We’re going to cover patellar tendonitis – what it is, why stretches won’t help, and how you can rehab it at home.
Patellar tendonitis is inflammation (or pain) in the patellar tendon, which is located just below the kneecap, aka the patella. The tendon connects your kneecap to your tibia.
This type of tendonitis is often called jumper’s knee. It’s common in jumpers (as you probably guessed from the name), cyclists, and any activity involving repetitive movements that move the knee joint through flexion and extension.
What Causes Patellar Tendonitis?
One reason could be the tendon simply isn’t ready for the load it’s given in these activities or the volume of the load. Say you took the winter off and then decided to go for a hard run on the first warm day of spring. Your body might not be ready for it.
The patella tendon gets inflamed from the sudden load. Then, inflammation turns into a long-standing issue or develops into a syndrome without recovery time. Not fun.
It could be a matter of volume or intensity – jumping too high too soon.
But if that’s not the case and it just creeps up on you, that’s another matter entirely. In this case, the common rehab strategy of strengthening the patellar tendon through squats, eccentric, and loads of load might not be sufficient to get you out of patellar tendonitis for the long term.
Tendinitis or Tendinopathy?
Now that we’ve learned a little more about the condition, it’s a great time to make a clarification about the condition’s name.
So far, I’ve been calling the problem “patellar tendonitis.” This is the long-held name for this issue, but it’s starting to change.
The name tendonitis suggests that inflammation of the tendon is the problem, but that’s not what’s actually happening…
Research has shown that while some inflammation might be occurring in PT , DEGENERATION of the tendon is the primary cause of the pain.
To this end, more and more experts are shifting to the term patellar tendinopathy (which can still conveniently be abbreviated PT). This name suggests a more general disorder of the patellar tendon.
It might seem inconsequential (to-may-to, to-mah-to, right?), but the name of a condition can affect how patients, doctors and trainers all approach it.
I mean, if something’s “inflamed”, you might think all you need to do is ice it and let it chill out.
And while a little ice when you’re dealing with acute patellar tendinopathy pain can help (we’ll get to that in a minute) relying on that alone without strengthening the tendon and surrounding muscles won’t get you very far. So let’s get into what TO do.
What To Do For Knee Pain?
Well, there are several different strategies and possible root causes. With the five exercises to follow, you might be able to address those root causes.
The first thing we want to look at is the foot and the ankle. That’s the first interaction your body has with the ground on each step you take. It’s also the first stage for absorbing force, so if the structure isn’t strong enough or joints aren’t functioning correctly, then all those forces that would have been absorbed through your foot and ankle move up to the next joint – your knee.
The first part of your foot to look at is the arch. Do you have an arch, and are your intrinsic foot muscles working?
Here’s the test.
Metatarsal pressure will tell you if your foot muscles are working right. The metatarsal heads are also called the balls of your feet. Each toe knuckle where it connects to the foot is a metatarsal head – you should have five.
When you push your foot into the ground, you should be able to put pressure on all five heads. Pushing through the ground and being able to hold your weight while pushing through the metatarsals helps you create the arch and strengthen those intrinsic foot muscles.
The stronger those muscles, the more force they can absorb. You will save your knees from overworking every time you run or jump.
You can follow along with the exercises in our YouTube Video here.
Metatarsal Pressure Exercise
This first exercise is simple. Take off any socks or shoes, so your bare foot is on the floor. Concentrate on pushing your metatarsals, not your toes, into the floor, then squeeze the muscles together.
- Put your foot flat on the ground
- Push through your metatarsals (not your toes)
- Squeeze your metatarsals together
- When activated, put some weight on your foot
- Hold for 5 – 10 seconds
- Repeat for 5 to 10 repetitions
Work your way up on the repetitions because building that endurance is the first step on the performance pyramid. Skipping endurance means you’re opening yourself up to injury.
If you’ve never done this before, it might feel weird.
You will improve over time. Most people wear shoes all day. Stuffing feet into shoes and tightening up those laces means your foot muscles don’t have to work anymore. Instead, the shoe structure creates support for your foot.
You have a lot of muscles on the bottoms of your feet. When they’re not working, they start to lose the ability to form a natural arch that lets you absorb the force when you come in contact with the ground.
Banded Dorsiflexion Mobilization
We’re looking at the ankle range of motion for this second exercise, specifically dorsiflexion.
For a video specifically on improving your ankle dorsiflexion (particularly important for anyone who regularly wears heels), check out this article.
Dorsiflexion range is anytime you’re pulling your toes up toward your knees. The angle of your ankle gets smaller in dorsiflexion.
This can be through open-chain dorsiflexion, where you pull your toes toward your knees. It could also be closed-chain dorsiflexion where your foot is on the ground, and you push your knee toward it, like doing a lunge.
How do we increase this range of motion?
Unfortunately, stretching is not going to cut it. Our bodies want to prevent injury, so stretching won’t loosen a muscle long-term.
Grab a strength band for this exercise. You will need to loop it around something low. If you don’t have a squat rack handy, a table leg will do just as well.
- Stick your foot through the secured fitness band, & point your toes away from the band
- Step on the band with your other foot to create a downward angle
- Drive your knee forward, maintain metatarsal pressure
- Hold for 5 seconds
- Repeat for 5 to 10 reps on each side
Keep your knee aligned over your toes and your heel on the ground.
The band helps stabilize the bones in the front of your leg, so you go into dorsiflexion properly. That will give you the strength to increase your range of motion.
Don’t forget that metatarsal pressure here is key.
ASMR: Anterior Thigh
Technique number three involves active self myofascial release for your anterior thigh, specifically the quadriceps.
You will need your trusty foam roller for this one. It’s a simple exercise but might take some adjusting to the feeling of lengthening your muscle tissue through the movement.
- Lay with your face toward the ground, use your elbows to prop yourself up
- Start the roller just above the knee
- Roll your body back so the foam roller moves up the quads
- Pull your heel toward your glutes as your roll up the thigh
Using the foam roller to loosen the tissue in your leg will actively lengthen the quadriceps and improve tissue pliability. Make sure to keep your quad and particularly your VMO activated.
Hamstring activation here is essential.
Extended Knee Ankle Plantarflexion-Dorsiflexion
This is another simple one. You only need a little pillow, a rolled-up towel, or even your other ankle.
Don’t let your knee flex at all while doing this exercise.
You might get a little foot cramp. Try to power through it, and promise yourself a banana or something else with potassium later on.
- Sit on the ground with your foam roller under your knee.
- Extend your leg straight out, tap your VMO to make sure it’s activated
- Point your toes (plantarflexion) for 5 seconds – do not flex your knee
- Pull your foot toward you (dorsiflexion) for 5 seconds
- Do 3 or 4 cycles on each side, 2 sets
Pay attention to your VMO here. You shouldn’t have any alignment issues if it’s activating properly. Tapping your VMO will tell you if it’s activated and help you keep it flexed.
Stability Ball Leg Curl
We’re going to get the hamstrings working now.
Sometimes patellar tendonitis comes from the rectus femoris filling in as a terrible substitute for your hip flexors. Your hamstrings can tighten over time if your hip flexors have been slacking off for a while.
Unfortunately, stretching won’t cut it here either. It might feel better for a moment, but you won’t notice any long-term changes. Instead, we’ll lengthen your rectus femoris using a stability ball for balance.
Time to get your stability ball also called an exercise ball.
- Lay on your back with your heels on the ball
- Bridge your hips up – you can put your arms to the side for stability
- Roll the ball to the bottom of your feet as you bring your heels toward your glutes
- Slowly roll the ball back out
- Perform 6 – 10 repetitions, 1 or 2 sets
Do your best to maintain a balance between your quads and hamstrings.
If this exercise felt great, you might like our article on the 2 Exercises for the Best Rectus Femoris Stretch.
Slumpy Psoas Activator
The psoas can get sleepy if you happen to spend much of the day sitting. It is unfortunate because then other, less competent muscles will take control of your hip joint.
In this case, the rectus femoris is causing problems again by constantly pulling your patella toward your hips. That causes stress on the tendon.
Time to get the psoas working again and put the rectus femoris back on standby.
- Sit on a stable surface with bad posture (flexed spine)
- Put your opposite palm on your knee
- Pull your knee up against the resistance of your hand
- Visualize using your psoas to pull the muscles, make sure it’s activated
- Hold the activation while you straighten (extend) your spine and extend your butt out (anterior pelvic tilt)
- Hold for 5 seconds
- Switch sides
This exercise uses your psoas to lift your foot off the ground, creating hip flexion. We’re also working both hip flexion and lumbar extension anterior pelvic tilt simultaneously. When you sit all day, your psoas shuts off, then gets weak over time, so other muscles come in to compensate.
Long-Term Patellar Tendonitis Rehab
We’ve addressed patellar tendonitis through different means, not just working on the knees and quads.
We got the foot working properly, improved ankle range of motion, activated the quads, woke up the hip flexors, and made sure you have more pliable tissue going forward.
We hope you enjoyed them.
Do these for two to four weeks to see lasting results. Most people will start seeing results in that period. If you don’t, there may be other structural issues that also need some attention.
Thanks for reading. Take care of yourself.