Patellar Tendonitis Research: Good News and Bad News

The Queen in her carEarlier this year in London, I saw the Queen, Prince Charles, and Dr. Peter Malliaras.

Only one of them came prepared with new insights about tendonitis.

Dr. Malliaras, PhD, is one of the world’s leading tendinopathy clinicians and if you get the chance to take one of his courses, I highly recommend you do so.

The two biggest aha-moments I had in his seminar fit the old “good news, bad news”-cliché.

Let’s start with the bad news.

Here’s the Bad News

As part of his work, Dr. Malliaras regularly performs ultrasound imaging. For him, it’s an important tool to reassure patients by saying “look, you’ve got 80% normal tendon” and to aid in differential diagnosis.

Clinicians can see tendon pathology on ultrasound, but much like a shoulder with a torn rotator cuff can be pain-free, a pathological tendon is not necessarily painful. This confirms my patellar tendonitis treatment advice: “Just because you’re pain-free, doesn’t mean your tendon is healthy”, but here’s the bad news.

Once a tendon has become pathological (i.e., the collagen alignment inside the tendon has degraded and other negative changes occurred), the pathological changes will not go away again.

You read that right.

Once a tendon has become degenerated, it will stay degenerated, as shown by ultrasounds of recovered tendinopathy patients. These folks are pain-free and able to enjoy their sports without a problem, but the inside of the tendon has not returned to the pre-injury state.

Here are my key takeaways from this.

1) Ignoring the pain is officially the worst way to deal with tendonitis, because of the high risk of doing irreversible damage to the tendon.

2) To prevent pain from coming back once you’ve recovered, keep doing strengthening exercises for your tendon. That brings us to the good news.

You CAN Get Rid of Pain (In Many Different Ways)

The most popular exercise for patellar tendonitis is eccentric squats on a slanted board. It’s been around for decades and looks like this.

eccentric squats on a slanted board for patellar tendonitis

A newer treatment approach relies on heavy slow resistance training (HSR), which you can do on the leg press machine, the leg extension machine, the smith machine, hack squats, and even with barbell back squats.

HSR exercises for patellar tendonitis, pictures B through D - Source: Koonsgard 2009

HSR exercises, pictures B through D – Source: Koonsgard 2009

Of course your next question is, “which one is better?”

It depends.

If you look at the landmark study by Koonsgard from 2009, you’ll find that while HSR has a slightly better outcome in terms of pain scores at the 6-month follow-up compared to eccentric training, the difference is not statistically significant.

In this study, some people did better on HSR exercises and others on eccentric training.

The key insights in terms of outcome difference were that both, eccentric training and HSR, are superior to corticosteroid injections over the long-term, and that patient satisfaction was higher in the HSR group, because of the lower training frequency.

At the seminar, Dr. Malliaras said, “It doesn’t matter what exercise you do, people will get better.” That is, as long as you’re using an exercise that can be progressed and are not progressing too fast.

Here’s my take on the advantages of heavy slow resistance training compared to eccentric squats.

Pros and Cons of HSR for Tendonitis

+ Lower training frequency (in the first months only – I advise against daily training with eccentrics as soon as you do single-leg variations)

+ Potentially better than eccentrics if exercise irritates your tendon easily (HSR allows for adding resistance in small increments, so you’re progressing more gently)

+ Allows for isolating the quadriceps muscle group (in the squat, quad weakness may be masked by more engagement of other muscles)

– Requires gym membership (and you will need to drive there)

– Requires technique instruction (for smith machine squat, back squat, and leg press) to reduce risk of back injury

If you already have a gym membership and are experienced with the required exercises, HSR is a good option. If you’d rather train at home, eccentric exercises are the more attractive option.

Regardless of which exercise you pick, be sure to move slowly and without momentum. You need to avoid flare-ups.

How to Make Your Knees Strong Again

The research is clear on one thing. Your knees won’t get better with resting. You need progressive loading.

Let me show you a simple way to get rid of pain and make your knees strong again.

Click here to get free instant access.

Patellar Tendonitis & Jumper’s Knee:
How to Get Rid of It

Patellar Tendonitis & Jumper's Knee: How to Get Rid of ItLearn how to get rid of your Patellar Tendonitis in this ultimate guide to curing Jumper’s Knee.

My name is Martin Koban and I suffered from patellar tendonitis (aka “jumper’s knee”) myself. I know how frustrating it can be and since you’re reading this, I don’t have to tell you about it.

To cut a long story short, I almost quit sports altogether before I finally discovered a number of techniques that helped me heal my knees and get back to being active.

I collected this knowledge through years of research and self-experimentation. The techniques you will learn on this page have already worked for thousands of people and professional athletes are using them as well.

If you want to get rid of your patellar tendonitis, this is your holy grail.

[Read more…]

Jumper’s Knee: It’s Okay to Train through Pain If… [Checklist]

If you had jumper’s knee for a while, you know that ignoring pain doesn’t work, so what should you do if you feel pain during your training or even during rehab?

Let’s talk about how you can recover faster by knowing when it’s okay to push through pain.

Do you want get rid of your tendonitis ASAP? Join my advanced course today.

Video Transcript

So you’re trying to get rid of patellar tendonitis, but because some pain is always there, you’re not sure how hard to push yourself during rehab or training. You don’t want to cause a setback. [Read more…]

From Crippling Tendonitis to MVP Award: How Pro Athlete Boki Nachbar Beat His Tendonitis to Feel “95% Better”

bokiImagine you had the opportunity to spend every day doing what you love and earning several Million Dollars per year doing it.

Would you take that job?

There’s just one problem.

If you can’t get your knee pain under control, the fun is over.

That was Boki Nachbar’s situation. Among other teams, Boki played professional basketball for the Houston Rockets alongside Yao Ming and for the New Jersey Nets, with Vince Carter and Jason Kidd.

Boki reached out to me for help with his tendonitis last year in August, because the knee pain was ruining his love for basketball. He wanted to keep playing without using painkillers.

Here are his results after Boki and I worked together on a detailed plan for him to follow during his off-season.

  • Won league MVP award in March after a season with horrible tendonitis
  • Feels “95% better” compared to last season
  • Most importantly: Basketball is FUN again

How to Beat Your Tendonitis Using Boki’s Approach

Boki invited me for an interview on his podcast and we talked about a number of topics you’ll find interesting such as:

  • Preventing and rehabbing knee injuries in sports, particularly tendonitis
  • Why my approach helped him get better while the advice his physical therapists gave him didn’t
  • What happens if you play through patellar tendonitis


Click here to listen to the interview.
(Use the link at the bottom of the page to download it to your device)


If you found the conversation useful, please leave a short review on iTunes.


Picture by Boštjan Nachbar

The Top 5 Patellar Tendonitis Exercises

The Top 5 Patellar Tendonitis ExercisesAre struggling to get rid of your pain?

Chances are you’re doing the wrong exercises or you’re making small technique mistakes that are hurting your knees.

On this page, I share the 5 patellar tendonitis exercises that thousands of my readers have already benefited from and I will show you how to do them correctly.

Using these drills you can finally heal your knees, so let’s get started with the very best exercise.

[Read more…]

Patellar Tendonitis Treatment: Do You Know These Secrets?

Patellar Tendonitis Treatment:  Do You Know These Secrets?Are you struggling to get rid of your pain?

Patellar tendonitis treatment can be extremely frustrating and according to academic research, it may last up to 15 years, especially without the right approach (Kongsgaard et al. 2009).

Read this article to learn the secrets I discovered through treating my own patellar tendonitis and helping countless readers with this injury.

[Read more…]