Patellar Tendonitis & Tendinopathy: Treatment & Prevention | Precision Movement

Patellar Tendonitis & Tendinopathy: Treatment & Prevention

Exercises to Eliminate Acute Pain and Address the Root Causes

By Coach E

patellar tendonitis treatment and prevention

“Jumper’s knee” interfering with your game? Patellar tendonitis is a common and painful annoyance for athletes – here’s how to treat the issue and prevent it from slowing you down.

Playing Through the Pain

The knee pain of patellar tendonitis can really get in the way of your workouts or activities – especially if you play a sport like basketball or volleyball, which involve a lot of jumping and landing.

Take for example, the all too common experience of a basketball player with jumper’s knee, as patellar tendonitis is often called. If you play, this might hit a little close to home…

You notice that your knee is starting to hurt a bit after your pre-season practices. At first, you mostly ignore it – you’re just excited to be back on the court.

patellar tendonitis - basketball

But as the season swings into full gear and things start to heat up, the pain intensifies.

You start to notice it every time you jump to shoot – it’s the landing that’s really painful. As soon as your knees bend and your feet land back on solid ground, you feel a stabbing pain in your knee.

You try to play through the pain and keep going, despite a few concerned comments from teammates who have noticed your wincing every time your feet hit the court.

Eventually, the pain catches up with you. There’s no avoiding or faking it. And there’s no way you’d be doing your team any favors by limping around out there during a game.

You have to sit it out and figure out what the hell is going on with your knee.

What is Patellar Tendonitis?

The patellar tendon connects your patella, or kneecap, to your tibia, or shin bone. It’s paired with the quadriceps tendon – which connects your kneecap to the quad muscles of your upper leg.

 patellar tendonitis - anatomy of the knee

Your patellar tendon works with these upper leg muscles to help straighten your leg [1] making motions like walking, jumping and running possible.

Think about a jump.

Your quads provide a huge amount of force, as you straighten your legs and move up into the air [2]…

patellar tendonitis - man jumping

…Then as you land, you bend into your knees to help absorb the force.

patellar tendonitis - female jumping

When your patellar tendon experiences too much stress, it can become strained and patellar tendonitis (PT) can develop.

Patellar Tendon Symptoms

The most common symptom of PT is pain and tenderness along the front of the knee.

The pain typically gets worse during activities like jumping and running, but it may even become irritated after sitting for a long time or stiff after waking up [3].

The pain, like experienced by our basketball player earlier, tends to start gradually and become worse and worse as activity levels increase.

Overuse is typically behind these injuries. As the patellar tendon is experiences high levels of stress and load, perhaps from an increase in activity or lots of repetitive jumping movements, small microtears can form in the tendon [4].

Overtime, if not allowed to heal and instead aggravated with further strain (I’ll remind you again of our baller who kept pushing through the pain) these microtears only get worse, causing more and more pain.

 patellar tendonitis - knee pain

Your patellar tendon experiences the most amount of stress, force and strain when you’re jumping and landing [5], so athletes whose sport involves a ton of these movements often fall victim to this pain.

Basketball and volleyball players are common patellar tendonitis sufferers, as are track and field athletes, dancers, gymnasts, skiers and soccer players.

patellar tendonitis - volleyball

And factors specific to individual athletes can increase their chance of PT.

If you’ve followed me for a while, you know that I often remind you that everything is connected when it comes to pain in the body. Strain in one area is often caused by imbalances up or down the kinetic chain, and research has found this to be true for patellar tendinitis as well.

For example, sufferers of PT have been found to have greater flexion in their knees and reduced motion in their hips [6] – a combo that could easily add strain to the knees.

One study looked at 14 male athletes, half of whom had PT, and found that the group with knee pain had weaker hip extension, reduced ankle dorsiflexion and less flexibility in their hamstrings [7].

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 [8], 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.

Acute Phase Treatment (Up to 7 Days)

STOP

As it was for our basketball player, it can be really tempting to just push through the pain of PT…

Especially at the beginning, the pain can be annoying but easy to ignore – particularly during the action of a game.

But it’s crucial to STOP any movements that provoke pain.

Pushing through training with this injury can greatly extend the recovery process [9] – taking it from a simple rehab process you can do on your own with a little patience and effort… to a major injury that will require more serious treatment.

Research has shown that regardless of what type of treatment was used to rehab PT patients, having symptoms for a longer time before starting that treatment resulted in less improvement of symptoms [10].

patellar tendonitis stop

So take it easy and make an effort to focus on the steps I’ll give you instead.

INFLAMMATION

Fish oil and turmeric are 2 supplements I recommend as you work to ease the inflammation of patellar tendinopathy during this acute phase.

Studies have found fish oil can reduce signs of inflammation in a variety of groups, including overweight adolescents [11] and healthy young adults [12].

And turmeric has been found to reduce inflammation in people suffering from everything from mouth inflammation [13] to osteoarthritis [14].

PuraThrive makes a great turmeric supplement, check them out if you’re searching for a good option.

You can also use ice to help ease the inflammation, but I suggest only doing so for the first 24 to 72 hours after pain develops. After that, use cold water on your knee in the shower and only use ice if you move in a way that causes a flare up of pain.

CIRCULATION

It’s good to encourage circulation in the knee at this early stage, but you don’t want to push it so far that it causes pain.

To get your blood flowing (which helps deliver nutrients and speeds healing), start with some simple and pain-free movements.

Try a simple seated knee extension, for example.

Sit down and just start to lift the foot of the affected leg, straightening your knee as you go. Perform 20 reps 2 to 3 times a day.

Another option you can try if you feel ready is to add in some gentle, but strength building isometric, or static, techniques.

In one study, isometric leg extension holds to about 60° of knee flexion were found to provide more immediate pain relief than weighted leg extension reps to in-season basketball and volleyball players with PT [15].

The findings of this study suggest that isometric strength building can be of huge benefit to people with PT pain – especially if they’re continuing to train and play.

Once knee pain is diminished, you can start to begin more aggressive therapy.

Post-Acute Phase Treatment and Prevention: 3 Factors

There is quite a bit of research into patellar tendinopathy, likely because it affects elite athletes such as basketball players where there is a lot of money involved.

The thing about research is that in order to conduct valid studies, the researchers have to limit the # of variables studied and require simple variables to study, which is why so much research has focused on simple interventions like Eccentric Decline Squats and Drop Squats.

However, newer research has uncovered additional factors such as quadriceps and hamstring flexibility, ankle dorsiflexion mobility and hip extension strength as being associated with the development of patellar tendinopathy.

My experience from training many elite athletes and having tens of thousands of peeps from athletes to seniors who just want to move without pain go through my programs tells me that there’s never just one factor that contributes to a condition, whether it be patellar tendinopathy or low back pain – there are so many moving parts that we need to ensure the entire system is working properly.

That’s why if you want to not just fix knee pain but ensure the whole system is working right so no other issues crop up, you’ve got to work on the system, which includes addressing the following 3 factors.

1) Hip, Knee and Ankle Mobility

Hips & Ankles: Deep Squat Pivot

This drill works to simultaneously train mobility in your ankle dorsiflexors and your hip flexors – important joints on either side of a painful knee.
patellar tendonitis - Deep Squat Pivot

  • Come into a pivoted deep squat position by placing your right foot and the ball of your left foot flat on the ground, keeping your left heel elevated
  • Bend your left knee down toward the ground as you pivot toward your right side
  • Dorsiflex your right ankle to lift your right toes off the ground
  • Hold for a few seconds before you lower the right foot flat on the ground, continuing to dorsiflex the ankle
  • Pivot to switch sides, completing 3 reps per side

Knees: SB Supine Squat for Quads

This technique works to improve knee health and quadricep flexibility in a smart way – by training both stability and strength when your quad is lengthened.
patellar tendonitis - supine squat

  • Sit down on a stability ball
  • Walk your feet forward as you lean back to achieve a supine position on the ball
  • In this position, roll forwards so that your knees travel over your toes and you finish in a fully knee flexed position
  • Now, contract your quads and push into your feet to roll backwards on the ball until your legs reach a 90° angle
  • To go back, actively contract your hamstrings and pull your body forwards into the knee flexed position
  • Complete 10 reps per side

Knees: Hip Hinge with Adduction and TKE for Hamstrings

This move will help build strength in your knee’s end range of motion while lengthening the hamstrings, making it great for both hamstring flexibility and overall knee health.

Just aim for between 0- 5° of knee extension to keep this move in a healthy range.
patellar tendonitis - hip hinge

  • Start standing with straight legs
  • Hinge at your hips and reach down to grab your leg just below the patella
  • Internally rotate your legs while contracting your quadriceps to straighten the legs – this will lead to “terminal knee extension” or TKE
  • Keep squeezing your legs for 5 seconds – making sure to stay internally rotated so that your adductor muscles along the inside of your thigh are activated
  • Release and come back up to standing with control
  • Repeat for 5 to 10 reps

2) Alignment and Balance

Midline Muscle Activation Drill

This 3-part drill accomplishes a lot – it is amazing for overall balance while helping you activate your feet/ankles and hips.

Part 1:
patellar tendonitis - Midline Muscle Activation Drill

  • Set up a band low to the ground and step in with your right foot
  • Loop the band just above your knee and step away until you feel slight resistance
  • Spread your toes to prepare
  • Stand on your right foot, letting your left leg hover
  • Press the ball of the foot and the big toe mound into the ground as you balance
  • Hold the balance for between 30 seconds and 1 minute before switching sides

Part 2:
patellar tendonitis - Midline Muscle Activation Drill Part 2

  • Balance on your right foot
  • Step back into a lunge with your left foot
  • Lower down into a split squat, bending your left knee down to the ground and then raising it back up
  • Resist the pull from the band on your right knee to maintain proper alignment
  • Do 10 slow reps, then switch sides

Part 3:
patellar tendonitis - Midline Muscle Activation Drill Part 3

  • Balance on your right foot
  • Step back with your left foot and lower into a reverse lunge
  • Lift back up to standing and repeat for 10 reps
  • Balance on your right foot
  • Keep your right knee straight as you hinge at your hips, lifting your left leg out behind you
  • Lift back up and complete 10 reps
  • Switch sides

3) Strength

15° Eccentric Decline Squats

Research has found the decline squat to be an effective technique for PT treatment and pain relief (5). It will work to strengthen your patellar tendon and surrounding musculature while operating in a moderate and safe range of motion.
patellar tendonitis - 15° Eccentric Decline Squats

  • Use a slant board, or just step on a plate with your heels, placing your toes on the ground
  • Squat down to about 60° of knee flexion (about a half squat)
  • Complete 3 sets of 15 reps
  • If this is going well, you can progress to a 1-leg version, stepping on the plate with your right heel, placing your right toes on the ground
  • Let your left foot hover in front of you, like a pistol squat, as you again squat down to 60° of knee flexion
  • Complete 10 reps and switch sides

Drop Squats

Research also supports the use of drop squats for PT pain relief [16]. This technique will load your patellar tendon and stimulate hypertrophy in the area. It will also help encourage proper form and build strength as you eccentrically control the landing.
patellar tendonitis - Drop Squats

  • Stand on top of a box
  • Step off the box with both feet and stick the jump – land with knees slightly bent, both feet pointing straight ahead, spine in neutral and legs with proper alignment
  • Step back on the box and repeat
  • Do 3 sets of 10 reps each, resting for 1-2 minutes between sets.

KB Swings

When treating patellar tendinopathy, you also want to build hip extension strength and speed, which this move does perfectly.
patellar tendonitis - KB Swings

  • Grab a kettlebell (or a dumbbell if you don’t have one).
  • Tilt over at the hips as you bend your knees only slightly and lower the kettlebell between your legs
  • Explode forward, pushing your hips forward as you swing the kettlebell up and straighten your legs
  • Tilt forward again as you lower the kettlebell and repeat
  • Remember that the strength and force is coming from your hips – not your arms! Just let your arms gently guide the motion of the kettlebell

By building hip, ankle and knee mobility, improving alignment and balance and building strength up and down the kinetic chain, you should be able to reduce PT pain, rebuild strength, and recover so you can get back in the game.

Plus (especially if you do anything that requires a lot of jumping) it’s wise to start to work on these areas BEFORE you notice any pain.

A little prevention in the form of these techniques can go a long way to keeping your knees healthy and pain-free, and to keeping you in the game.

Maybe you should share these moves with your teammates, too – keep your entire squad healthy so you can get out there and dominate every match.

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.