Patellar tendonitis (Knee Tendonitis)

The following article investigates the causes for patellar tendonitis and offers a treatment plan for tendonitis knee pain. This research-based program contains exercises for jumper’s knee that do not require access to a gym. You can follow these treatment suggestions at home or anywhere else.

Adults, senior citizens, amateur athletes, world-class professionals and even children: it seems everybody is at risk of getting jumper’s knee and while many struggle to get along with it, only few manage to get healthy.

On this page you will be given the weapons to fight knee tendonitis, but you should consider this: only those who persevere will prevail. Successful treatment takes much more than some NSAIDs and a few days’ rest.

Update: I’ve dedicated a whole book to helping you with this problem

book-cover

    I’ve done a lot of research and self-experimentation since this website has been published almost 2 years ago. In this time, I’ve discovered faster and more effective ways to resolve jumper’s knee.

    I’ve compiled everything into my proven treatment formula to fix hidden causes of jumper’s knee and stay pain-free for life.

    To learn more about this book, go here.

Jumper’s Knee: Symptoms, causes, risks and conservative treatment

Knee pain is an indication of some aspect of the body not working as it should and finding that underlying problem is the tricky part. By getting more familiar with the disease, we increase our odds of solving the tendonitis knee riddle. The following paragraphs will detail symptoms, causes, risks and conservative treatment options of patellar tendonitis.

Symptoms

Where You'll Feel Patellar Tendonitis Symptoms

Picture: Where you’ feel the pain. The pain can occur in one or both knees.

The symptoms for knee tendonitis are pain on the side of, in front of, below or even behind the kneecap. Most commonly the pain will reside below the knee cap, where the patellar tendon attaches to the patella. The pain usually gets worse with activities like squatting, running, climbing stairs and jumping. Additionally, you may feel tenderness below the kneecap and in the area of the bony protrusion right below.

You should also know that patellar tendonitis progresses in stages and that each stage requires a different healing approach. To learn more about the symptoms of the individual stages, go here: patellar tendonitis symptoms.

Causes and risks of knee tendonitis

Jumper’s knee is an overuse injury and the result of repetitive microtrauma to patellar tendon. Usually such microtrauma is caused by activities that include a lot of jumping, running and cutting. Not surprisingly, sports such as basketball, volleyball and tennis have a high incidence rate of this injury, but it is not limited to these groups.

A common theme among people who suffer from knee tendonitis is playing through pain or regular overexertion on the court. Pain, just like fatigue, causes movement patterns to deviate from the desired optimum and the worse you move, the more likely you are to suffer injuries such as patellar tendinopathy. But what happens if it is left untreated?

Initially tendonitis will make itself felt as the pain accompanying the inflammation in the tendon below the kneecap, but with repeated tissue damage cellular degradation will set in. The body is unable to repair the damaged tissue and tendonitis turns into tendinosis: a painful chronic condition that will take months, if not years to heal, especially if the athlete lacks commitment to getting healthy before competing again. Ignore tendonitis and your pain will get worse, your condition will get more permanent and your weakened patellar tendon will be more prone to tearing.

Do nothing and your athletic career might be over before it even started. Act early and you can be back to competition in a few weeks.

How Long Will Recovery Take?

Watch this video to learn more about how long recovery will take and how to avoid 3 dangerous mistakes that will add months to your recovery time, if you make them.


Join my Free Email Course on patellar tendonitis:

Conservative Treatment of tendonitis

Some athletes get relief by wearing an infra-patellar strap, which helps by improving load distribution in the tendon.

Some athletes get relief by wearing an infra-patellar strap, which helps by improving load distribution in the tendon.

There are several conservative treatment options for tendonitis. A common recommendation is the RICE-protocol (rest, ice, compression, elevation), combined with the use of NSAIDs (Nonsteroidal anti-inflammatory drugs). Other modalities used to deal with knee tendonitis include ultrasound treatment, deep friction massage, shockwave therapy and plasma-rich platelet injections. Speaking of injections: in his book “Framework for the Knee”, Nichalos DiNubile, MD, explicitly warns against cortisone shots, as they can “cause a rupture of the tendon” (page 20).

In physical therapy, the rehab protocols for tendonitis revolve around strengthening and stretching of the leg muscles, with a focus on stretching the quadriceps muscle group. Keeping these traditional approaches in mind we can build on them to create a more holistic approach for knee tendonitis. This will help us to deal with jumper’s knee more thoroughly and also seems necessary, as the traditional methods of treatment apparently only provide temporary relief.

The holistic approach: simple, but not easy

There are a lot of simple things you can do at home to deal with patellar tendonitis and most of them don’t even require additional tools or help by others. The following list will get you started with your healing process and after that we will cover a number of exercises which will help you put the plan into operation.

Healing Knee Tendonitis Step 1: Freeze right there!

As most of you know, the inflammation in the tendon can be decreased through icing, which is mostly done after exercising. Using a wet towel between the ice and the knee is recommended, as this will prevent frostbite and improve temperature distribution. Apply the ice for a maximum of 20 minutes, directly post-exercise or several times throughout the day. You can also apply ice after performing rehab exercises, to minimize pain and inflammation.

However, icing only helps with pain management and will not speed the healing process if you have already progressed from tendonitis to tendinosis (i.e. you have knee pain not just post-exercise, but also throughout the day and the condition did not improve after two weeks of rest). If this is the case you can experiment with using a warm water bottle or a heating blanket for 20 minutes, several times a day. With the warm water bottle you again have to use a wet towel to prevent burning and improve heat distribution. When using heating blanket you should wrap it around your knee and then wrap a big towel or a blanket around it, to keep the heat in.

I have successfully used heat with my patellar tendon pain and I felt like it definitely sped up the healing process, which is only logical as the increased temperature improves circulation. On the other hand, being outside in the cold winter weather increased knee pain noticeably. Your mileage may vary, so just experiment to find out what works best for you.

In conclusion one could say that while ice is the way to deal with inflammation you feel after exercising (be this rehab or performing in your sport), it actually slows healing once you’re dealing with tissue degradation instead of inflammation. Tendonitis pain should go away after a week or two of rest, but if the knee pain persists you’re more likely dealing with tendinosis. Only you and your physician know where you stand.

Step 2: Check your posture

Poor Posture: guaranteed to cause knee painDriving a car with your feet on the gas and the brake at the same time will ensure lower performance and early malfunctions. This is what’s going on in our bodies most of the time when we suffer from ailments such as knee pain, as bad biomechanics prevent us from achieving our athletic goals and predispose us to injury.

Anterior Pelvic Tilt (forward tilted hip) is one of the conditions which can lead to patellar tendonitis, as Dr. Perry Nickelston points out in his article on “Lower Crossed Syndrome and Knee Pain”. Check where you stand in terms of posture and immediately address every problem you uncover. You can use this article on anterior pelvic tilt as a starting point. The exercises at the end of this page will also help you improve your posture.

I’ve only devoted three paragraphs of this article on improving posture, but believe me: it’s of utmost importance.

Step 3: Improve tissue quality and length

Rumble Roller: different modelsAs explained earlier, jumper’s knee occurs when the patellar tendon is overloaded. Dr. Kelly Starrett of San Francisco Crossfit points out that this can actually occur as a result of tight calves and hamstrings, which is all the more obvious when looking at the muscles around the knee. Hamstrings and gastrocnemius are both responsible for knee flexion and if either of these structures is tight, the quadriceps has to work against additional resistance when extending the knee (research supports this). This will obviously put additional load on the patellar tendon.

Before stretching, tissue quality has to be addressed first. You can have this done by professionals, using active release massage technique for example, or you can do it at home using a foam-roller. In my free email course I’ll show you a special technique that brought me great results without having to buy any tools.

Join the Free E-Mail Course on Patellar Tendonitis

  • Get rid of your pain without ice or painkillers
  • Prevent patellar tendonitis from coming back
  • Safely strengthen your knees







Once you’ve improve tissue quality you can get started with the stretching. Remember: with stretching you’re not lengthening the tissues; you’re actually reprogramming your nervous system to allow for more muscle extensibility. You will be a lot more effective at retraining your central nervous system if you stretch daily or even several times a day. The stretching will help take load off the patellar tendon and will have an immediate impact on your knee discomfort.

The exercises further down will give you detailed instructions on how to improve tissue quality and length.

Step 4: Train mobility and stability at hip and ankle

We need a certain degree of mobility and stability at every joint. Some joints need more stability and some need more mobility. Both, the hip and the ankle, need to be mobile and if they lack mobility the body will make up for it by increasing mobility at the neighboring joints (i.e. knee and lower back), which should not be too mobile. This can translate to knee ailments such as knee pain, lower back pain and a host of other problems that are beyond the scope of this text.

Decreasing tendonitis knee issues will require more than just diligent stretching though, because a lack of mobility can actually be caused by low stability (i.e. you cannot move safely through certain ranges of motion and your central nervous system knows that, which is why it will stop you from entering those ranges). By tensing up, the central nervous system uses your muscles to protect the body against injury. Hence, a lack of mobility can sometimes be attributed to the CNS not knowing how to use the muscles properly and it uses tension to keep you from performing movements that it deems dangerous, like touching your toes or doing a full split.

In the section on jumper’s knee exercises we will go through several drills that can be done daily and will help you improve mobility and stability by retraining your central nervous system to allow proper movement.

Step 5: Check for movement imbalances

Daily movement habits burn deep movement grooves into the records of our central nervous system and the more we move in a certain way, the more our CNS tries to keep us in those movement patterns. Take the deep squat for example:

Proper execution of the deep squat for knee health and hip flexibility

Assume a stance with your feet directly under your hip and parallel. Now squat down by sitting back as far as you can, rather than dipping straight down. Pay attention to how your knees move: does one knee cave in? Do both knees cave in? Do you have trouble maintaining your balance in the bottom position, meaning, do you keep falling over backwards? If you answered yes to any of these questions you have one or more imbalances, which you need to fix before venturing into the field of athletics. If you don’t, you risk getting tendonitis knee pain or worse, a torn ACL or meniscus.

Here is how an imbalance like that can lead to knee pain: if your knee collapses inward during running or when landing, you will put excessive stress on the patellar tendon and thereby increase your risk of getting knee tendonitis (and slowly shred your ACL).

The only way to retrain your central nervous system is by moving the right way and since you need to overwrite wrong programming, you’re going to have to do it very often. We will get to that in the exercise section.

Step 6: Retrain your gluteal muscles

The gluteal muscle group is very important for knee health. Strong and functional gluteal muscles will not only help you produce force more efficiently, providing a more forceful hip extension which allows you to jump higher or sprint faster, they also resist movement in the opposite direction. This is important for preventing knee tendonitis, because healthy glutes will prevent the knees from collapsing inward when landing from a jump. On top of that, poor gluteal function can lead to overworked hamstrings, which in turn leads to a tighter muscle, requiring more tension in the knee extensors, thereby putting the patellar tendon under higher load. Poor gluteal function will also put you more at risk of pulling or even tearing your hamstrings, as these muscles are chronically overworked. Finally, among many other problems, weak or non-functional gluteals can cause lower back pain.

With all that in mind it’s safe to say that gluteal training should be included in the training regimen of every athlete and it should be emphasized for those suffering from jumper’s knee.

Pro tip: train your glutes throughout the day when climbing stairs. Shift the load from your quads to your glutes and try to squeeze your glutes hard with every step. This will help strengthen the neural connection to your glutes.

Step 7: Strengthen the patellar tendon through eccentric exercises

Research indicates that eccentric exercises can be very beneficial for speeding up the healing process of damaged tendons. To apply this method to knee tendonitis we simply have to squat with an emphasis on the lowering part of the lift. Lower yourself down slowly (i.e. taking 4 to 5 seconds) and get back up assisting yourself, for example by grabbing a hold of a sturdy piece of furniture, a doorway or the hand of your training partner. The efficiency of eccentric squats can be improved further by performing them on a slanted board of around 25 degrees, as this puts more load on the patellar tendon than if you were to do squats on even ground.

Step 8: Take it slow

Pain and tendon tissue damage in patellar tendonitis / tendinopathy – source: BMJ Publishing

Pain and tendon tissue damage in patellar tendinopathy – source: BMJ Publishing

A picture says a lot and in the case of this graph we can learn several things about tendonitis and the associated knee pain. The following three points are most important though:

  1. Even if you are asymptomatic (i.e. don’t have pain), you can still have tendon tissue damage
  2. If you don’t allow your tissue to recover, you will get injured
  3. If you’ve been injured and you return to training to soon you will stall healing or even reverse it

All this can be compressed in one simple, albeit hard to follow, piece of advice: take it slow! If you train too hard, too often, you’re going to get injured. The irony of that is that most people train hard with the intention of progressing quickly, but they eventually get injured, which stalls or even regresses their training progress. Don’t be that guy (or gal).

Once you’ve crossed the Rubicon and have gotten injured you will need to take it slow with getting back to training, or else you risk delaying recovery indefinitely.

Jumper’s Knee Exercises

The following exercises address the issues we covered in the 8-step action plan. Once you know all the exercises you can start the recovery program for tendonitis knee pain. You don’t need a gym membership to perform these drills, as a matter of fact, you only need to get two tools: a foam-roller and an elastic band (I use Therabands). I suggest you get one of the stronger rubber bands, but not necessarily the strongest one there is. Additionally you will need a blanket and a stick, such as the stick of a broom for example.

Unless stated otherwise, all exercises are to be performed barefoot. This will help strengthen your ankles and will enable you to derive maximum benefits from the exercises. The only acceptable reasons for wearing shoes are the need to wear orthotics and having to train in public places with a high risk of infection (e.g. the gym). Wear minimalist shoe wear in that case. For more information on that: benefits of minimalist shoe wear.

Foam rolling and knee tendonitis

A few words of caution before we get started: foam rolling should not be used on body parts that you have recently suffered an injury to. You should consult your physician about foam rolling if you have circulatory problems or chronic pain conditions such as fibromyalgia. Please also take note that while foam rolling is a cheap and easy way to improve tissue quality, results will not appear overnight. You will have to work on your fascia daily for a week or more in order to notice improvement. With foam rolling you’re targeting your soft-tissue (i.e. you should not be rolling your joints or other bony structures).

Adjust the pressure you create with the roller to not cause pain, but don’t use too little pressure either. Just imagine you’re getting a massage: you wouldn’t want the therapist to leave bruises, yet at the same time you don’t want them to be too gentle either. In time, tissue quality will increase and you can spend less time foam rolling, but in the beginning you might have to spend between 1 to 2 minutes per muscle to achieve results. Don’t roll a muscle longer than that, as it can actually have a negative impact on tissue quality. If you want to do more, just do several sessions per day. Once you’ve done this for a couple of weeks you will know when you’ve reached the point of diminishing returns.

Foam rolling the rectus femoris muscle

Patellar tendinitis, knee tendinitis: foamrolling can helpReleasing trigger points in the quadriceps muscle group is an important part of our exercises because it will increase the efficiency of the quadriceps stretches we’ll do later. A muscle with trigger points or other soft-tissue problems will resist stretching, making the process not only more time-consuming but also more painful.

Get in a plank position and place the roller under your thighs. Roll back and forth moving your thighs across the roller by pushing and pulling with your arms (make sure to not shrug your shoulders towards your ears). Keep your knees straight for a few repetitions and then experiment with bending your knees, turning your feet out and combining both variations. This will enable you to hit certain spots you might have missed before.

You can increase the intensity by just rolling one leg. Once you have rolled out the tension in your rectus femoris, simply turn your body to one side to proceed with the next patellar tendonitis exercise.

Foam rolling the vastus lateralis muscle

Foam Rolling the Vastus Lateralis is a good patellar tendinitis exerciseThe Vastus Lateralis is on the outside of your leg and can sometimes become attached to the iliotibial band, thereby restricting free gliding of the fascia. This way a tight Vastus Lateralis can contribute to lateral knee pain.

You can hit the Vastus Lateralis better by rolling a bit more on the front of your thigh, as opposed to just on the side.

As with the other drills you can increase or decrease pressure by placing more weight on the supporting limbs. Like in the previous drill, try bending the knee of the leg you’re working to hit some unnoticed trigger points.

Once your vastus lateralis is all nice and soft, just continue turning to the side and proceed to the next drill.

Foam rolling the iliotibial band (ITB)

Foam rolling the iliotibial bandThe iliotibial band runs down the outer side of your thigh and rolling it might be a bit uncomfortable the first couple of times. Reduce the pressure by putting more weight on your supporting limbs if it’s too painful for you.

To foam roll the iliotibial band, just place the roller on the outside of your thigh and then roll back and forth until you feel the pressure “melting”. Remember to relax. Don’t react to trigger points by tensing up your muscles and that also applies to facial expressions: keep a relaxed face. After a couple of sessions you can increase the pressure by putting more weight on the working leg.

Once more thing: sometimes space is limited and if that’s the case rolling in short strokes might be more feasible than doing the entire ITB in one long stroke, especially if you’re a tall person like I am. Once you’re done with your ITB you just move the roller up to the side of your hip for the next exercise.

Foam rolling the tensor fascia latae (TFL)

Foam Rolling the tensor fascia latae (TFL)The area we’re targeting with this drill is on the side of your hip, slightly to the front. Lie down on your side, with the roller under your hip, slightly to the front. Avoid all bony prominences in that region and just concentrate on the soft tissue. You can change the intensity by putting more weight on your supporting limbs.

Gently roll back and forth for a few minutes until there’s no tension left. As with the other drills: go slowly. Once you’re done with the TFL turn sideways to prepare for the next exercise.

Foam rolling the Gluteus Maximus

Foam Rolling the gluteus maximusTo hit the Gluteus Maximus you sit down on the roller, balance with your hands behind your back and just roll back and forth like in the previous drills. You can increase the pressure by just rolling one side. Some coaches recommend using a tennis ball or lacrosse ball, but I found those small implements to be too inconvenient. I spent more time fiddling with the setup than I spent actually rolling. You might want to give it a shot though, as tennis and lacrosse balls are cheap and can also be used for other muscle groups like the chest.

From this position you can easily move to the next area by moving your body backwards and letting the roller move to the back of your thighs.

By the way: in some cases rolling your Gluteus Maximus can alleviate back pain, as too much stiffness in the GM can cause flexion in your lower back.

Foam rolling the hamstrings

Foam Rolling the hamstringsRolling on the back of the thigh you can hit your hamstring muscle group. I prefer to roll each leg individually, as this makes it easier to roll all muscles. On the inside of the back of your thigh you can hit the semimembranosus and semitendinosus. The biceps femoris is on the outside of the back your thigh.

Make sure to be thorough, as soft tissue problems in this region can directly contribute to hamstring “tightness”, which will place more stress on your patellar tendon, as your knee extensors have to work harder (i.e. against the additional resistance of the “tight” hamstring).

Push the roller down to your calves and journey on.

Foam rolling the calves

Foam Rolling the CalvesFoam rolling the lower leg is very similar to rolling the thigh. Roll your calves keeping your knees straight to hit the Gastrocnemius and then roll your calves with your knees slightly bent (not pictured) to hit your Soleus.

You can also tilt your body to the side to hit the muscles on the side of the lower leg (e.g. Peroneals) and on the front (e.g. Tibialis Anterior). Be careful not to use too much pressure though, as these are very small muscles.

Foam rolling the Plantar Fascia

If you have a tennis ball or a lacrosse ball you can use it here. Just place the ball under your foot (without shoes on obviously) and roll the bottom of the foot (Planter Fascia). This can magically free up additional range of motion in the rest of the body, as the fascia of the whole body is interconnected.

Join the Free E-Mail Course on Patellar Tendonitis

  • Get rid of your pain without ice or painkillers
  • Prevent patellar tendonitis from coming back
  • Safely strengthen your knees







Stretches for tendonitis knee pain

Patellar tendonitis exercises wouldn’t be complete without a good stretching regimen. We’re going to stretch the quadriceps muscles, the TFL, the calves and the hip flexors.

Stretching the hamstrings?

As I’ve mentioned before, tightness in the hamstrings can contribute to tendonitis knee pain, as the knee extensors have to work against additional resistance, which will put extra load on the patellar tendon. In most cases it is not a good idea to stretch the hamstrings though, as the tightness you feel is just your body’s reaction to that muscle being overworked.

The typical postural misalignment of today is anterior pelvic tilt (pelvis tilted forward), because we sit a lot, which leads to a neurological shortening of the hip flexors (e.g. rectus femoris, iliopsoas). Once we stand up, those short hip flexors pull the top of our hip and our lower back closer to our thighs, creating an excessive curvature of the lower back. This will lengthen the gluteals, because they are the antagonists of our hip flexors and normally create hip extension. The gluteals will slowly lose function and the hamstrings now have to pick up the slack to create hip extension which will lead to overworked and tight hamstrings.

This is why I suggest you stretch your hip flexors and strengthen your glutes: it will remove factors that are very likely to contribute to hamstring tightness and thereby allow your hamstrings to get back to normal. It is very likely that you are in a similar situation, in which case simply aggressively stretching your hamstrings will not work to remove the tightness permanently. That being said, let’s finally move on to the stretches.

Stretching the hip flexors

Kneeling hip flexor stretchThe hip flexor stretch is tricky and easy to do wrong. Set up in a lunge position with your bottom knee padded using a blanket, towel, yoga mat or something similar.

Keep your back straight and vertical. Looking at the anatomy of the human body you can see that some hip flexors attach to the hip and the Psoas Major even attaches to the lower back. Now, if you want to stretch the hip flexors you have to lengthen the muscle, which creates forces that try to tilt your hip forward and increase the curvature in your lower back. You have to resist these forces by bracing your core and strongly tensing your glutes.

The compensational patterns most people slip in to (i.e. errors):

  • Rounding of the lower back
  • Tilting the hip forward
  • Leaning forward
  • Not keeping the hip squared up

In order to stretch your hip flexors you have to brace your abs (as if bracing for a punch) and tense your glutes. Depending on the surface you work on you now either have to sink forward and down, having your upper knee travel forward or you can get everything tight and push the rear leg backwards by tensing the glutes. Tensing the glutes will not only increase your ability to engage them actively, but it will also help stretch the hip flexors through a process called reciprocal inhibition: if you use a certain muscle, its antagonist relaxes.

To make change, perform this stretch for at least two minutes per side. I usually start with my tighter hip flexor and stretch both sides twice for a total duration of 4 minutes. You can also make this stretch more dynamic by moving your hip forward and back, thereby increasing and decreasing the stretch with the movement. Just make sure not to slip into the compensational patterns.

Once you’re familiar with this stretch you can combine it with a simple ankle mobility drill. Place a stick just on the outside of your toes and as you sink into the stretch you move your knee beyond the stick on the outside. This will prevent your arch from collapsing and will improve your ankle mobility. Don’t force the range of motion, but only go as far as you can without straining. With mobility drills you won’t feel a stretch and the exercise is more about working the available range of motion of the joint to slowly restore its complete ROM.

Stretching your quadriceps muscles

helps with patellar tendonitis: Kneeling quadriceps stretchThe setup for the quadriceps stretch is similar to the hip flexor stretch, but here you grab your leg with the arm of the same side. Make sure to have ample padding under your knee for this one.

Personally, I prefer getting into position for this stretch by lunging down to have my knee on the pad, after which I will lean forward at the hip and grab my ankle (don’t grab the foot). After that I will get my torso upright again, holding on to the ankle and get into a good position for the stretch. Getting into position this way made it easier for me to find a more comfortable position for my bottom knee.

At this point you need to pay attention to the same things as with the hip flexor stretch: keep your back straight and vertical, don’t let your hip tilt forward and don’t lean forward. To move into the stretch you can pull your leg closer, tense the glutes and let your hip move forward (not tilt forward!) and sink down.

In a nice variation of this exercise (easier on the arms) you prop your rear leg against a wall.

Stretching your iliotibial band and tensor fascia latae

Stretching the iliotibial band or rather: the tensor fascia lateaTo perform this drill, set up with your side towards a wall, bend the leg that is away from the wall and place it forward, while keeping the other leg straight. The forward leg will help you support your weight and maintain balance.

In the beginning this setup will be a bit tricky and it takes time to find a “comfortable” way to do this. Once you’re in position for this stretch, sink down, keeping your torso upright or slightly bent away from the wall.

You should feel the stretch on the outside of your hip. Increase the intensity by leaning away from the wall. Remember to always keep the bottom leg straight. It helps to have a surface that prevents the foot of the working leg from slipping away from the wall, but you can also have a training partner block your foot from slipping away.

One way to progress faster in this stretch is by pushing the bottom foot into the floor for a couple of seconds and then relaxing into the stretch once you stop pushing.

Stretching the Calves

Stretching the calvesThere are several ways to stretch your calves, but I found this one to work best for me. You will need something sturdy to stand on and shoes with a solid sole. Step on the object, placing the balls of your feet on the ledge. Now sink down into the stretch, keeping your knees straight. You can intensify the stretch by putting more weight on one leg.

A word of advice: don’t let your arches collapse and keep your knees aligned over your feet. Your ankles shouldn’t rotate inwards at all. If you feel pain in your ankle you will need to find another position to perform this stretch (e.g. standing on a curb and leaning forward).

Once you’ve stretched your calves with your knees straight, you can bend your knees. This will shift the focus to different muscles in your calves (from the Gastrocnemius to the Soleus).

Strengthening exercises for tendonitis

With the strengthening exercises we’re going to improve strength and function of your gluteal muscles, improve your mobility at the ankle and the hip and we will also speed the healing process up by directly strengthening your patellar tendon.

To derive maximum benefit from these exercises you have to pay attention to proper postural alignment of all body parts. With regard to your feet and knees: keep your feet either pointing forward or pointing in the same direction as your thigh. Your thighs will only point outward when working in a very wide stance and therefore your feet should also only point outward when working in a very wide stance.

Training the gluteals: glute bridge

Glute Bridge and single-leg glute bridgeLie down on your back and bend the knees to create a 90 degree angle, while your hip is still on the ground. With both feet planted, push through the heels squeezing your glutes to form a straight line from your chest to your knees. This is the regular glute bridge.

In the advanced version you keep one leg straight and push yourself up using only one leg. Just like in the two-legged version you squeeze your glutes and lift your body up.

In both versions you have to hold the elevated position for around 5 seconds, squeezing your glutes hard during that time. Touch the gluteal muscles with your hands to help your nervous system rediscover the neural pathways to the muscles, should you have trouble getting them to fire. The main workload has to be felt in the gluteals and not in the lower back, hamstrings or abs. Only move on to the one-legged version once you feel your glutes working hard and you can keep good form throughout the set.

Bird dog

The bird dog is a good exercise for gluteal activationThe bird dog integrates gluteal function with core stability. I highly recommend using a stick on your back in the beginning. This helps with:

  • Keeping your spine neutral
  • Not tilting the body to one side
  • Not letting the head sag

Put the stick on the middle of your back and have it touch your head, your back between your shoulder blades and your tailbone. Maintain these points of contact during the movement and don’t tilt your body to the side, or else the stick will roll off. The distance between your lower back and the stick should not increase too much. You can have a partner cue you through the movement or use a video recording (e.g. your cellphone). If these options are not viable, you can put your hand in the space between your lower back and use the stick to gauge the distance.

In the advanced variation of this exercise you will also raise your opposite arm toward the front.

side-lying clams

Side-lying clams

With the side-lying clams we train another movement pattern at the gluteal muscles. This is a very subtle movement in the beginning, as the neural pathways to the required muscle have been dormant in most of us. Pay attention to performing the exercise the right way.

Lie on your side with your body straight. Now bend both knees a bit. Rotate the upper leg out without tilting your hip back to perform one repetition. I prefer to hold the upper position for 2 or 3 seconds, as this helps me feel the correct muscles working.

As the name suggests your legs should imitate the opening motion of a clam. Keep your upper body in place throughout and don’t roll on your back (3rd frame) to increase the range of motion. This will trick you into using the wrong muscles for the job.

Side-lying hip abduction

side-lying hip abductionThis is the third exercise we use to retrain the gluteal muscle. Lie on your side with your body forming a straight line. Then raise the upper leg upward, just moving from your hip. As in the previous drill, your upper body remains in place and does not contribute to the movement. Only go as far as you can without compromising technique and hold the top position for two to three seconds. Keep your feet parallel to each other or lead with the heel of the working leg.

X-Band Walk

How to setup for the x-band-walk

This exercise is specifically designed to teach you to resist movement at the hip. Take your rubber band and hold it out in front of you. Now step onto the band with your feet hip-width apart. Put the bands into the opposite hands and you’re in the starting position.

From the starting position you squat down slightly by sitting back and now you walk sideways, moving one leg at a time. Don’t let the “rear” leg drag on the ground, but pick it up and resist the tension of the band. You can make this exercise (a lot) harder by using a stronger band or pulling on the band more. Just like in the other strengthening drills: move without using momentum. You should be able to stop at any point and then reverse the movement into the opposite direction.

Assisted one-legged deadlift

The assisted one-legged deadliftOnce you’ve performed the basic strength drills and stretches for a couple of weeks you can start working on the one-legged deadlift and the other advanced drills. The one-legged deadlift will do many things for you:

  • Improve balance and proprioception in a sport-specific setup (i.e. no wobble board)
  • Improve hamstring flexibility and strength
  • Improve gluteal strength
  • Improve your postural awareness
  • Reveal weak spots

I suggest you perform this exercise with a stick as a guide for the first couple of times. This way you can find your ideal head and back alignment a lot easier. Have the stick touch the back of your head, your upper back between your shoulder blades and your hip at all time.

I also highly recommend performing this drill with the big toe of the other foot on the ground (as shown in the picture). This helps grooving the proper movement in the beginning, as the body would quickly resort to unwanted compensational patterns if it felt too threatened or overwhelmed.

For our purposes, the error you need to avoid is having your knee collapse inward (last frame). This is the at-risk position for injuries to the knee from simple patellar tendonitis to ACL-tears. Strengthen the correct movement pattern and your risk of injury will drop significantly.

To perform this exercise you assume a stance with your feet hip-width apart and pointing forward. Move one leg back and bend it, so that only the big toe touches the floor. The majority of the weight will now be on the working leg. Start the movement by sitting back and once your knee is bent a little, you bend forward at the hip. Keep your shins vertical and your back straight (i.e. touching the stick at the supporting points).

Go as low as you can without compromising technique. To return to the starting position, squeeze your glutes hard and reverse the movement. Keep squeezing your glutes until you’ve locked out in the top position again. You can experiment with different degrees of knee bend. The less you bend your knees, the more hamstring flexibility the exercise will require.

You can progress to more demanding variations of this exercise once you’ve mastered the easier versions. To make the exercise more difficult you take the supporting foot off the ground. This step should be open to you after the first week of training. Be sure not to have your knees collapse inward und continue to use the stick if you need to. You can also gradually improve the range of motion, although this happens automatically in my experience.

The next step in loading would be holding a weight on the hand opposite to the working leg. Use a light weight to be able to maintain flawless technique. Once you feel confident you can of course use heavier weights and later you can even hold weights in both hands.

The benefit of this exercise goes way beyond knee health, as the improved proprioception and strengthening of the ankle will also bullet-proof your ankle. In spite of landing on other people’s feet after rebounding I haven’t sprained my ankle even once after implementing this exercise into my training.

The King Deadlift

king deadliftThe King Deadlift is a very difficult single-leg exercise that will require a lot of strength and a good deal of balancing skills. This is a strength drill, so perform it in a controlled fashion without any bouncing or momentum. You have to be able to freeze at every point during the movement.

To perform the King Deadlift you stand on one leg and start sitting back while keeping the other leg bent. The knee of the other leg should be the first thing to touch the floor (use padding in the beginning!), but of course it’s ok to assist yourself with your other leg a little bit at first.

To get up from the bottom position you must not use momentum. If you don’t have the strength to get up just using one leg you can assist yourself with your back leg. Always remember to never sacrifice poundage lifted for technique, because in the end that mentality will not only get you injured, but also prevent you from setting records.

When doing the King Deadlift you also have to pay utmost attention to the position of your knees. Don’t let your knees collapse and don’t let it travel forward too far. The knee should stay behind the toes of the foot.

Two-legged eccentric squat on a slanted board

Eccentric squats on a decline surface have been shown to speed the recovery of patellar tendonitis and they should therefore be included in our training. You can improvise a slanted board using wood and some books, but you could also go to a hill. As a last resort you could wear shoes with a sturdy sole and stand with your heels on the curb. The shoes shouldn’t restrict your ankle though. Be creative.

Eccentric Squat on Flex N Go Slanted Board

To perform the eccentric squats you assume a squatting stance on the board and squat using just the strength of your legs on the way down. Support your weight in some way on the way up. I used the stick to push off from the ground.


Join my Free Email Course on patellar tendonitis:

Many people perform squats in a way that is more stressful on the knees and doesn’t recruit the gluteal muscles a lot. To perform it the right way, imagine sitting back on a chair that is far away, rather than dipping straight down. Start and lead the movement with the hip. Only start bending at the knee once it’s necessary to go lower, but keep your shins close to vertical throughout (will happen automatically if you sit back as far as you can and only move from the hips). Don’t let your knees collapse inward.

To reverse the movement, you push your hips back as far as you can. You should feel your gluteal muscles working as you get up. Oh and don’t let your knees collapse inward.

Depending on your strength and pain level, you have to determine how low you want to squat. In the beginning you can just squat to slightly above parallel (second frame) and once you feel confident you can perform the full range of motion.

The question of how deep you should squat is controversial to say the least and could fill another 25 page article, but I will trim it down to one paragraph. Without a heavy barbell putting additional load on your back it’s totally safe to squat all the way down. Children do it all the time. Billions of people in other cultures spend a significant amount of time in a full squat and you know what? Their incidence rate of hip and knee pain is a lot lower. On top of that the cartilage in the knee only gets supplied with nutrients if the knee is moved through the complete range of motion. If you only ever squat to parallel your cartilage will not get enough nutrients to stay healthy.

2 Proven and Powerful Slant Board Exercises for Patellar Tendonitis


Join my Free Email Course on patellar tendonitis:

Single-leg eccentric squats on a slanted board

one-legged eccentric squat on a slanted boardThis is a very advanced drill that should only be performed if the two-legged version can be done pain-free through the complete range of motion for at least 50 consecutive reps. You also have to be proficient in the one-legged deadlift and king deadlift before trying this.

Steve Maxwell has written an excellent piece on the full ROM single-leg squat (aka pistol) and I suggest you read it before tackling this skill: how to become a pistolero. Since this is a very advanced variation you don’t need to read it now, as there will still be plenty of time in the coming weeks while you work on the foundational movements.

To perform the single-leg eccentric squat you lower yourself on one leg sitting back as far as possible (just like in the regular squat). Use the second leg on the way up. If you need to hold on to something for balance you can use a training partner, doorway or a sturdy piece of furniture. Depending on how you are built you might have to use a light weight between 5 to 10 pounds for balance (hold it out in front of you). Hang on to a doorway or a sturdy piece of furniture if you have to.

Range of motion in this drill is even more controversially discussed than ROM of the two-legged squat. I’ve been doing pistols for years now and the only time I ever felt it in my knees was when I increased my volume injudiciously (as in from 3×6 to 5×9). Now, we know from the graph in “Step 8: take it slow” that there will be tissue breakdown before pain sets in, so we have to give our bodies enough time to recover and only increase volume (number of reps), frequency (how often you train it) and intensity (how low you go) judiciously.

That being said, if you slowly increase one training variable (volume, frequency or intensity) in a given training cycle of 6 to 8 weeks you will derive great benefits from a properly performed pistol. If you do too much too soon with improper technique, you will get hurt.

The anti-knee tendonitis program

Now that you are familiar with the exercises we can put them in a program for tendonitis knee pain. The program is divided into phases and it’s up to you to decide when to go to the next step.

The number of repetitions given for single-leg drills has to be performed with each leg.

Phase I: Gentlemen, we can rebuild him

On the surface this phase may seem boring and useless, but trust me, performing these seemingly simple drills can teach you a lot. Those are the basics that everyone has to master and any athlete that has a flawed foundation will never reach his or her full potential.

Stay in this phase for at least 1 to 2 weeks.

Perform all foam rolling drills daily:

  • Rectus Femoris
  • Vastus Lateralis
  • ITB + TFL
  • Gluteus Maximus
  • Hamstrings
  • Calves
  • Plantar Fascia
  • If required: SIM on problem areas

Do all stretches daily:

  • Hip flexor
  • Quadriceps
  • ITB Stretches
  • TFL
  • Calves

Twice per day (morning and evening), go through this strength training circuit (will take less than 5 minutes) and concentrate on having both glutes fire really hard:

  • Bird Dog, 10 reps
  • Side-lying clams, 10 reps
  • Assisted One-legged deadlift, 5 reps
  • Eccentric-only squats, 10 reps
  • two-legged glute-Bridge, 10 reps
  • Side-lying hip abduction or x-band-walk x 10 reps (or steps in each direction)

In the second week you go through the strength training circuit twice (so four times a day).

Phase II: We have the technology

Stay in this phase for at least 1 to 2 weeks.

Perform the foam rolling at least 4 times per week.

Do the stretches at least 5 times per week (perform the hip flexor stretch with the stick to work ankle mobility).

Twice per day, perform squats on the slanted board (no support), 2 sets of 10 – 15 reps

Practice the unassisted one-legged Deadlift drill two or three times per day. Only do a couple of repetitions per set and then rest before starting the next set. Pay utmost attention to picture perfect form and never exhaust yourself.

Every two days, go through this training circuit 3 times:

  • Bird Dog with arm movement, 10 reps
  • Band-resisted side-lying clams, 10 reps
  • Assisted one-legged deadlift, 10 reps
  • One-legged glute-bridge, 10 reps
  • Side-lying hip abduction with band or x-band-walk, 10 reps

Phase III: Better than he was before

Stay in this phase for at least 1 to 2 weeks.

Perform the foam rolling 3 times per week.

Do the stretches at least 4 times per week (perform the hip flexor stretch with the stick to work ankle mobility).

Every two days, go through this training circuit 3 times:

  • Bird Dog with arm movement, 10 reps
  • Band-resisted side-lying clams, 10 reps
  • One-legged glute-bridge, 10 reps
  • Side-lying hip abduction with band or x-band-walk, 10 reps

Twice per day, perform squats on the slanted board (no support), 3 sets of 10 – 15 reps

Three times a week: perform the one-legged deadlift. Start with 2 sets of 8 reps and add repetitions once you feel proficient and strong enough. Technique should be as close to perfect as you can manage.

Phase IV: Better … Stronger … Faster

Stay in this phase for at least 2 to 3 weeks.

Perform the foam rolling at least 3 times per week.

Do the stretches at least 3 times per week (perform the hip flexor stretch with the stick to work ankle mobility).

Practice the King Deadlift two or three times per day. Only do a couple of repetitions per set and then rest before starting the next set. Pay utmost attention to picture perfect form and never fatigue yourself.

Every two or three days, go through this training circuit 3 times:

  • Bird Dog with arm movement, 10 reps
  • Band-resisted side-lying clams (use stronger resistance), 10 reps
  • One-legged glute-bridge (tense the working glute really hard for 5-7 seconds in the top position), 10 reps
  • Side-lying hip abduction with band (use stronger resistance) or x-band-walk, 10 reps

Once per day, perform squats on the slanted board (no support), 10 reps

Once per day, perform one-legged eccentric squats to just above parallel on the slanted board (use both legs to stand up), 2 sets of 5 – 7 reps (rest as much as needed between sets and hold on to something for balance if you have to). Remember: sit back as far as you can and keep your shin vertical!

Three times a week: perform the one-legged deadlift. Start with 3 sets of 8 reps and add repetitions once you feel proficient and strong enough to perform the amount of work with very good technique.

Phase V: You … will be that man

Stay in this phase for at least 4 weeks

Perform the foam rolling at least 3 times per week.

Do the stretches at least 3 times per week (perform the hip flexor stretch with the stick to work ankle mobility).

Twice per week, go through this training circuit 3 times:

  • Bird Dog with arm movement, 8 reps
  • Band-resisted side-lying clams (use stronger resistance), 8 reps
  • One-legged glute-bridge (tense the working glute really hard for 5-7 seconds in the top position), 8 reps
  • Side-lying hip abduction with band (use stronger resistance) or x-band-walk, 8 reps

Twice per day, perform one-legged eccentric squats to just above parallel on the slanted board (use both legs to stand up), do 2 sets of 5 to 8 reps. Don’t add more than one rep per week and rest as much as you need to maintain perfect form.

Twice per week: perform the one-legged deadlift and the king deadlift. Start with 3 sets of 6 repetitions per exercise and add repetitions once you feel strong enough. Don’t add more than one rep per week. Perform the following activation exercises prior to this training and concentrate on feeling your glutes work:

  • Bird Dog with arm movement, 5 reps
  • Side-lying clams, 5 reps
  • One-legged glute-bridges, 5 reps

The next steps: force absorption work, pistols and fame

Once you have followed the 5 phase program you will have stronger muscles, healthier joints and better movement patterns. By then it will be time to move on. You will have to prepare yourself for the rigors of the athletic world.

Depending on your sport you could add force absorption work, full range of motion single-leg squats or other demanding exercises that will strengthen your joints, muscles and tendons even further. That is a topic for another day.

Conclusion: Knee Tendonitis resolved

I’ve tried to put as much knowledge as possible into this article and it gives you everything you need to know to start fixing your tendonitis knee pain. There still is a lot more that can be said about the topic of knee health. I also highly recommend you check out my book Beating Patellar Tendonitis. It’s a very comprehensive resource about all the possible mistakes you are probably making right now and that are preventing you from getting rid of patellar tendonitis.

Bonus: Random Facts about knee tendonitis

If you’ve made it this far, chances are you’re into these kinds of facts on knee tendonitis, so here goes:

  • Tendonitis knee pain is more common in volleyball than in basketball, with a prevalence rate of 44.6 % as opposed to 31.9 % (Lian et al. 2005)
  • Sports that place high demands on the leg extensors have higher incidence rates of patellar tendonitis (Lian et al. 2005)
  • Knee Tendonitis is just as common in females as it is in males
    (The Sports Physical Therapy Section of the American Physical Therapy Association 2010)
  • Continuing your regular training while trying to recover from tendonitis knee pain WILL NOT WORK (Visnes, Bahr 2007)
  • Some researchers had their subjects perform painful eccentric exercises (Alfredson et al. 1998)
  • Other researches preferred pain-free exercises (Stanish et al. 1986)
  • Tendon massage helps with normalizing collagen alignment (The Sports Physical Therapy Section of the American Physical Therapy Association 2010)
  • Using a 25° decline board will increase loading on the patellar tendon by 25 to 30 % (Frohm et al. 2007)
  • Squatting depth is a controversial subject (The Sports Physical Therapy Section of the American Physical Therapy Association 2010)
  • Efficacy of patellar tendon straps has not been researched (The Sports Physical Therapy Section of the American Physical Therapy Association 2010)

References & further Reading

Alfredson, H.; Pietila, T.; Jonsson, P.; Lorentzon, R. (1998): Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. In Am J Sports Med 26 (3), pp. 360–366.

BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine (1998): Patellar tendinopathy: some aspects of basic science and clinical management. — Khan et al. 32 (4): 346 — British Journal of Sports Medicine. With assistance of K. M. Khan, N. Maffulli, B. D. Coleman, J. L. Cook, J. E. Taunton. Available online at http://bjsm.bmj.com/content/32/4/346.citation, updated on 1/12/1998, checked on 6/03/2012.

Perry Nickelston, D. FMS SFMAC: Lower Crossed Syndrome and Knee Pain. Available online at http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=52178, checked on 6/03/2012.

Chek, Paul (2004): How to eat, move and be healthy! Your personalized 4-step guide to looking and feeling great from the inside out. San Diego, CA: C.H.E.K. Institute.

Christian Thibaudeau (2006): 7 Secrets to Rapid Recovery | T NATION. Available online at http://www.t-nation.com/free_online_article/sports_body_training_performance/7_secrets_to_rapid_recovery, updated on 27/01/2006, checked on 6/03/2012.

DiNubile, Nicholas A.; Scali, Bruce (2010): Framework for the knee. A 6-step plan for preventing injury and ending pain. Emmaus, Pa: Rodale.

Dr. Kelly Starrett: Episode 33: FGB Push Press Prep. Patellar Tendonitis – YouTube. Available online at http://www.youtube.com/watch?v=ydoRfEXvmU8&feature=player_embedded, checked on 6/03/2012.

Frohm, Anna; Saartok, Tonu; Halvorsen, Kjartan; Renstrom, Per (2007): Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols. In Br J Sports Med 41 (7), pp. e7.

Lian, OysteinB; Engebretsen, Lars; Bahr, Roald (2005): Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. In Am J Sports Med 33 (4), pp. 561–567.

Peter Blanchonette (2006): Eccentric Exercise – A Solution to Tendonitis? | T NATION. Available online at http://www.t-nation.com/free_online_article/sports_body_training_performance/eccentric_exercise_a_solution_to_tendonitis, updated on 3/09/2006, checked on 6/03/2012.

Stanish, W. D.; Rubinovich, R. M.; Curwin, S. (1986): Eccentric exercise in chronic tendinitis. In Clin Orthop Relat Res (208), pp. 65–68.

Steve Maxwell: How to Become a Pistolero | Steve Maxwell Strength & Conditioning. Available online at http://maxwellsc.com/blog.cfm?blogID=60, checked on 6/03/2012.

The Sports Physical Therapy Section of the American Physical Therapy Association (2010): EVIDENCE–SUPPORTED REHABILITATION OF PATELLAR TENDINOPATHY. With assistance of Marsha Rutland, Dennis O’Connell, Jean-Michel Brismée, Phil Sizer, Gail Apte, Janelle O’Connell. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/?tool=pubmed, updated on 1/01/2010, checked on 6/03/2012.

Visnes, Havard; Bahr, Roald (2007): The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. In Br J Sports Med 41 (4), pp. 217–223.

Witvrouw, E.; Bellemans, J.; Lysens, R.; Danneels, L.; Cambier, D. (2001): Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study. In Am J Sports Med 29 (2), pp. 190–195.

Wolf, Robb (2010): The paleo solution. The original human diet. Las Vegas: Victory Belt.

This page was originally published by on the 6th of March 2012.

Join the Free E-Mail Course on Patellar Tendonitis

  • Get rid of your pain without ice or painkillers
  • Prevent patellar tendonitis from coming back
  • Safely strengthen your knees







54 comments

  1. Liz Bayley

    Really well researched and explained – well done :-)

  2. I originally pulled my left hamstring playing soccer one years ago. I went to PT, and returned too quickly to sports, injuring my hamstring once again. After another month of PT, I was finally able to get back to playing/running. I began to notice knee pain but thought nothing of it until it did not resolve. I still ran on it/jumped on it, etc. until I realized it wasn’t getting better. I proceeded to go back to an orthopedist who diagnosed me with patellar tendonitis. The PT worked, but playing sports with the PT was highly counter-intuitive, and prohibited healing. I am now stuck in a position where I’m looking to heal my tendonitis, and get back to sports ASAP. This program is long, but I’m hoping it will do the trick.

    • Martin Koban

      Hey Austin,

      The trickiest part about patellar tendonitis is the patience. Tendons take a long time to heal, at least several weeks, and it’s tempting to jump back into sports too soon.

      Track your pain as you go through the program and back off the intensity if it increases.

  3. P V Sai Krishna

    Three year back I woke up with knee pain. The pain was horrible, the orthopedics I met then couldn’t diagnosis it as tendonitis. After a gap of year I returned to running and other activities, but I still feel my injured tendon weak and it pains sometimes when there are sudden reactions like jumping, standing and going down on stairs.

    I recently got my MRI scan and it show no tears. I this program good for me to strength my weak tendons ?. Currently, I do have pain rarely but I feel my leg to be very weak.

    • Martin Koban

      I don’t know your body and I’m not your doctor, so please be careful when you start this program.

      Start the program slowly and see how your body reacts. If your pain increases, it’s not good for your condition.

  4. I am 13 and it seems like I’m suffering stage 2 jumpers knee possibly stage 3. How quickly do you think I can resume basketball? Will my knee be as strong as it was before?

    • Martin Koban

      Hey Jean,

      don’t worry about the duplicate comments :)

      I think your knee can become as strong as before, but you need to be careful to not further aggravate the injury by keeping playing.

      Make sure you have a doctor check out your knee so that you can rule out any other injuries and once he has cleared you for exercise, start strengthening your knee with very slow eccentric training. Use a journal to write down your pain scores on a scale of 1 to 10 for every day and adapt your training so that your pain slowly decreases.

      I can’t give you a time estimate on that, but don’t expect anything under two or three months.

  5. Hey martin, so I’ve had chronic patellar tendonitis in both knees for about 3 and a half years. It’s absolutely killing me. I got your book and started following your program a couple weeks ago, although this last week I haven’t been too diligent with it. My problem mostly has been the eccentric squats though, because right now my right knee is worse than my left knee. So I’m not sure what to do about that. Plus, it seems like the littlest things aggravate my knees, however, I’m never quite sure what exercise it is that makes them more stiff and/or painful the next day. It seems that the assisted one-legged deadlift might do that since the knee is slightly bent, but I don’t know. Do you have any suggestions? I haven’t put much emphasis on the eccentric squats either, so maybe I should focus more on that?

    • Martin Koban

      Hey Garrett,

      Skip or modify any exercise that causes an increase in pain. You can modify the eccentric squats by replacing them with isometric exercises like wall-sits.

      The important thing is to regularly give the tendon some stimulation to increase collagen synthesis again.

  6. I’m 19, 6’5″ and I’ve been dealing with tendinosis and a partial tear in my left knee for about 3-4 years now and tendonitis in my right knee for about 8 months. I’m still able to dunk with power and run fast but not with the ease from back in my younger days and it seems like the pain always keeps coming back after a little bit of time off from playing. I just bought your book on amazon and I’m hoping that it can take care of my problems so I can get back to being explosive on the court without any pain or discomfort

    • Martin Koban

      Hey CJ,

      Thank you for buying my book.

      I’ve been exactly where you are. The most important thing is patience and restraint. It will get better and if we get tempted into going back too soon, it’ll get worse again. Track your progress and take your time with the recovery.

      Good luck.

  7. I’ve just signed up for the email and I’m wondering if your book has detailed diagrams/pictures for the various stretches/exercises? Also do you have youtube videos for more complex movements? I was diagnosed last year with Jumpers knee. Partially from sitting for the past 6 years everyday for 8hrs a day as my job requires. But mainly from being overweight and trying to continue my biking, snowboarding, and hiking as if I’m in 100% perfect condition. I can’t do these activities everyday as I need to rest between as my muscles don’t seem to recover quickly and the PT causes my knee to buckle. Besides your book/course would a physical therapist be able to do any more for me? Or is the best way to recover form this by following your book as though my life depended on it?

    Thanks Again

    • Martin Koban

      Hey Ian,

      Thank you for buying the book. It’ll be of great use to you.

      Yes, it contains detailed pictures and thorough explanations of the exercises and stretches. The lack of good pictures and short explanations was something I disliked in other books on knee pain, which is why I made sure to go into as much detail as necessary.

      As for your question about physical therapy: if you can find a good PT, then yes, it’s going to help you a lot in recovering faster. I recommend looking into people that are Neurokinetic Therapy certified: http://neurokinetictherapy.com/certified-practitioners

  8. Thank you for the quick reply. Unfortunately where I live there’s no certified practitioners for 100′s of miles. Your book will be all I have. Also other than a roller and a slant board is there anything else needed? I do have a bench to do leg extensions, are those helpful in your experience?

    Thanks Again

    • Martin Koban

      You will also need a small training journal and some type of rubber band for the advanced exercises. You can get that later though.

      About leg extensions:

      I prefer squats and their single-leg variations over the leg extension machine, however, when I trained with the players of the German National Volleyball team I talked a lot with the setter of the team. She swears by slow leg extensions for her patellar tendonitis. So in the end you have to experiment to find out what works for you, in either case you have to execute movements slowly (at least 2 seconds for the eccentric and at least 2 seconds for the concentric part). With tendonitis, slower is better.

      I’ve done single-leg squats as slowly as 10 seconds down, 5 seconds up in the past. It’s great for making sure you have full control over the movement. There’s no cheating when you’re going slowly.

  9. Two questions….
    First is in regard to Stage. For lack of a better thinking, I broke the following into 0-10 scale, 0 no pain, 10 highest pain.
    Walking: 0
    Sitting: 0
    During exercise: 0-3. It can vary but typically one knee will have zero pain, the other light pain. Occasionally both experience the same.
    Squatting (beyond 90deg): 1-5. Usually nothing till knee is at a right angle.

    One last thing regarding pain, it is usually most noticeable to the touch rather than during movement. Sometimes I will have little to no pain, and touch near the tibial tuberosity will have a slight bump and light to mild pain.

    After two days of rest I will generally have 0-1 pain, with exception of squatting. Slight bump still present. Stage 1? Stage 2?

    Second question, any cardio recommendations for those dealing with Patellar Tendonitis recovery?

    Thanks so much for your help!
    Reed

    • Martin Koban

      Dear Reed,

      Let’s start with the easier question, cardio: the first thing that came my mind was swimming. It can be as intense as you want and it’s very easy on your knee (unless you swim breast stroke and have issues with your LCL, ACL, or meniscus). Something else you could try are backwards sled-drags with your knees almost extended or kettlebell swings (to unload the knee, a correct hip hinge is important in the KB swing).

      As for your squatting pain: you need to get that “slight bump” examined by a doctor. It could just be light swelling from tendonitis, but it could also be something more serious and I don’t want to speculate. Either way, stay away from painful exercises and minimize pain and discomfort as much as possible by modifying exercises. For squats, you could try Amosov Squats. Here’s a description that is part of my “Top 5 Knee Health Exercises” email course (you can find it in the menu at the top):

      To perform this exercise you need a sturdy door or a sling trainer (e.g., gymnastic rings or something of similar nature). In the starting position, you place your feet about hip-width apart and hold on to the support as if you were waterskiing.

      Supporting most of your weight with your upper body by holding on to the sling trainer, you sit back as far as you can. The weight should be on your heels. Your buttocks should touch the floor somewhere behind you, not underneath you and your shins have to either be vertical or, better yet, pointing away from the sling trainer. Don’t let your knees cave in towards the midline of your body.
      Only perform this exercise in the pain-free range of motion. It’s completely fine if you can only bend your knees to a 90-degree angle. Gradually improve the range of motion with each session and keep working on it until you can touch the ground. Remember to sit back. Don’t sit straight down!

      Once you feel like the full-ROM Amosov Squat is too easy, you can start doing regular bodyweight squats instead. Sit back as far as you can without falling over and keep most of your weight on your heels when doing squats.

      Good luck!

  10. Hi Martin,
    I’m a soccer player and had patella debridement surgery with PRP done on my right knee in 2008, with decent success. Partially tore my left patella in 2012 and now considering having the tenex (fast procedure) done. http://www.tenexhealth.com
    I am seeing a PT whom has seen positive results from tenex being performed on 2 of his patients for patella tendinopathy. Tenex seems very similar to the debridement surgery without being as invasive.
    Any opinions, suggestions, thoughts on tenex?
    Also, great book, super helpful and thanks for all the free info on the website as well. You are saving all of us with patella tendinopathy issues a lot of research and time. Much Appreciated….
    Thanks,
    Adam

    • Martin Koban

      Hey Adam,

      I’m not familiar with the tenex procedure. Generally, I’m not a fan of surgeries unless absolutely necessary, that is, unless all other options have been exhausted. Other options being patient treatment through slow eccentric exercises, stretching, massage, deep tissue laser therapy, Neurokinetic Therapy, and other non-invasive treatment modalities.

      It’s very tempting to think of surgeries as the silver bullet, but at least for patellar tendonitis that’s not the case. There’s no magic surgery and no magic treatment method that will guarantee success, but at least with treatment through exercise you’re not doing something irreversible.

      Maybe you can do some Googling to find more success stories of tenex for patellar tendonitis. Two people with positive results as a farcry from a reasonable sample size.

      Sorry to be so pessimistic about this.

      I hope you find a solution. Let me know how it works out.

  11. Christoph

    Hi,

    thanks alot for your work! I have just purchased your book as I am sufferting from patellar tendonitis since Februar 2014 and it didnt leave me since then. I got it from playing soccer when suddenly the pain got so intense that I had problems walking, however I was stretching and strengthening my legs ever since the inflammation went away. I still have problems walking down stairs but I hope with your program I can get rid of that pain. I am getting a shockwave therapy now but it didnt help too much.

    Do you also recommend training the hamstrings with a lying leg-curls that can be done in the gym?

    I noticed that my hip mobility isnt good when I started your training program. Can the range of motion of my hip be increased with this program?

    THanks alot for your help! You really motivated me!

    Best regards,
    Christoph

    • Martin Koban

      Hey Christoph,

      Thank you for buying my book!

      The program will definitely increase your hip mobility. You’ll notice that after a few weeks on the program.

      The shockwave therapy mostly has a pain-reducing effect, at least that’s what research studies into treatment modalities for patellar tendonitis revealed. In other words, they help cope with the pain, but don’t solve the actual problem, which may be why you haven’t noticed any progress.

      As for your question:

      Machine-based hamstring exercises are usually problematic for people with knee pain or those with a tendency to get knee pain. For this reason I’ve included standing single-leg exercises that train the hamstrings in my program. These also train balance and good body alignment and there’s a much higher carry-over to athletic movements (compared to hamstring curls).

      If you want, you can try the hamstring machine to see if it causes you any problems. Some people are fine with it.

      Best,

      Martin

    • Christoph

      Thanks for your reply Martin!

      I have another question and hope you can answer it too:

      As I have patellar tendonitis since February and have pain walking down stairs I guess I am in the chronic stages. However after doing your quadriceps stretch and massaging beforehand I always get instant pain reduction but after some time the pain gets stronger again. Does that mean after doing the stretches for several weeks (I have doing your program for 1 week now) that I will be pain free and that it is healing?

      Also I have to say I had very intense pain (going downstairs) but at day 4 of your program I noticed that the pain was really reduced when I was walking stairs. Now the pain is stronger again but not as much as it was before I started your program!

      As I said I can feel the pain when I am going downstairs and also when I am doing a similar movement to the ankle dorsiflexion drill where you have to touch the object with your knee. The question I have about the dorsiflexion drill is, do I have to make a half circle with my working leg when I am returning from the wall to my starting position?

      Sorry for so many questions but they just popped in my mind along the way I was writing this :D

      Thanks alot for your effort! You are of great help and I will recommend your book to everyone with knee problems!

      Best regards,
      Christoph

    • Martin Koban

      Hey Christoph,

      Strengthening the tendon isn’t a linear process. I’ve created a simplified picture to illustrate that process: http://www.fix-knee-pain.com/blog/wp-content/uploads/2014/07/positive_adaptation.PNG

      The key to beating patellar tendonitis is to keep doing the things that reduce your pain and to do them at the right intervals, so that pain keeps reducing. Eventually, the pain when walking down stairs will get lower as well.

      In tendonitis, pain is only a delayed indicator of tissue damage. In other words, even when you’re pain-free, you still have to continue your strengthening regimen for at least a month and you have to be really careful about transitioning back into your training.

      Check out this new video I put up yesterday. It’s about how long it takes to recover from patellar tendonitis: https://www.youtube.com/watch?v=WwFbG_1mDVo

      About the dorsiflexion drill: yes, always train both sides. This way you can track differences between sides and you’ll improve motor control for both legs. Improving motor control is another benefit of these exercises that I haven’t emphasized in most of my material. Basically, you’ll learn to move better, which reduces your risk of non-contact injuries. For this reason, always do all single-leg exercises with both legs.

      And don’t worry about asking questions. I’m glad if I can help :-)

    • Christoph

      Thanks alot Martin for your fast reply.

      How long do you think will it take me do be pain free when I have had chronic patellar tendonitis since Febuary 2014? (An estimated time from your knowledge)

      I do all the single leg workouts with both legs for sure, but the question about the dorsiflexion drill where you touch a wall infront of you with your knee by using the motion of the ankle was if I have to leave the position when I am touching the wall with my knee in a half circle to the starting position? or is it rather just a going forth and back movement? (Do you recommend doing this workout even if I notice a little pain in my patellar tendon?

      Thanks alot for your kind help!!!

      Best regards,
      Christoph

    • Martin Koban

      Sorry about the misunderstanding.

      Yes, get out of the touching position in an outward half circle. The idea of this being that we don’t only use our ankles in one dimension (back and forth), but more than that .

      If you notice pain during that exercise, you have to evaluate if it leads to an overall increase in pain after the exercise or if it’s just during the exercise. If doing the exercise increases your pain overall, you can modify the exercise similarly to hove I’ve demonstrated it here: http://youtu.be/pv0DYn1Ksyg?t=2m59s (If you don’t have a slant board, put something else under the balls of your feet).

      About the recovery question:

      3 to 6 months is a realistic estimate. It took me around 6 months to recover from it, but I wasn’t following a sophisticated approach back when I did it (many years ago). At any rate, expect a minimum of 3 months. Tendons are very slow to heal, unfortunately.

    • Christoph

      Hi Martin,

      thank you so much for answering me that fast!

      I am kind of sad at the moment because I now can feel a little pain in my tendon even when I am lying in bed. I just had the pain before when walking stairs and some other movements. Now it seems like a new area of the tendon a bit further under the patellar is starting to hurt. I am always watching my pain levels while doing the excercises however I never have major pain when I am doing your exercises and I would say they never go beyond a 2 out of 10.

      Is that maybe a sign of healing or is it getting worse?

      Thanks alot for your suggestions and help! You are my knee guru :D

      Best regards,
      Christoph

    • Martin Koban

      Hey Christoph,

      It’s impossible to say what’s going on inside the tendon without a biopsy (ouch!) or at least an ultrasound. Additionally, each injury occurs differently and heals differently.

      If I were you, I’d stay at the current training volume for a week or two and see how things change in that period. If pain doesn’t go down slowly, you may still be training too much. How many sessions are you doing per week and how many sets and reps per session? Also, is that the volume at which you started your training or did you increase it already?

    • Christoph

      Hi Martin,

      I have been doing your program as it is stated in your book for 2 weeks now. Strengthening and Stretches (everyday) + Eccentric Excersises 3-4 times a week. At first I had really great pain reduction after 3 days of doing your program. However after 1 and 1/2 week pain levels were going up again, so that it felt like inflammation was back. I noticed the pain even when I am not moving at all, that was when I first started to try the dorsiflexion drill(touching the object with the knee).

      As my tendonitis is chronic but it still felt like inflammation, I was taking painkillers for the last 3 days and the pain is reducing now. I am leaving out the dorsiflexion drill now and I know that the healing process isnt linear.

      However… during eccentric excersises I still just feel a pain level of 2 out of 10, if any.
      I hope that I am getting pain free some time because its hard to be motivated when you always get set back :(

      Is that really normal that pain levels vary that much from week to week? Or should I notice reducing pain levels from week to week?

      The other question that came up was: I felt pain during self-massage but kept going, now a muscle group of my left leg feels kind of numb when I am touching it (for like 4 days now), do you have any experiences with that?

      As always thank you so much. I really apreciate your help!

      Best regards,
      Christoph

    • Martin Koban

      Hey Christoph,

      No, I have no experience with muscles going numb due to self-massage, sorry.

      Unfortunately, recovery from patellar tendonitis can take a long time in some cases. It’s important not to get demotivated and quitting. The whole process can involve a lot of trial and error, that is to be expected.

  12. I am 20 and other than running track in High School I wasn’t the poster child for athletics. I have always been more into horses and riding. Eight months ago I was forced to stop due to horrible knee pain in both knees. The doctor told me I had a torn meniscus and put me in a full leg brace. I walked around for six weeks in that stupid thing only to find out it was for no reason. After an MRI he then told me I had patellar tendonosis and sent me to PT for six weeks. Deep tissue messages, the shock machine, stretches, band exercises, and icing. I slowed wayyyy down on all my running and focused just on recovering. They released me and I hoped for the best, but know my pain has come back but this time so much worse. It has sent me home from work on several occasions. It has come back even though I was very careful and I haven’t even returned to any heavy physical exercise. For goodness sakes I can’t even run two miles. I want this done and over with so I have turned to google and found your page and I am going to buy your book and follow your instructions very carefully I want this done and over with.

    • Martin Koban

      Hello Carly,

      I’m sorry to hear that you’ve been misdiagnosed.

      The book will give you a very clear picture of what you’re dealing with and how you can reclaim your health. If you have any questions after reading the book, don’t hesitate to come back and ask :-)

      I wish you a speedy recovery.

  13. Hi there, im 18 and ive had knee pain for a year now. I believe i have posterior pelvic tilt rather than anterior as i always keep my legs up above my hips on a stool when sitting. How should i rectify this? Many thanks

  14. Hi thanks for the reply, should i continue doing your program as well as whats mentioned on that page as it says my glutes are more tight than my quads. Also how long should i hold each stretch for as i couldnt find. I also have osteochondritis as well as high rheumatic inflammation in both knees and physiotherapy has not helped my condition so should i continue the program if im not seeing any improvement in pain/balance after a few days of it? Many thanks

  15. First I just want to say, thank you so much for writing an incredible book on how to beat patellar tendonitis. I picked up your book on Amazon last week because of all the awesome reviews on it, and I started your Phase 1 program on Monday.

    One of your reviewers is right about the program taking a lot of work, however, I’m putting all my effort and dedication into your program, so that I’m able to run, walk, and do things that require my legs without my knees being in pain.

    I have a couple of questions if you don’t mind answering?
    First question I have is if it’s ok to substitute one of your exercises with a different one such as doing the calf stretch on the slant board instead of on the stairs? Or instead of doing the one-legged RDL, if I could perform that movement doing a two-legged RDL. I noticed that I don’t have a good hip hinge, so I was told that I need to learn the proper technique of hinging at the hip before I start doing them on one leg or using any weight.
    Also, as well as learning how to squat properly before I do them on a slant board or using weights as well.

    Another question I had is if the self-massage and the stretching portion of the program will reduce the tight and stiffness in my knees, calves, and hamstrings?

    My last question is if you will be making videos on how to perform the exercises you state in your book? I’m still not 100% sure if I’m doing the movements correctly. I looked up all the exercises on YouTube on how to perform each one, but I’m still not understanding how to do the Z-Sit or the squat on the slant board. I would love to see a demonstration on how to perform these exercises correctly.

    Sorry for the super long message, and I’m really hoping that your program can help me be knee pain free.

    Chong

    • Martin Koban

      Dear Chong,

      Once you understand the rationale behind the exercise and have gotten to know your body, you can modify the program to be more specific to your individual needs by doing less of the exercises you’re already very good at (if you don’t have the time for example).

      Yes, it’s completely ok to substitute exercises with other exercises if you’re missing equipment, if you have pain, or if you can’t do the exercise for another reason.

      The advice of learning proper form of the RDL is also spot-on. You can regress any exercise to a less-demanding variation if the technique is too challenging. That’s completely fine :-)

      The self-massage and the stretching reduces tightness for the vast majority of people. Some folks have deeply hidden issues that are causing tightness, which can only be fixed by hands-on care through a qualified professional, but like I said, that’s only the case for a fraction of people.

      As for the videos, I will create the slant board video later this month and send it to my mailing list. If you’re signed on you’ll get it.

      I won’t make a video of the Z-Sit just yet though (it takes a lot of time to make these and I have to think carefully about what I put my time into, since I’m running a business :-) . I’m currently debating creating a video course with all the exercises I have in my books, but I still have to see whether enough people are interested in that to justify the work it would take.

      And Chong, don’t worry about sending long messages :-D

  16. Thanks for replying to my message Martin.

    I hope you consider making the video course with all the exercises into maybe like a workout video, or program that we can follow along.

    If I have anymore more questions about your program, should I post them here, or if I could email you because I don’t want to clutter this blog post with my super long messages.

    And yes, I have signed up to your news letter. A lot of great context you mention there.

    Chong

  17. I pulled my hamstring many years ago playing baseball. I was playing 2nd base on an artificial surface infield, just past infield it went to natural grass. A little pop fly I was going for over first base, as I went from infield artificial to the natural grass, my hamstring popped. The bruising was black and blue all down my leg, never before had I had bruising this bad. Hamstring has never been the same.
    A few years ago I started running again, training for physical ability tests to get into law enforcement. I tested five different times and passed each time. The test was a 300 yd run and a 1.5 mile run. nothing happened, no job offers. I kept trying and then noticed knee pain, diagnosed as patella tendonitis, wrong shoes caused it. Now the hamstring keeps getting strained and pulled no matter how lightly I jog.
    Started doing somatic stretching to try to re set the set point of the hamstrings. Running today I felt it first in the knee and then the hamstring pulled again.
    Months and months of trying this and trying that and here I am, going to try this.
    Wish me luck….

    • Martin Koban

      Randy, have you tried strengthening your gluteals? Reoccurring hamstring issues can be caused be weak gluteals or tight hip flexors, so make sure you check into that.

      I saw you’ve signed on the the email course on patellar tendonitis. Later this week you’ll get an email that details the gluteal exercises if you’re not familiar with them already.

      Also, I think artificial surfaces are the worst for your knees. Combined with shoes that stick to the ground and don’t slide all. It’s great to be extremely explosive, but it’s also super easy to overload your knees. Nowhere in nature do we find such high-friction surfaces.

  18. I am a basketball coach and work with elite junior players of 15-18 years of age. Several of the boys I work with have encountered knee pain (including my 17 year old son). I also see many opponents wearing various knee straps and braces so assume they have similar problems. As adolescents many of them are going through growth spurts which seem to cause/compound the problem. The advice given to these boys by physicians seems to vary considerably; some are advised to have weeks of rest along with some stretching exercises and some have been told to carry on as normal as it’s a growing pain that will sort itself out over time! Is the approach that you describe for rehab correct for athletes of this age? Does the fact that they are growing quickly change anything?

    • Martin Koban

      Hello David,

      One aspect of my approach to patellar tendonitis that definitely works is the part about improving movement technique and strengthening the muscles necessary to do so. More specifically, paying attention to proper body alignment when running and jumping and strengthening the gluteal muscles. When I was that age my legs and glutes were extremely weak and I would have benefited greatly from a training program geared at strengthening glutes and improving movement technique (knee alignment, force absorption, jumping technique, etc.).

      Combined with a reasonable training volume and enough training variety this will fix most problems. However, when children and teenagers are pushed into specializing for one particular sport, overuse injuries become more difficult to avoid. Eric Cressey has written about this in relation to baseball, but similar problems occur with other sports.

      As for whether eccentric training helps speed up the healing process in children and teenagers, I could only guess since I haven’t come across any studies on that subject. My go-to approach would be resting, strengthening the gluteals, and improving movement technique. Once pain has gone down, slow reintroduction into sports activity.

      Stretching the quads and calves, as well as self-massage may also work, but you will have to try this yourself since I haven’t worked with teenagers.

  19. Hi,
    I am 38 years old and have been suffering from patella femoral syndrome for the last 2-3 years. Recently, I am also experiencing pain just below the knee.
    Couple of things.. is patella femoral syndrome and patella tendonitis the same?
    Is eccentric squat and sissy squat essentially the same?
    I have been doing knee strengthening exercise for 3 years now, but with little result.
    My osteopath mentioned that the problem is actually with my hip and ankle rather than the knee.
    Would defintely like to try the slant board exercises.

    • Martin Koban

      PFPS and patellar tendonitis are not the same. The causes are very similar, but the injury itself is different.

      No, sissy squat isn’t the same as an eccentric squat on a slanted board. In a sissy squat most of your weight is on the balls of your feet. In an eccentric squat on a slanted board, your weight is distributed more or less evenly, with a little more load towards the heel.

      And your osteopath could be right. Ankle and hip problems usually lead to knee problems and lower back issues, which is why healing ankles and hips is important for relieving knee and back pain.

  20. Andrew Crabtree

    I am a soccer player and cross country runner. I started having knee plain from patellar tendonitis about 3 months ago. At first I didn’t do anything about the knee pain because I didn’t know what it was, then I went to a sports doctor who gave me a patellar strap for my knee and told me to try to ice my knee often. I did not decrease my running or soccer at all because the doctor said I didn’t need to, but eventually the pain in my knee got so bad that I had to run less and stop playing soccer.
    I finally started going to a physical therapist a little over a month ago and when I first started my knee was very swollen, I had difficulty squatting at all, and sometimes my knee would simply ache even if I wasn’t doing anything physical. I started out doing hyper-extension exercises with my knee because the pt claimed it would work out any kinks mechanically with the knee. I was advised to ice my knee as often as possible and stay off off it so that the knee could get out of the inflammatory phase and I could start strengthening the knee.
    So that is where I am currently at, I am finally able to start strengthening my knee because all of the swelling is gone and it is no longer painful. I am honestly scared to resume jogging or anything impact based, so I have been just trying to do elliptical machines and the strengthening exercises my pt told me to start doing.
    Soccer was the real problem with me, It’s when the pain started and it’s what caused the most sharp pain. Should I wait until I think the tendon is fully healed to start playing soccer again? Should I continue to ice my knee on a regular basis despite it not being swollen and painful anymore? There are injections to help this kind of thing heal faster, although I’m sure it’s expensive is that a viable way to speed the healing process? Thanks and I really appreciate this website and all the useful information that you have.

    • Martin Koban

      Hey Andrew,

      I’m sorry to hear that your doctor underestimated how bad patellar tendonitis can be come, but it sounds like you’re starting to get better, so that’s good.

      You should definitely continue strengthening your tendon for at least 2 or 3 months after your pain is gone before returning to sports. Heavy slow resistance training like very slow squats with weight (or leg press, or smith machine squats) are best to strengthen your tendon.

      Icing is a good option to deal with the pain, but it will not speed up healing and only delays inflammation. Unless you need it to deal with the pain you might as well do it less often (only when needed).

      I don’t know exactly what type of injections you’re referring to. Research into PRP-treatments and similar types of treatments showed inconclusive results, which is why I’d recommend you try other options before spending that amount of money on something that MIGHT work.

  21. hi martin,this is great infomation your providing thanyou very much. Ive had patella tendonitis 6/7 years my question is in my job i walk 12k a day 5 days a week do you think this will hamper my recovery if i follow the instructions you kindly provided. Also ive had 2 injections over that period. One was PRP which did nothing what so ever, only cost me a lot of money the other which was a steriod injection gave some relif for a short period, i would recomend trying your treatment first to anyone im sorry i didnt have this information a couple of years ago.

    • Martin Koban

      Hey John,

      Don’t beat yourself up, hindsight is always 20:20.

      I did many things in my life that I wish I could undo, but oh well, we have to live with our past choices. All we can do is make the best of it.

      I hope you’re better now and have found a way to get healthier.

  22. Hi martin, i’m at stage 2 of the program your wrote above, I believe i’m at stage 3 of patellar tendonitis and I had it for almost 3 years if not more, looking back I was doing things wrong with my training, thanks for this, I feel better but I try to keep it totally real, I expect this to work but I dont want to get my hopes to high. Now, when you talk about one legged deadlift, should I add weight? what’s your approach? I’m using a 10 kg plate on a broomstick because it helps me to feel the glutes and keep posture, your thoughts? thanks

    • Martin Koban

      Hi Ivan,

      Glad to hear you’re making progress.

      My rule of thumb for loading body weight movements is that I only do it once I can complete 3 sets of 12 repetitions (without pain, obviously). Once that’s the case I load the movement or progress to a more difficult variation.

      A safer alternative you can use if you don’t feel like you’re quite ready for external weights is to execute the movement even slower. That will help teach even better movement technique and it will also reveal any weaknesses.

  23. Will not 4 strength training circuits per day in phase 1 overload the knee?

    • Martin Koban

      Hey Daniel,

      The only exercise that places a lot of load on the patellar tendon are the squats. The other exercises either load the muscles on the back of the thighs or the hip muscles, which causes little stress to the patellar tendon when done correctly and executed slowly.

  24. Martin,

    I’ve suffered from PT for the last 3 years. I bought your book and started going through the program. I’m in phase two. One question. I actually hardly feel any pain when doing squats or anything less than 50 reps total. My biggest problem comes when I run. Something about the repetetive motion hits me about 10 minutes into running. As part of my recovery, would incorporating running slowly help to strengthen the tendon? Ie. run for two minutes a couple of times a week and keep increasing the duration. Thanks for all your help.

    • Martin Koban

      Hey Kevin,

      Do you notice anything when you do single-leg exercises?

      If I were in your situation I’d work up to comfortably doing very slow single-leg squats before returning to running.

      However, you can of course try your approach and see whether it increases your pain or not. If there’s no increase in pain you should stay at that level of training for a while and then increase slowly.

      Make sure to work on the other causes for patellar tendonitis as well though (tissue quality, glutes, ankles, etc.).

Leave a Reply

Copyright © fix-knee-pain.com | The pictures on this page are licensed under Creative Commons Attribution 3.0 Unported. You may use them for any purpose, as long as you include a clickable link back to the page you found them on. Some of the links on this website are affiliate links. If you purchase a product through these links, I will earn a small commission. However, my opinion isn't for sale and I only recommend products that I have used myself.