Patellar Tendinitis can be quite the nuisance, and most have been there (especially runner’s).
You get that nagging pain right below the kneecap when you walk, jump, squat, or just bend your knee. It also feels like it lasts forever, and can just catch you off guard out of nowhere.
Even if you rest it and take some time off, it somehow finds its way back into your life. But not for long……
To first understand how tendinitis comes about you will want to see our last two blog posts on tendon strains here and here so you can understand more about pre-stretch and tendon loading.
Like any tendon strain or tendinitis, we need to start to see where the repetitive loads are being distributed, and what muscles are not leveraging well enough to support the tendon.
In this case, the quads act as a braking force to pre-stretch the patellar tendon and redistribute loads around the upper and lower leg.
When the quads are in a poor position to manage force efficiently, the patellar tendon becomes overloaded and strained.
Most times, the quads are being steered by the hip and pelvis position.
Many cases, the pelvis is being pushed forward and changing our center of mass to be directly over the knee, which can lead to unnecessary downward forces on the knee joint that should be dispersed amongst the body.
The first step in this case is to reestablish hip position to offload the knee joint itself, followed by a management of loading on the tissues surrounding the knee joint. (That’s a fancy term for gaining control through the quads).
As a quick aside, some ideas to start to learn how to adjust your weight to shift backwards by doing squats with a heel elevation, keeping the weight on the heels, or by doing pelvic tilts into a bridge. There are many more ways, but these can be a start.
With the pelvis under control, the quads have a better leverage point to act as a brake to the knee joint.
First step would be to increase the stress tolerance to the muscles so they can still maintain their positioning under fatigue.
We usually like to start with tempo squats at this point or some version of eccentric focused squatting patterns.
The tempo is a nice way to keep the loads light and have constant tension on the quads, all while controlling the hip and knee in position with the descent and ascent of the lift.
You can do you tempos for a count down for 2-4s, followed by an up count for 2-4s. The movements are continuous and you should not be locking out at the top or stopping in transition. Nor should it be so hard that you have to breathe heavy or hold your breath.
Many times we start with bodyweight squats or split-squats and progress to lighter weights of 5-30lbs.
The goal here is to perform 8-12 reps with a 1 min break, and repeat for 2-3 more sets. That means 1 rep is anywhere from 4-8s depending on your count.
The best thing about these is that you can get a lot of workout having to do many exercises or have it take up too much time, and you only have to do these 2x/week to see real benefits.
Another thing to note, you don’t want to feel like you are getting pressure towards the knee itself. That means your weight is shifting onto your toes too much. Keep the pressure towards the heel, even as the knee translates forward. This will give you the work on your quads (mid thigh) and the butt.
After getting comfortable with the tempos, we like to progress the intensity so you can access the “brakes” quicker, without a change in force distribution. This way you can be ready for quick changes of direction or faster, repetitive movements.
One of our favorite things to do when introducing a power or plyometric based activity for patellar tendinitis rehab is an oscillatory isometric split-squat (OI SS).
This move is great at learning how to stop and absorb forces, without large amplitude of movement.
The key is to just let yourself drop lazily, and then catch. It’s not a jump and catch.
As you progress through the OI SS moves, you can move to depth jump landings or box jumps, progressing from 2 legs to one leg.
The progressions are limitless, but the degree to which you need to progress your exercises are always dependent on the activity you want to achieve.
If you are feeling stuck and don’t know where to start or you don’t know how to progress further……
We are more than willing to help you on your journey to relieving patellar tendinitis.
Request to talk to a PT so we can give you more insight on what your best solutions would be.
Dr. Peter Dionisopoulos is the owner and founder of Dynamic Performance & Rehab. He has worked with many high-level athletes and military personnel, but his true passion is to help active adults maintain their lifestyle by providing information and potential solutions to their aches and pains so they can continue with the activities they love.