excessive strain on the knee. Strengthening the hips will help protect the patellar tendon during the healing process.
You can have access to our minicourse with instructional exercise videos showing you how to perform eight, science-based exercises with mini-loop bands to increase hip strength. The value of the minicourse is $30, but we'll include the minicourse to you as a bonus when you purchase our mini-loop band set. Our mini-loop bands are essential for rehab, injury prevention, and strength training. Nearly every rehab or fitness professional uses mini-loop bands. If you aren't using them then you are really missing out on potential benefits. Order Evercore mini-loop bands now and learn how to use them properly with our minicourse. Click Here to Order.