Curing Jumper’s Knee: The 3 Secrets of the Treatment Triangle

"Fly Away" by 55Laney69 (Flickr)Jumper’s knee is a stubborn knee injury that can take months to heal and even once it has healed, the pain might reappear after you return to your sport.

The jumper’s knee treatment triangle will help you solve this problem by fixing the three most critical causes for jumper’s knee.

In this article I will walk you through everything in detail. Keep reading to find out.


End Jumper’s Knee Once and For All

Back when I suffered from patellar tendonitis, I was so frustrated with my lack of healing progress that I often considered quitting my sports, basketball and volleyball, altogether. Stretching, warming up thoroughly, quad strengthening exercises, knee sleeves, no matter what I tried, the pain always kept coming back.

Today, my knees are stronger than ever. I can do extremely demanding leg exercises, such as deep single-leg squats, without any problems. I can play my favorite sports without having to worry about aching knees and I know how I can train my legs to become even stronger without risking a return of the injury.

It took me years of research into knee health and a lot of self-experimentation until I finally discovered the reasons for my jumper’s knee. Up to that point, I had completely ignored these hidden factors, but once I addressed them, my pain slowly disappeared.

In this article, I will show you the three most important secrets to successfully treating patellar tendonitis. I’ve called this the jumper’s knee treatment triangle, because if you ignore one of its parts, the whole thing collapses. You’ll also learn an exercise with which you can heal your patellar tendons.

What Is the Jumper’s Knee Treatment Triangle?

The treatment triangle will help you address the three most common causes for patellar tendonitis. I came up with the idea for the triangle during the research for my book Beating Patellar Tendonitis and while I deal with many other causes of this knee injury in the book, the three causes addressed with the treatment triangle are the most important.

The triangle provides the foundation for a successful recovery from jumper’s knee. If you want to make sure you stay pain-free in the future, this is where you need to start. Here’s what the triangle looks like:

The Jumper's Knee Treatment Triangle

Let’s talk about why its parts are important for healing this stubborn knee injury and determine how you can take care of them.

3 Hidden Causes for Patellar Tendonitis

Three major causes for jumper’s knee are low ankle mobility, low gluteal strength (hip strength), and bad leg alignment during athletic activity. Unfortunately, these hidden causes are commonly ignored by athletes, trainers, and physical therapists, which is why the injury will reappear eventually after it has seemingly healed.

As you will see, all three of these causes are connected, which is why you need to address all of them if you want to make healing progress. Additionally, they all have strong research supporting their importance for preventing jumper’s knee. For these reasons, the exercises introduced in the following paragraphs need to become a staple in your training regimen.

Cause #1: Low Ankle Mobility

Ankle mobility encompasses a number of ankle movements, but the most important one for our goal is dorsiflexion. Low ankle dorsiflexion range of motion has been linked to patellar tendonitis in a number of research studies, for example (Malliaras et al. 2006) and (Backman, Danielson 2011).

So what is ankle dorsiflexion? You dorsiflex your ankle when you pull your foot up towards your knee or when you bring your knee out in front of your toes, with your foot planted. The opposite movement, plantarflexion, occurs when you point your foot away from your knee or when you push yourself up to stand on the balls of your feet.

Ankle Dorsiflexion vs. Plantarflexion

There are two major reasons why low ankle mobility will lead to knee issues. First, if you lack ankle mobility, the body will compensate for it by increasing mobility at the neighboring joint, the knee. This increased demand of mobility will slowly overload the knee, which in time leads to pain and injury.

Secondly, if ankle mobility is low, you will have a difficult time maintaining good alignment of your leg. This is how ankle mobility is connected with the third major cause for jumper’s knee (Cause #3 leg alignment).

As you can see, the evidence supporting the importance of ankle mobility for healing the patellar tendon is strong, but how do we improve it?

How to improve ankle mobility

There are numerous ankle mobility exercises to choose from, but if you want to improve ankle dorsiflexion, the following drill will provide good results and direct feedback on your progress. Additionally, you don’t need any equipment to do it, which means you can do it anywhere.

All you need to improve your ankle dorsiflexion is a piece of furniture, a wall, or another vertical structure. Place one foot perpendicular to the object and the other foot a little more than shoulder width behind it. Now try to touch the knee of the front leg to the object by bringing it over the toes.

How to improve ankle mobility

In ankle mobility drills, you might not feel a stretch. The goal is to move the joint through its full pain-free range of motion gently. By doing this you slowly increase the range of motion of the joint.

The important point is to bring the knee forward on the outside of your big toe (if you’re working your right foot, bring your knee forward and then to the right). Have your knee tracking somewhere over the second, third, or fourth toe. Don’t bring the knee towards the inside of your foot and don’t turn your foot out, as this would lead to the arch in the foot collapsing.

Knee movement during ankle dorsiflexion drill

If you could touch the object, move your foot back a little more. Once you can barely touch the object, switch sides by placing the other foot at the same distance. Now, perform the same test.

Is it easier for you to touch the object with one side? If so, you’ve discovered an asymmetry between sides, which you need to correct as quickly as possible by improving the mobility of the weaker side.

You will slowly improve ankle mobility by doing this drill once or twice daily. Do at least 15 repetitions per foot in each session. You’ll know when your mobility has improved, as you’ll be able to move the foot farther away from the object.

When we talk about cause #3 we will come back to ankle mobility and examine more reasons why it is so important for a healthy patellar tendon. For now, let’s talk about the second major cause for patellar tendonitis: low gluteal strength.

Cause #2: Low Gluteal Strength

Your glutes are the big strong muscles on your hip. These muscles are used when running, jumping, landing from a jump, and many other athletic movements.

The gluteal muscles also help you control the alignment of your knee during these movements. Therefore, if you have weak gluteal muscles, your legs are more likely to end up in a position in which you place excess load on your knees. Research has also uncovered low gluteal strength as a risk factor for patellar tendonitis (Ireland et al. 2003; Powers 2010), so let’s look into how you can make sure those muscles are strong.

How to improve gluteal strength

For a healthy patellar tendon, the three important movements your gluteals need to be strong in are hip abduction, hip external rotation, and hip extension. If you are strong in these movements, it will be easy for you to maintain good leg alignment in your sport. We will train these movements with the following three exercises.

Gluteal Exercise 1: Hip Abductions

To do hip abductions, lie down on your side with your body in a straight line. Put some padding under your hip if you’re on a hard surface. Now, lift the upper leg up, merely using the muscles of your hip. You should feel the contraction on the outside of your hip.

hip abduction drill

Keep your feet parallel to the ground, so don’t let them rotate outwards. If you let them rotate outwards (your foot points towards the ceiling instead of being parallel to the ground), other muscles of the leg will take over, and the exercise will be less effective, so pay attention to your technique.

Hold the elevated position for a second or two and contract the working muscles as hard as possible during that time. Lower your leg again. That’s one repetition.

Gluteal Exercise 2: Clamshells

To do clamshells, lie down on your side with your legs a bit in front of your body and your knees slightly bent. Put some padding under your hip if you’re exercising on a hard surface. Now, rotate the upper leg out without moving your upper body or hip. Move by using the muscles on the outside of your hip.

Clamshells for hip external rotation strength

Pay attention to keeping your hip and upper body in one place during the exercise. Don’t compensate by turning your whole body over. The movement might be very small in the beginning. As your muscles get stronger, your range of motion will improve. Lastly, don’t push off with your feet. The only muscles working should be the ones on your hip.

As with the other exercise, hold the elevated position for a second or two and contract the working muscles as much as possible. Lower your leg again. That’s one repetition.

Gluteal Exercise 3: The Glute Bridge

Lie down on your back with your knees bent. Move your heels closer to your body until your fingertips gently touch your heels. This is the starting position. Now, pull your feet up into the air so that only your heels touch the ground and elevate your hip until there is a straight line through your knees, hip, back, and shoulders.

The glute bridge

You should feel the contraction in your big buttocks muscles and not in your lower back or hamstrings. You can touch your hamstrings to make sure they’re not contracted as hard as your glutes.

Hold the elevated position for a second or two and contract your glutes as much as possible. Then lower down again. That’s one repetition.

Cause #3: Bad Leg Alignment

By working on cause #1 and #2, we’ve laid the foundation for fixing cause #3. To improve bad leg alignment, you need your gluteal muscles to be strong, so that they can successfully resist forces that are trying to push your knees into bad positions. The following picture illustrates bad alignment:

bad leg alignment

As you can see, we’re trying to avoid internal rotation and adduction. For this reason, we’ve trained gluteal muscles that create external rotation and abduction, the opposite movements.

Unfortunately, many people start and end in this position when they run, jump, or squat. This is problematic, as it puts undue load on your patellar tendon and on other passive stabilizing structures of your knee, such as the ACL. Knees collapsing to the midline of the body are the main cause behind ACL-tears, especially among women. However, this faulty movement pattern will also overload your patellar tendon.

If your knee collapses inward when you move, the force transmitted through the patellar tendon will be off-axis and not parallel with the collagen fibers inside the tendon. It’s much like opening and closing a zipper by pulling it off to the side, instead of straight up and down. It will slowly break down the zipper and you need to expend more energy to get it done because it’s less effective.

In your knee, the force pulling off-axis will slowly overload your collagen fibers. This overuse eventually results in jumper’s knee. Oh, and you’re wasting energy when you move that way, which means that if you learned to move properly, you’d be able to jump higher and run faster with the same amount of energy expended.

As you can see, it is critically important that you maintain good alignment of your legs during all of your training. Make sure your knees are tracking above the second, third or fourth toe and make sure your thigh is parallel to your foot whenever your knee is bent.

Avoid having your knee collapse to the inside of your foot and check for proper alignment during your training. Make corrections when necessary.

A second alignment problem many people exhibit is walking with their feet turned out. The following picture illustrates that concept (left) and a more optimal foot alignment (right).

Walking with feet turned out

The next time you walk, look at your feet and their alignment. Are they pointing to the outside?

One of the reasons why people walk with their feet turned out is because they lack ankle mobility (cause #1!). The body compensates for this lack of ankle mobility by turning the feet out. If you repeat the drill under cause #1 with your feet turned out, you’ll notice that you seemingly have more range of motion. This is exactly what the body tries to accomplish by turning your feet out and to prevent this we need to work ankle mobility.

If your feet point to the outside, your knees are much more likely to collapse towards the inside of your foot, leading us back to the alignment problem explained earlier. Additionally, your arch will collapse a bit more, lowering your ability to transfer as much force into the ground as you could with a proper arch. All these factors combined essentially lower your athletic potential and set you up for a number of injuries such as ACL tears, Achilles tears, and patellar tendon degeneration.

Don’t walk like a duck. Have your feet point forward.

The Next Step: Healing the Patellar Tendon

Once you’ve addressed each of the hidden causes, it’s time to help your patellar tendon heal faster. Depending on your situation, you can use two different methods to improve tendon healing through exercises. Let’s look at the basic idea behind these two healing methods.

Tendon Healing Method #1: Load Modification

If you’re still in the early stages of the injury, you can successfully help your patellar tendon heal by reducing the load it has to handle. You’re in this stage if you’ve only been experiencing the pain for a couple of weeks.

Reduce your weekly training load to a level at which the discomfort in your patellar tendon goes away. Stay at that level for a few weeks. Once you’ve done this, increase your weekly training load by 10%, until you’ve reached your previous level of activity. If your pain returns, you increased your training load too quickly.

The best exercises to perform during this phase are non-ballistic exercises (i.e., no jumping). Do slow weight training or even isometrics to help your tendon grow stronger. Stop all activities that lead to pain.

Tendon Healing Method #2: Eccentric Squats on a Slanted Board

If your pain has been there for a month or longer or if this isn’t the first time you’ve had jumpers knee, your injury has already progressed into one of the advanced injury stages. In this stage, you need to stimulate the cells inside your tendon to increase collagen synthesis again, so that your tendon can become stronger. You can do this by utilizing different exercises, but the one with the most scientific evidence in support of its efficacy are eccentric squats on a slanted board.

To perform this exercise you need a slanted board (a 25-degree angle works best) and something to support part of your weight. You can improvise the slanted surface by standing on something elevated with your heels (wear shoes). In the picture, I’ve supported my weight by using a stick, but you could also place chairs next to the board for example. This is what it looks like:

Eccentric Squat on Flex N Go Slanted Board

Place more weight on the injured leg on the way down and lower yourself very slowly. Place as little weight as possible on the injured leg on the way up (shift your weight to the non-injured leg or your chair/stick/training partner).

I talk about the research that supports this exercise and the specific methods you can use to make sure you achieve optimal progress in my book. The important thing is that your pain slowly decreases from day to day, as you do this exercise. If your pain stays constant, you need to experiment with the repetition count and execution.

Avoid all unnecessary exercises that increase your pain if you’re in the advanced phase.

Putting It Together

You’ve now learned five very effective exercises that you can use to end your patellar tendonitis and to prevent it from returning. Start doing the exercises today and begin monitoring your pain, so that you can modify your activity level. Remember always to pay attention to your leg alignment. Download the following program overview for the treatment triangle to help you remember everything:

overview-program-download

Your Next Steps

    1) Did you use the triangle to heal your knees? I’d love to hear about it! Please tell your story in the comment section.

    2) To help you get rid of your patellar tendonitis, I created a free course. I’ll also send you the two most important chapters of my book Beating Patellar Tendonitis as a gift. Sign up below …

Here's How You Can Beat Patellar Tendonitis

Most treatments fail and that breaks my heart. I want to help you get back to 100%, so I created an advanced course on patellar tendonitis with some of my best material:
  • Get rid of your pain without ice or painkillers
  • Discover the 5 mistakes that make patellar tendonitis come back
  • Learn why resting doesn't work and what to do instead
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About the book

Beating Patellar Tendonits by Martin KobanIf you suffer from patellar tendonitis or simply want to learn everything there is to know about this disease, you definitely have to check out my book Beating Patellar Tendonitis. It contains a detailed 3-phase training plan to address every single cause of jumper’s knee and it will help you get your knees healthy and strong again.

It’s the first book about patellar tendonitis on the market and it will give you a ton of practical advice so that you can go back to enjoying your sport as soon as possible. Be sure to check it out if you want to treat your knee injury as thoroughly.

Get the First Chapter Free!

Citations

Backman, Ludvig J.; Danielson, Patrik (2011): Low range of ankle dorsiflexion predisposes for patellar tendinopathy in junior elite basketball players: a 1-year prospective study. In Am J Sports Med 39 (12), pp. 2626–2633. DOI: 10.1177/0363546511420552.

Ireland, Mary Lloyd; Willson, John D.; Ballantyne, Bryon T.; Davis, Irene McClay (2003): Hip strength in females with and without patellofemoral pain. In J Orthop Sports Phys Ther 33 (11), pp. 671–676.

Malliaras, Peter; Cook, Jillianne L.; Kent, Peter (2006): Reduced ankle dorsiflexion range may increase the risk of patellar tendon injury among volleyball players. In J Sci Med Sport 9 (4), pp. 304–309. DOI: 10.1016/j.jsams.2006.03.015.

Powers, Christopher M. (2010): The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. In J Orthop Sports Phys Ther 40 (2), pp. 42–51. DOI: 10.2519/jospt.2010.3337.

Photo Credits

Flickr User Hansel15569

Comments

    • MDH says

      Short but complicated question. What is if you have jumper’s knee in both knees although worse in one than the other?

      • Martin Koban says

        Do two-legged eccentric squats with support. Put chairs on either side of the board and help yourself up with your hands. At this point it doesn’t matter that one knee is worse, you have to work on both knees anyways. Work towards doing the squats on the slanted board without support, but take your time.

  1. Jonas says

    Hey Martin, i really really hope you are seeing this, i have a question whose answer i couldnt find anywhere here on your website…
    Its about the role of the adductors…
    as you wrote, we want to avoid internal rotation, and promote external rotation.
    well, as the adductors job is to internally rotate the femur, would it be a good idea to stretch it? Like with kind of splits to the side or i dont know how to call them… but on the other side i thought that down there is the VMO, vastus medialis obliquus, which having strong is detrimental for knee health…
    so how should you treat those adductors? (what about foamrolling?)
    i did joedefrancos limber 11 today, which also includes adductor stretch and foamrolling, but know my knee, well not really my knee but more the muscle on the side /front of my shin which attaches to the knee, i think its the soleus, hurts at its ‘origin’ point at the knee there (feels very tight) . uce experienced this before….

    hope dou can help me
    thanks man, greets from germany
    Liebe Grüße aus Deutschland,
    Jonas

    • Martin Koban says

      Hello Jonas!

      Thank you for writing. As for your question: whether or not the adductors contribute to internal rotation depends on how much hip flexion you have. That being said, stretching the adductors will not necessarily carry over to help you better create hip external rotation.

      A better approach is to get as close to the position you want to achieve as possible (like a squat, lunge, or hip hinge pattern) and to then use mobilization techniques to address soft tissue and muscle restrictions (e.g., massage tight muscles, use compression like voodoo flossing on neighboring joints, if applicable, put the joint under traction with an elastic band, etc.).

      If you really do need to stretch, remember to put your body into the position that you’re trying to improve.
      As for your second question: I’m afraid I can’t be of much help here, since I’m not familiar with this stretching routine. Generally, my philosophy is to only stretch if you need the flexibility in your sport. In other words, don’t just stretch for the sake of stretching, but have a valid reason for doing so (e.g., stretching your hip flexors after a day of sitting).

  2. charlie22 says

    Mr.Koban.

    I have patellar tendinosis. does your book help with this condition? I have been suffering form this condition for 9 months. I have been following your exercises for two months and my pain has gone down a bit. I notice I have a lump on my tendon. I believe its scar tissue. What do recommend for that. Thank you

  3. Andy Barrera says

    Hi Martin – I got jumper’s knee from playing basketball about 4 months ago, trying to get ready for a corporate basketball league. I have a desk job, was overweight, wasn’t working out as I should and tried to do too much too fast and got the jumper’s knee. I could barely walk and thought I’d have to miss out on the b-ball season.

    Luckily, I injured myself a couple of months prior to season start and came across your exercises above. Needless to say, the exercises drastically improved the knees and I was able to play the season (and was one of the top scorers on my team).

    On top of the exercises above, I began working out about 5-6x a week, started slow at first, then gradually increased. Also changed my eating habits and I’m eating much healthier. I’v lost a total of 20 lbs so far.

    I also do not sit at my desk anymore. Every hour or two, I’ll get up and walk, do your exercises, for about 10 – 15 minutes during the workday. The sitting all day at the desk is what got me in trouble in the first place.

    My question to you is, with all that above, I still experience some aches in the knees, especially when seated at my desk. When working out, they feel great, but when sitting still, they ache.

    In addition, now knees pop when ever I go from a seated position, to standing up. It’s not painful, but it’s getting annoying.

    What do you recommend. Will this go away in time? Is it time to see the doctor? Thanks so much for this article, you’ve made the difference for me! Any help you can give me is greatly appreciated!

    • Martin Koban says

      That’s a great story. “Luckily I injured myself” … I don’t know if that was bad luck or good luck, either way, you made the best of it!

      As for the remaining issues:

      The popping sensations require a bit of experimentation to get rid of. Here are a few things you can try:

      Work on squatting technique – sit back as far as possible and keep your shins vertical, with your knees tracking over your second or third toe. You should feel like you’re almost falling backwards.

      This has helped my girlfriend mostly get rid of her popping knees and generally takes a lot of stress off the front of the knee.

      Keep doing the massages – foam roll or self-massage daily, with a focus on your quads, the outside of your thigh, and the inside of your thigh

      Do some quad stretching exercises, but be careful not to aggravate your knee with it. Here’s a link: http://www.fix-knee-pain.com/psoas-stretch/

      Good luck and keep me posted about how it goes.

  4. Lara says

    Hi Martin!
    I got jumper’s knee a year ago ( I am a 16 year old high jumper so I do a lot of jumping and running during my training) ,back then I went to physical therapies and did static exercises for quads and after 4 month of not training my knee was fine but still very weak and I wasn’t really happy about doing no exercises at that time.
    This season wasn’t succesful for me because I was afraid that I would get the same injury again so I didn’t push my leg a 100%

    Somehow I started feeling the pain again during May and it got worse over period of 3-4 weeks of competitions so now I don’t train again .
    I would like to try your exercises but I wonder if I should push trough the pain?
    Do you have any advice about nutrition for healthy joints or something?
    Greeting from Croatia! :)

    • Martin Koban says

      Hi Lara,

      The isometric quad strengthening exercises are a great way to strengthen and heal the patellar tendon. You should get yourself a small notebook and put down daily pain scores on a scale of 1 to 10 (10 being the worst pain possible). Next, adapt your quad strengthening training to reduce pain over time.

      A great way to make this process more efficient is by doing the self-massage exercise and the stretches I demonstrate in my email course on patellar tendonitis (you can find it at the end of this article).

      As for nutrition, following an anti-inflammatory diet has produced good results for some of my readers. There’s not clearly-defined anti-inflammatory diet, but generally it revolves around decreasing food intolerances (avoid gluten (in grains), alcohol, excessive coffee, dairy, excessive grains, and increase cold water fish or omega-3 supplementation). If you google for “anti-inflammatory diet” you can find some other suggestions, but your results with implementing it may vary.

      Lastly, don’t train through the pain. If you have pain, drop your regular training, take a 5 to 7 days of rest, and then start with the isometric (or eccentric) strengthening exercises until your pain is gone. Next, resume your training at a level that doesn’t cause pain. Once you’ve found that you can increase your weekly training by a percentage that doesn’t bring back pain.

      Good luck :-)

  5. John says

    hi, martin. i am now 37 and suffered from jumper’s knee for over ten years. though my knee pain is not as painful as before but it’s i’ll still easily get acute pain if i play basketball very fiercely. Do you think i can be fully recover from it? i really want to get rid of the pain. thanks very much!

    • Martin Koban says

      Hey John,

      I’m always confident about being able to recover, but I’m not a doctor so I can’t really give you a prognosis like you want.

      However, if you stick with the exercises and carefully strengthen your patellar tendon with slow eccentric training you may be able to get rid of most of the pain.

  6. Gary Zeiger says

    Hello,
    I tore 4 ligaments in my left ankle in February. Initial doctor put me in a small air brace that slightly limited side to side movement, but not dorsi-flexion or plantar flexion (up/down of ankle foot – hope I’m using terms correctly). He didn’t know about the tears because no MRI was done. So, I changed doctors, got an MRI 6 weeks later, and then my orthopedic specialist put me in a walking boot to immobilize the ankle. After about 10 or 12 days of this, I woke up unable to put any weight on my left leg. Orthopedic doctor diagnosed patellar tendonitis, due to compensation for the ankle injury/walking boot.
    Since this happened at work – an outside doctor (who never saw me) reviewed my records, and said “the knee problem is not related to the ankle or to the immobilization boot” because he was aware of no scientific studies showing a relationship between the two. (This matters because Texas Workers’ Compensation does not want to pay for my medical treatment or any time missed from work, and they justified this with the second doctor’s opinion of unrelatedness between ankle/knee issues…)
    Your opinion? I think my orthopedic doctor’s original diagnosis and explanation made perfect sense – and the other doctor’s assertion that the knee issue is unrelated (again – based on review of records – without seeing me at all) is, on it’s face, ridiculous. I’ve never had knee problems before in my life, didn’t do anything to injure the knee.

  7. Andrew Crabtree says

    Hi martin, I had patellar tendonitis and was treating for about a month and a half with physical therapy and limited physical activity. It did not seem to work very well, the swelling went away and it was relatively painless, but pain returned as soon as I returned to training for soccer. I guess I have probably done the thing that you specifically said not to do in returning to full activity too soon. I have been running through minimal pain now for a couple of days now, but the pain is slowly getting worse and my knee is back to being swollen at the patellar tendon area. I don’t really want to repeat the same process I went through before because It was so time consuming, and I am going to give the three step process described on this page a try and see if that will provide better results.
    I know that you said that returning to training too fast could add months to recovery time but I really have just recently returned to full activity and I don’t think I could of done that much harm to the tendon. If this three step process does en up fixing the underlying cause do you think that as soon as I address that problem I will be able to return to activity? I know it is hard for you to say because you can’t actually see my knee but any advice is appreciated.
    Thank you for your help.

    • Martin Koban says

      Hey Andrew,

      It seems to me that you don’t lack a new treatment approach, but you lack the patience to follow it until the treatment is actually complete.

      People with tendonitis need to change their attitude from “I want to get back to my sport ASAP” to “I want to get rid of this injury completely and heal my knees back to 100%” … Believe me, I can relate to wanting to get back to sports quickly, but with an injury like this it’s like ripping the band-aid off before the skin has fully healed: you just end up aggravating the injury again which will put you back on square 1.

      Follow the eccentric strengthening exercises until your pain is completely gone, even when doing single-leg eccentric squats. Only then can you assume that a SLOW return to sports will be successful.

      Best,

      Martin

  8. Paul Lockwood says

    Thanks for this advice, I bought the book and a slant board.

    After ~three weeks ramping up repetitions of eccentric squats I have no pain where it used to (left of kneecap mainly) but the other side of my knee is now somewhat sore/painful. Is this normal, do you know what it might mean?

    I am about to start running/ maybe cycling again. After ~five years following what doctors and physios said I don’t think I’ve been this pain free. My legs muscles became super well developed with their exercises but the patella pain never fully went away.

    • Martin Koban says

      Hey Paul,

      I’m not completely sure which area you mean, but my advice to you is to continue with self-massage and eccentric strengthening until there’s no pain at all before returning to your sport. Else you risk undoing your progress by being tempted into doing too much. It’s a real risk.

  9. Julie says

    Hi Martin,

    I am an avid competitive squash player, and just recently have been told I have patellar tendonitis. For me, its causing me pain just to walk to and from class. I am young, 22 years old, and really hope my body will be able to bounce back from this.. My question for you is even if I am experiencing pain from just walking, is it okay for me to continue with these exercises? Is it okay for me to have a light training session? Obviously not a match but just going on the court to hit? I am soso sad I can play right now and want to get better asap :(

    Thank you,

    Julie

    • Martin Koban says

      Hey Julie,

      Unfortunately, until your pain is 0 during every day activities, going back to playing your sport is highly counter-productive.

      Maybe you can find some other outlet for your competitive nature until your tendonitis is healed.

      Think about it this way: you can either spend the time to heal your knees now, or you’ll end up suffering from this for months and maybe years. Most tendonitis-sufferers end up taking the 2nd route and then regret it years later because rehab will no longer take just 2 or 3 months, but 6 months and (much) more.

      Stick with slow leg training until the pain is gone.

  10. Sawyer Kochel says

    hey martin, Im commenting on your website for an obvious reason. I was just told that I had ‘Jumpers Knee’ from my doctor. I am extremely frustrated with this and the reason it occurred is because I had been lifting legs pretty frequently. twice every week every other day I would squat. I have always had small thighs but a well built upper body frame. To make up for this I wanted to increase the size of my thighs. Not only do I have ‘Jumpers Knee’, I also get shins splints but that is because of my low hip strength and bad running form. Anyways the reason Im so worried about this problem Im having is because Im scheduled to leave for the marines boot camp in exactly 58 days. Ive become extremely worried that this will affect my performance and ultimately my health in the long run. This has mentally crushed me, I have become so frustrated with all of the problems I’ve been having with my running performance. This stress has just added to the pile, I hope you read this and get into contact with me. I would really appreciate, as I am extremely desperate with trying to get this problem fixed.

    • Martin Koban says

      Dear Sawyer,

      I’m sorry to hear that you’ve had such a hard time with this injury.

      For the shin splints, you need to actively work your dorsiflexors with slow contractions. You can build a contraption for that (http://tnation.t-nation.com/free_online_forum/sports_body_training_performance_bodybuilding/shin_splints_no_more), but you can also do slow ankle mobility work like lifting up your foot and then drawing an imaginary circle with the heel, concentrating on highest range of motion (use the muscles in front of your shin to pull your feet up towards your knee during the upper part of the movement).

      For the tendonitis, I highly recommend you switch to doing only slow strength training. Aim for 5 second eccentric and 5 second concentric. This will help the tendon heal and prevent bouncing.

      Of course, working on ankle and hip mobility, as well as foam rolling the legs and the hips is just as important.

      Lastly, I don’t think the Marines care about the size of your quads. So you should definitely prioritize getting rid of the tendonitis over hypertrophy, especially considering that the intense training in boot camp will most likely undo all gains anyways (especially if you’re a hard gainer, which it sounds like you are).

      So concentrate on the slow strength training for your knees and the dorsiflexion drills for your shin splints.

      Hope that helps :-)

    • Martin Koban says

      The Total Knee Health course is much more comprehensive than the book Beating Patellar Tendonitis. Either of these resources is a great starting point, but if you prefer to have follow-along workout videos and video demonstrations of all exercises plus the option to easily get in touch with me if you have questions, the Total Knee Health course is the better option. You can sign up when enrollment opens up again in a few months (It’s close right now).

  11. Dawn says

    Hi Martin,
    I was diagnosed with patella tendinitis Dec 2013. Have had PT, cortisone shots, and rest. I did ok with PT and ultrasound therapy. I was ok for 2 months then in Aug 2014 the pain came back after jumping. I am now learning I returned to my high impact routine too quickly. I had another MRA this month and I now have tendinosis. I had a prp injection 2 weeks ago with no relief as of yet. Do you have any experience with those shots and what is your opinion of them? I now feel I need to stick to low key eccentric exercises until the pain decreases. I’ve done more rest than I care to do! What is your advice for me? Thanks!

    Dawn

    • Martin Koban says

      Dear Dawn,

      In the research I read for my book Beating Patellar Tendonitis, the researchers did not recommend PRP injections for patellar tendonitis because there’s conclusive evidence in favor. Also, medical professionals claim they know how PRP works, but if you look into the research, there’s still a lot of speculation about the mechanism of action or in other words, they don’t know what the heck it does. With that in mind I’m not a fan of PRP injections, especially because they’re so expensive. I’m not at all convinced they’re worth the investment if much cheaper treatment options that can be carried out at home are available.

      Of course, some people hope there’s some kind of silver bullet treatment, so where’s demand, supply will follow.

  12. Tally says

    Hello! Bought your book while back, I’ve had tendinosis in both knee two years now. I’ve been on your regimin since June this year. While I’ve gotten stronger, the pain hasn’t gotten better. I’ve never been able to properly progress to single leg squats without flare ups, and I do double leg decline eccentric squats 3 sets of 10. 3 times a week.. Any more frequent I get a flare up. No pain whenver I do my hip, glute, and other leg exercises like straight leg lifts. I dont run, I don’t jump, I haven’t done normal activity in two years. Went to my doc, he gave me NSAIDs said to try it while I do the squats because part of my issue is I feel weakness, which is my body guarding from the invisible pain. Anyway took the NSAIDs for 2 weeks, did not change my program and got a flare up so bad I’ve been limping for 3 days. Stopped the NSAIDs and just icing and massaged.n. You think you can degrade tendons that quickly? Also where do you practice? If you are anywhere near San Diego or Los Angeles can I please pay and see you as my physical therapist? You are the only one with actual knowledge on the issue. I tell other PTs (5) I want to try eccentric squats and not a single one recommends the, but obviously their exercises aren’t doing it, so I’m on my own with my training.

    • Martin Koban says

      Hey Tally,

      I’m an author and personal trainer based in Berlin, not a physical therapist or doctor.

      NSAIDs can wreak havoc on soft-tissue adaptation to training so in other words, taking NSAIDs while training is asking for trouble. Most doctors aren’t aware of this risk and don’t warn their clients to stay away from exercise. Also, a lot of folks take NSAIDs like Ibuprofen for health issues other than tendonitis, but then end up with tendonitis because of how NSAIDs affect the soft-tissue adaptation.

      Except for surgery, the slow weight-bearing activities like eccentric exercises or isometric exercises (Wall sits) are the best treatment option according to all the research I read about the subject. Rest doesn’t do anything to help the tendon heal (the tissue damage will just stay the same and once you return to activities, pain will come back too).

      If you haven’t yet, try the supplements fish oil and vitamin c. Also “organic silicon” is a supplement I just discovered recently and it may also be beneficial for tendonitis, although I haven’t had the time to research it in enough detail yet. Silicon is required for healthy soft-tissues such as skin, but also tendons.

  13. Gary Tribble says

    Hi Martin – thanks for the exercises for my jumper’s knee – I bought the Heel Cord Box & that has helped tremendously – I’m wondering if you have any exercise routines that might help with my Plantar Fasciitis – thanks very much – GT

    • Martin Koban says

      Hey Gary,

      The only thing I know is that plantar fasciitis can be caused by tight calf muscles and low ankle mobility. You can use the slant board to stretch your calves. Supplementing with vitamin C and fish oil for a while may help as well.

  14. Laura says

    I’ve a history of a lateral TPF about four years ago that led to cartilage fissures and subchondral cysts, as well as a tibial tuberosity transfer to address loss of cartilage behind my patella (caused by internal scarring rubbing the back of my kneecap). Now, I’ve been diagnosed with patellar tendinopathy after having pain through the front of my leg for more than 18 months. Doc said it’s not inflammatory; it’s degenerative. The tendon is scarred and thickened (he compared it to the patellar tendon in my other knee and said it was noticeable with just observation). MRI also showed infra patellar fat pad scarring, so I’m not altogether sure where the pain is actually coming from…

    I obviously have a somewhat different mechanism of injury because I’m not doing high impact activities, but I’m wondering if this program would still be beneficial. I’ve tried the decline squats, and I can do them, but they are very painful. I don’t know that I want to enter into a formal program to do them daily unless I’m fairly certain they can help. I don’t know if it matters, but I cannot do a normal squat–the pain is so bad, it feels like my knee is physically blocked. The decline squats are doable though.

    I’d be interested in your take on the situation. Thanks!

    • Martin Koban says

      Dear Laura,

      Unfortunately, that’s outside my area of expertise, so please clear my suggestions with your doctor before you implement them.

      That being said, a safer exercise than eccentric squats are wall sits (sit against a wall with your knees at a 90-degree angle). This puts isometric load on the patellar tendon, which also stimulates collagen synthesis and usually leads pain reduction.

      Additionally, check into omega-6 fatty acids in your diet and supplement with omega-3 fish oil if you have a lot of omega-6 fats in your dietary intake. Other supplements of interest for tendon issues are vitamin C and potentially “organic silica”. You can find the latter on Amazon, although I have to say that I didn’t do much research into it yet. A good dietary source of silica, which is an important mineral for bones, cartilage, and connective tissue, is oats. Other dietary source don’t contain a lot of it (unless you count beer).

      Going the supplement route, you can rest assured that you’re not risking any more damage through too intense rehab drills.