3 Mistakes That Ruin Your Patellar Tendonitis Recovery Time

Some people recover from patellar tendonitis within a few weeks, others deal with it for years. How can recovery time be so different?

In this video, you will learn how to avoid three very dangerous mistakes that will add months to your recovery time, if you make them and how much recovery time you should expect.

“Patellar tendonitis can last up to 15 years.”
(Kettunen et al. 2002; Kongsgaard et al. 2009)

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

Video Transcript:

The three dangerous mistakes I’ll show in a moment are mistakes that you may consider harmless. I sure did, back when I had patellar tendonitis.

But academic research and anecdotal evidence from thousands of people confirm that if you make these three mistakes when recovering from patellar tendonitis, you’ll either add months to your recovery time or you’ll prevent recovery altogether.

Mistake #1 Will Completely Prevent Recovery From Patellar Tendonitis

Let’s start with the most serious mistake. If you make this mistake, you will completely prevent recovery; and here’s why…

In patellar tendonitis, your body tries to strengthen your patellar tendon by putting more collagen fibers down inside of it. These fibers are like the threads of a steel cable and the more of these fibers there are the more force the tendon can handle.

The collagen fibers inside your patellar tendon are like the threads of cable.

The collagen fibers inside your patellar tendon are like the threads of cable.

For this to work, you have to allow your body to do its job, by giving it appropriate rest periods. If you don’t rest enough, your tendonitis will progress into a more advanced stage in which the fibers of the tendon have become messy.

Recovery from patellar tendonitis will take longer the more the collagen alignment degenerates.

Recovery from patellar tendonitis will take longer the more the collagen alignment degenerates.

The more the alignment of collagen fibers degenerates, the longer it will take you to recover from patellar tendonitis. This is why every week you continue your regular training in spite of patellar tendonitis is at least a week added to your recovery time because you’re causing more damage that you’ll eventually have to repair.

The more you overuse your patellar tendon, the longer your recovery time will be.

The more you overuse your patellar tendon, the longer your recovery time will be.

Academic research also confirms that continuing your regular training while rehabbing patellar tendonitis stops healing and that athletes should be removed from sports activity during rehab. (Visnes et al. 2005; Visnes, Bahr 2007)

Mistake #2 Seems Safe But Will Make Your Patellar Tendon Weak & Fragile

The second mistake seems safe, especially since doctors recommend it all the time, but it will actually make your tendon weak and fragile.

Let’s get straight to the point: resting too much also weakens the tendon. Much like lying in bed when you’re sick will make you weaker. (Yamamoto et al. 1999; Cook, Purdam 2009, p. 409)

Everyone with chronic patellar tendonitis knows that resting doesn’t get you back to 100%. To strengthen your tendon and recover from patellar tendonitis, you need to apply just the right amount of training at just the right intervals.

Resting will not get you back to 100%.

In my book Beating Patellar Tendonitis, I recommend people use a training journal to track their pain levels. Once you’re tracking your pain scores you can start doing tendon-strengthening exercises such as very slow eccentric squats or isometric wall-sits two or three times per week.

For your patellar tendon to get stronger, you have to do the right training at just the right time.

For your patellar tendon to get stronger you have to do just the right amount of training at the right time.

Next, you use your pain scores to adjust your training so that pain goes down over time. This ensures progress and I highly recommend you do it too. Without this systematic approach, you can only guess which training intensity is safe for your patellar tendon and as soon as you do too much, you’ll reinjure your tendon, which will cost you additional weeks of recovery time.

Mistake #3 Will Flush All Your Progress down the Toilet

If you make this last mistake, you will flush all your progress down the toilet. Let me explain.

Let’s say you’ve safely strengthened your tendon over the last 8 weeks and your pain has gone down significantly. You were smart enough to stop your regular training when you started rehabbing your patellar tendonitis and you’ve been tracking your progress with a journal.

For the last 8 weeks, you couldn’t do the things you love because of pain, but now the pain has gone down. That’s where patellar tendonitis will trick most people into making the third mistake.

Once the pain has gone down, most people jump back into their training and pick things up right where they left them when they started rehab.

Same mileage, same number of hours on the court, same amount of weight lifted in the gym, and so on. And I get it, I’m an athlete too, but here’s the problem.

In tendonitis, tissue damage occurs before pain is felt.

(Huisman et al. 2013; Khan et al. 1998, p. 351)

In fact, one study on Achilles tendonitis found that two-thirds of tendons that were degenerated enough to rupture were still pain-free. (Kannus, Józsa 1991)

In other words, just because your pain has gone down doesn’t mean that your tendon is completely healthy again. You need to ease back into your training slowly and pay attention to every little bit of discomfort in your knee. This way you can prevent mistakes that will flush all your progress down the toilet.

With tendonitis, it’s better to be safe than sorry.

Before we get to how much recovery time you should expect, let’s recap.

In summary, you can avoid the three mistakes that will add months to your recovery time by following these steps:

Step 1:

Don’t continue your regular training while rehabbing patellar tendonitis, regardless of how tempting it may be. It won’t work.

Step 2:

Get a training journal and track your pain scores every day. Next, start doing tendon-strengthening exercises like slow eccentric squats or isometric wall sits.

Step 3:

Once your pain has gone down significantly, ease back into your regular training very slowly. Use your pain scores to avoid anything that increases your pain.

How Much Recovery Time You Should Expect

Picture by  Dafne Cholet - FlickrNow, as for how much recovery time you should expect, academic research found that if you follow a safe strengthening regimen you will notice a reduction in pain after 3 to 4 weeks (Rutland et al. 2010), but repairing the tendon completely will take at least 3 months (Khan et al. 1998, p. 348; Wilson, Best 2005).

Now you can see why it’s so important to avoid mistakes that add additional months to your recovery time.

What I’d like you to do next is leave a comment below this video and tell me how long you’ve been struggling with this injury; and if you discovered any other mistakes that also slow down healing, share them with me and the other readers so that we can benefit from your experience.

Also, if you’re new here, I recommend you join my free email course on patellar tendonitis. It will show you great healing exercises to get you back to your sport as soon as possible. You can sign up right below this video or by going to fix-knee-pain.com/tendonitis.

Lastly, if you know someone with patellar tendonitis or have friends in jumping sports such as basketball or volleyball, give them a head start on this injury by sharing the link to this video.

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Cook, J. L.; Purdam, C. R. (2009): Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. In British Journal of Sports Medicine 43 (6), pp. 409–416. DOI: 10.1136/bjsm.2008.051193.

Huisman, E.; Thornton, G.; Roberts, C.; Scott, A. (2013): IDENTIFICATION OF BIOMARKERS FOR EARLY TENDON DEGENERATION USING AN IN-VIVO RABBIT MODEL. In British Journal of Sports Medicine 47 (9), pp. e2. DOI: 10.1136/bjsports-2013-092459.57.

Kannus, P.; Józsa, L. (1991): Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. In J Bone Joint Surg Am 73 (10), pp. 1507–1525.

Kettunen, Jyrki A.; Kvist, Martti; Alanen, Erkki; Kujala, Urho M. (2002): Long-term prognosis for jumper’s knee in male athletes. A prospective follow-up study. In Am J Sports Med 30 (5), pp. 689–692.

Khan, K. M.; Maffulli, N.; Coleman, B. D.; Cook, J. L.; Taunton, J. E. (1998): Patellar tendinopathy: some aspects of basic science and clinical management. In Br J Sports Med 32 (4), pp. 346–355.

Kongsgaard, M.; Kovanen, V.; Aagaard, P.; Doessing, S.; Hansen, P.; Laursen, A. H. et al. (2009): Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. In Scand J Med Sci Sports 19 (6), pp. 790–802. DOI: 10.1111/j.1600-0838.2009.00949.x.

Rutland, Marsha; O’Connell, Dennis; Brismée, Jean-Michel; Sizer, Phil; Apte, Gail; O’Connell, Janelle (2010): Evidence-supported rehabilitation of patellar tendinopathy. In N Am J Sports Phys Ther 5 (3), pp. 166–178.

Visnes, Håvard; 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. DOI: 10.1136/bjsm.2006.032417.

Visnes, Håvard; Hoksrud, Aasne; Cook, Jill; Bahr, Roald (2005): No effect of eccentric training on jumper’s knee in volleyball players during the competitive season: a randomized clinical trial. In Clin J Sport Med 15 (4), pp. 227–234.

Wilson, John J.; Best, Thomas M. (2005): Common overuse tendon problems: A review and recommendations for treatment. In Am Fam Physician 72 (5), pp. 811–818.

Yamamoto, E.; Hayashi, K.; Yamamoto, N. (1999): Mechanical properties of collagen fascicles from stress-shielded patellar tendons in the rabbit. In Clin Biomech (Bristol, Avon) 14 (6), pp. 418–425.

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  1. Max says

    I’ve been struggling for about two years with PT. From time to time I happen to play Basketball but normally it just takes a few months until the problems return. Unfortunately they don’t return gradually but immediately and are usually accompanied by severe pain. It might just happen that I play basketball on a regular base for a couple of weeks without pain and suddenly after one workout I might get unable to walk up stairs.
    So I can completely identify myself with Mistake #3.
    Again an excellent video Martin! ;)

  2. Anne says

    I have been struggling with patellar tendonitis for almost 2 yrs. I have started more aggressive quad stretches lately and am finding they are aggravating even though my tendon feels tight. Can you show me some gentle quad stretches or should I stop stretching for now? Thank you . Anne

    • Martin Koban says

      Hello Anne,

      If stretches are too intense for you, concentrate on self-massage of the quads and hip flexors. You can do that using a foam roller, but for the quads I actually prefer just using a simple stick. That also relaxes the muscles somewhat.

      As for stretching alternatives, one thing you can do is try to do hip flexor stretches and to avoid quad stretches for now. Here’s a list of great hip flexor stretches: http://www.fix-knee-pain.com/psoas-stretch/

      Alternatively, you can try to stretch your quads with the “couch stretch”. You need a couch or a similar piece of furniture. Position yourself in front of the couch and place on knee on the couch, right where the back support meets the seat. Slide your knee all the way back. It should look somewhat like this: http://www.normanstrength.com/Websites/soonercrossfit/images/Kelly-Starret-Couch-Stretch-550x400_c.jpg

      Just with your knee on the couch instead of the ground. The tricky part is to have the pressure from the couch above your kneecap, not directly on it. In other words, your knee should touch the couch slightly above the kneecap, not directly on it. Now, relax into that position. While active stretching like PNF or AIS are more effective at getting the muscles to relax, passive stretching is probably easier on the tendon since it requires less muscle tension.

      Again, just doing the self-massage might already be enough to get some more tissue length in your quads.

  3. Kip says

    I have been struggling with PT for a year this month. I was on one knee and then moved to both knees. I have spent about $3,000 on physical therapy, doctors visits, and such to tell me the same thing and NO help. They keep trying to do surgery but I feel there has got to be a way to fix this without surgery. This is ruling my life and keeping me from doing the things that I love and continuing my fitness business. However, I am running out of options and it is getting more tempting to just forgo the surgery. I am going to try this program and can say that I have been violating all the rules above. Weighted, repetitive movements highly irritate mine. The pain is not something I cant stand but actually goes away during the exercising. However, a few hours after is when the pain and swelling occurs. Very odd. Thanks for your help Martin and I will keep in touch with progress of this program.

    • Martin Koban says

      Kip, I can totally relate to your story. As my tendonitis became worse I was still in a basketball team in the local league in Dresden. I couldn’t just quit and leave my teammates hanging because they needed my defensive presence under the rim for rebounds and blocks. At the same time, the injury slowly became worse and worse. I only managed to get rid of it once I stopped playing regularly after our team disbanded because key players had graduated and moved to different cities.

      If you run a fitness business you’re in a similarly difficult situation in that you need to demonstrate exercises *AND* be in good shape. So scaling the training down to recover isn’t an easy option.

      One thing you can try is heavy slow resistance training. It’s a newer treatment approach for patellar tendonitis that I briefly discussed in my book. There are only two studies about it, but both showed that it’s more effective than regular eccentric exercise. If you run a fitness business you probably have access to the needed equipment. Here’s one of the studies: http://www.ncbi.nlm.nih.gov/pubmed/19793213

      In a nutshell, they loaded the knee extensor mechanism with several exercises and high loads (75% 1RM and more if I remember correctly). The key was very slow execution without any use of the stretch shortening cycle (i.e., no bouncing, no momentum, and taking at least 3 second for the concentric and eccentric phase, respectively). Personally, I’ve found very slow single-leg squats to be extremely effective at healing my knees. At times I’d do eccentric pistols taking 10 seconds on the way down. Very intense, but great to stimulate collagen synthesis.

      The good thing about heavy slow resistance training is that you won’t lose strength. Actually, you might even get stronger. The bad thing about it is that it’s tough as nails :-)

  4. Karen says

    Thank you for all your useful information Martin. Both in your book, and on your website. It has been helping me, but unfortunately it’s taking a long time to heal. I’ve had PT since my ACL tear and surgery 4 years ago (skiing injury). It was about a year ago that I went to a physical therapist (after the initial pt post surgery) to deal specifically with my PT. They worked on movement quality and strengthening my glutes, but it still didn’t fix the problem. Since then I’ve quit doing my sports (cycling and skiing and running mainly) and have been following your program for about 5 months. It’s discouraging that it’s not healed yet, but I guess more patience is needed:( . I keep reading your information and watching your videos because it gives me hope that one day it will be better. Thanks again!

    • Martin Koban says

      Hello Karen,

      I’m sorry to hear that you haven’t made any significant progress yet :-(

      I so wish there was some ultimate treatment approach to just make it go away in a reasonable amount of time, but so far I haven’t found it yet.

      In the meantime, if you’re close to NY, you should pay Dr. Perry Nickelston a visit: http://painlasercenter.com/Contact_Us.html … if anyone can help you speed up your healing, it’s him.

  5. dar says

    Hie thee to an Osteopath that uses manipulation for an alignment …only then can true healing begin of the ‘cables’& recovery stat!

  6. Christina says

    I had been doing plyo metric workout programs for about 3 years with little rest plus running. Def overused! Almost 3 weeks ago I woke up with both knees burning. I thought it could be from wearing flip flops a lot since summer hit, but the pain didn’t get better wearing sneakers. I iced and foam rolled they got better than I did a yoga class that left me back to the start. I think I have jumpers knee in both knees! I’ve ordered your book, slant board and ready to put in the time. I’m still in pain which feels inflamed all around both knees. Only one side has the tenderness on the tendon. when can I start the program as I’ve tried to foam roll and stretch and feel its relieving some pain short term but then is back. Do I have to wait for the inflammation to go away? This has really been awful no warning I’ve never had this before. Can someone have this in both knees automatically at the same time?

    • Martin Koban says

      Hey Christina,

      Yes, you can certainly have it in both knees. It depends on what kinds of exercises brought it on. If you play basketball or volleyball, you’re more likely to have it in one knee only because in those sports you have a dominant leg. If you do a lot of plyometric exercises, you’re more likely to get it in both knees since most of these exercises are two-legged.

      If I were you I’d concentrate on self-massage for at least a week and avoid any other lower body training.

      A hunch tells me that you’ve been doing Crossfit-type workouts to stay in shape. If that assumption is true, you can still do your regular upper-body training and core training, just take it easy on the legs. If you absolutely, positively cannot rest ( that happens :-) ), you can try doing exercises that mostly use the posterior chain like deadlifts or good mornings. The important part is to pick exercises that don’t use any momentum.

      However, the safest route is to rest your lower body completely for a little over a week and to then start doing tendon strengthening exercises. Long isometric holds will reduce the pain and eccentric squats or heavy slow resistance training (at least 6 seconds per repetition, the slower, the safer) will then help heal the tendon.

      The most important part is to track your pain and to modify your activity based on that, regardless of whether you decide to do heavy slow resistance training, eccentric squats, or isometric exercises.

  7. Becky says

    Hi Martin,

    I was a level 10 gymnast and on my senior year of high school, I pushed through the pain and ended up quitting the sport. I went to college for 6 years and have been working for 2 years. During that time I have done a lot of sitting and have not been too active. I’ve tried physically therapy two times within those 8 years but did not feel like it was helping all that much. After giving rest, my knees felt better so I tried getting into running and biking but I was only able to do it for a week before getting pain. I finally came across your books and have read them. I’ve been on and off with doing the exercises due to busy schedule but I do plan to get into a consistent routine of the exercises. Question for you, do you know anyone who has had a similar experience where they reached chronic tendonitis and then was inactive for a very long period of time? I’m wondering how long recovery is going to take since I’ve done a lot of sitting for 8 years. Do you have any insight on this?

    Something interesting about my knees is when I was a gymnast, my right knee was a lot worst than my left knee because when I landed flips on the beam it was the foot that was underneath and took most of the weight. As well on the floor when I landed twisting flips (twisting right) my right foot would land first and take the impact of twisting and landing. However now my left knee is much worst than my right knee. Sometimes if I’m going down stairs and I put pressure at a certain angle, I get a sharp pain right below the knee cap. But my right knee only has slight pain. I can’t do the eccentric squats on my left knee because it’s too painful. So I kind of think that it’s interesting that my left is worst than my right but my guess is that i drive with my right foot and that pressure from holding the gas pedal down for a period of time reminds me of how it feels when i do eccentric squats.

    I am also thinking about looking into platelet injections, any thoughts on this? This seems like a very new procedure.

    Thanks for putting these books out. You are the first person I have come across who has done a good job at explaining the problem and how to fix it. It has given me hope that if I commit to doing the exercises consistently and have patience that my knees have a chance of recovering.

    • Martin Koban says

      Hello Becky,

      Most of the people I know that have had patellar tendonitis have always been active to a certain degree. I remember anyone that has had it in the past and then rested for years.

      Here’s my educated guess as to what is going on inside the tendon when you develop tendonitis and then rest it for years:

      In tendonitis, the body tries to strengthen tendon by putting more collagen fibers down inside of it. Continued overuse will prevent this from happening properly. Instead of putting the right types of collagen down in good alignment, you’ll end up with more scar tissue and misaligned collagen fibers. The tendon has can’t withstand as much tensile force as a result of this, which means that it’s more easily damaged. Continued overuse will then lead down a rabbit hole … the tendon will continue to degenerate.

      Once the overuse stops, the degeneration stops as well. However, in chronic patellar tendonitis (i.e., tendinosis or what Dr. Jill Cook calls “late tendon dysrepair/degenerative tendinopathy”) the body no longer tries to repair the damage. Some tendon cells have already died inside the tendon and it’s like a war-torn city in which people (i.e., the tendon cells) have given up trying to repair things.

      Based on what I’ve read in research and in anecdotal evidence, it is my understanding that the body doesn’t restart healing for no apparent reason once you’re in this stage. Pain will persist, but to instigate healing you have to load the tendon with very slow exercises. That starts to stimulate collagen synthesis again, but some amount of pain or discomfort seems inevitable at this stage.

      With continued training, pain goes down.

      One thing I’d also like to emphasize is that the most important type exercise for patellar tendonitis is the one that safely loads the tendon (i.e., slow eccentric squats, isometrics, heavy slow resistance training). By stopping all overuse and implementing these exercises, the tendon will get stronger over time. All other exercises in the book(s) are geared towards fixing hidden biomechanical causes that contribute to the tendon becoming overloaded once you return to activity.

      In other words, if you’re not an active athlete and don’t have a lot of time to train, concentrate on eccentric squats/isometric exercises to heal your tendon. Combine that with daily self-massage. If you have time left, incorporate gluteal exercises. If there’s still more time, do calf, hip flexor, and hamstring stretches (and quad stretches, if they don’t aggravate the pain).

      The goal is to prioritize the most important exercises.

  8. Paul says

    Hi, I’m a physical therapist here in Colorado and have been dealing with patellar tendonitis for 2 years, I understand how to fix it but being an athlete, esp a cyclist, it’s still hard for me to slow down the training. Thank you for reminding me the importance of slowing down my normal training program, keeping a pain log, etc so I can actually let it heal properly…I like reading all of your articles and expert advice, thanks again!
    Stubborn physical therapist
    Paul Sanders

    • Martin Koban says

      Hey Paul,

      Thank you for your feedback.

      I know how tempting training can be. My solution for this “problem” is to find exercises that are safe for my body and to concentrate on those. The slower the exercise, the safer it’ll be for joints and tendons but oh boy, these can be so intense.

      Yesterday I actually came across a blog post by one of my role models, Steve Maxwell. He writes a lot about the psychology and philosophy of training and why we make the mistakes that eventually get us injured. Maybe you’d enjoy reading it too: http://maxwellsc.com/blog.cfm?blogID=125

  9. Mohana Ganesh says

    I run the Half Marathon for the past 5 years. I have been having PT for the past 3 years. After following your exercises there has been a lot of improvement but not complete relief. Maybe I am not giving enough rest. I get no pain while getting up or going down the stairs. After a run there is little stiffness and slight pain on the side and behind my right knee. I find a lot of relief by applying Arnica Ice Gel when there is severe pain. Thank you for your exercises. Will definitely recommend to my runner friends.

    • Martin Koban says

      Hello Mohana,

      First off, sorry that I haven’t gotten back to you on your emails yet. I’m so behind on my emails it’s ridiculous :-(

      As for your question: yes, it takes a long time to get to the point where you don’t feel pain anymore. The most important part is sticking with the training that reduces pain, even months after the pain has gone down a lot. That way you can make sure your tendon has become stronger and can withstand the demands of your sport.

      There’s a lot of experimentation involved. Getting to know your body. Learning how it reacts to certain things. Modifying exercise so that pain keeps going down. It’s not an easy process, but with an injury like this you’re forced into it, whether you want to or not.

      The upside is that you learn a lot about your body and your training.

  10. Mark says

    Thanks for the info – it helps. My physio and surgeon think I have a mild bucket tear on my miniscus (I did not have a mri as it was not affordable). I have been doing rehab exercises for 8 months now along with milder exercise. The pain has reduced, but I still get pain if I do a deep squat. Have you seen people recover from such injuries and could you suggest other exercises and maybe treatments that could help me avoid surgery? Thanks. Mark

    • Martin Koban says

      Hello Mark,

      Unfortunately, I’m not familiar with any exercises to repair a torn meniscus. As far as I’m aware, this injury requires surgery.

      All the best for your recovery!

  11. Dympna says

    Yes, excellent video and has reminded me of the importance of the journal and that recovery takes time. I think I may have had symptoms for about six months and have been doing the rolling and stretching. The stretches have shown how tight I am in the ankle and hip so will continue working on those for a little while longer before I start on the squats. I am having difficulty getting into position for the one legged RDL.. I am not getting very far whilst folding at the hip before losing spinal alignment. I am losing contact with the lower back, ie I have too much space there between fingers and stick. Should I just do the lift from there? When I do, I don’t feel I am doing very much and don’t think I am getting very much from the exercise. Apologies if this is not the correct place to raise this query. Best regards and many thanks Dympna

    • Martin Koban says

      Dear Dympna,

      Don’t worry about asking the question here, it’s totally fine :-)

      The problem you’re describing sounds like it’s caused by lack of motor control. The main goal of the exercise isn’t to strengthen your body, but to increase motor control, so you should actually work towards getting better at it. Here some thoughts what you could try to get better:

      Try standing next to a mirror and look at yourself from the side. Now, tilt your hip forward, so that the curve in your lower back gets bigger. Next, tilt your hip backward, so that the curve in your lower back gets much smaller.

      You can tilt it backward by bracing your abdominal muscles and tensing your glutes. That’s the feeling you need to mimic during the RDLs. I’d also invite you to do the RDL with both feet on the ground first, so that it’s easier for you to concentrate on your back.

      Here’s another exercise you can do to learn how you can use your abdominal muscles to control your pelvis: lying leg raises (video demo: https://www.youtube.com/watch?v=JB2oyawG9KI).

      You start by lying on the floor. You can put a very thing tower under your lower back or just slide some fingers under, like you’d do with the stick. Now, you have your legs up in the air. Brace your abdominals and lower your legs slowly, until you start to lose contact at the lower back area. Then go back up again.

      Since you’d be using this exercise to learn motor control of the abdominals it’s ok to bend your legs so that the exercise becomes easier. Work towards extending your legs and then work towards going all the way down until your heels touch the floor, WITHOUT your lower back coming off the towel/your fingers. Notice the tension in your abs. That’s the feeling you need to imitate during the RDLs.

      Let me know how it goes :-)

  12. Julian Morgan says

    Hi Martin,
    I’ve been struggling with tendonitis for two years now, and i just started doing some physiotherapy to strengthen my tendon, I am about to start college and I’m looking forward to playing for my college team, and there is a limited time for me because the season starts in October and i need to be fully recovered by that time, what do you think i should do right now and do you have any exercises you can recommend for me?

    • Martin Koban says

      Hey Julian,

      You’ve had tendonitis for two years, so there’s no chance in hell you’ll get rid of it completely in 2 months. My recommendation for you would be to sit the next season out and focus on strengthening your tendon first, before you play.

      Either way, you should concentrate on very slow strength training for your legs, like slow squats, slow smith machine, or slow leg press (3 to 5 seconds eccentric, 3 to 5 second concentric). Start with two sessions per week (3 sets of 10 reps) and adjust the weight when your pain goes down.

      Additionally, do the self-massage religiously and stretch your calves and hamstrings (quads as well, if it doesn’t increase pain).

      Don’t forget to train your glutes and posterior chain.

      Good luck with your training and the season.

  13. Andrea says

    Hi Martin – I’ve been diagnosed with quadricep tendonitis (in both legs), and have suffered this pain for about 2 years now. I’ve played netball and done a lot of cycling/running/triathlons in the past, but even now with a COMPLETELY reduced fitness regime, I’m no better. I’ve had cortisone in both quads with little results.

    Like all the other posters, I’m incredibly frustrated with the lingering pain and haven’t had any tangible benefits from the many physios, osteos, sports doctors I’ve seen. I’ve given up on them.

    Have you any experience with a quadricep tendonitis diagnosis? I have been doing some of the stretches (achilles, calf, etc.) you have suggested and I feel like they’re making a difference. I am getting a slant board soon to try also…

    Do you think there’s any point in me following your exercises or the ‘training program’ outlined here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/table/T2/

    Or should I be focussing on something else? Any suggestions are welcome!

    • Martin Koban says

      Hey Andrea,

      Quad tendonitis and patellar tendonitis are very similar in terms of causes and required approach for recovery. You may still have to adapt the training to your individual needs by dropping or modifying exercises that cause pain.

      I wouldn’t advise going on the training program you linked for two reasons:

      Reason #1: It will have you do eccentric exercises twice per day.

      That’s the volume that was originally used in 1998. That training volume may be much too high for you.

      In my book I recommend people start with 3 sessions per week and 3 sets of 10 reps per session (of very slow eccentric squats). I used a similar frequency myself and newer academic research also points towards this frequency being more reasonable than training twice per day.

      Reason #2: It has a too optimistic timetable

      Personally, I’d rather take 3-times the amount of time and make sure that my tendon has healed properly rather than trying to stick to an optimistic timetable like that.

      The timetable basically suggests that your recovery should stick a certain schedule, but that’s not going to be the case, so you’ll either end up frustrated or moving along too quickly.

      Focus on the strengthening your legs with very slow strength training (like the eccentric squats). Slow strength training stimulates collagen synthesis and should lead to your body repairing the damage, unless there are other problems.

      Lastly: depending on how long in the past the cortisone shot has been, you may be at higher risk of soft-tissue injuries. Corticosteroids and NSAIDs impede soft-tissue healing, which is why you should only take them if absolutely necessary.

  14. Sam says

    I’ve been struggling with tendonitis for about a year now. It started during cross country season. As the coach, I often run with the kids. After the season, I took some time off and noticed that my knee never healed up. I recently purchased the flex-n-go board and have been following your recovery program from your book for the past two weeks. I realize the process of strengthening my tendon will take a considerable amount of time, so I will keep working on the program. One question that I have for you concerns the use of kettlebells. As long as my pain scores are low enough, would you recommend exercises such as swings, snatches, or single leg deadlifts and when would you recommend starting a simple program. As I recently had hernia surgery, I am taking a few months off before I would start training again. Thanks Martin.

    • Martin Koban says

      Hey Sam,

      I’ve done a ton of kettlebell training and it never bothered my knee in the slightest. All those exercises place most of the load on the posterior chain, which is why I consider them safe for people with patellar tendonitis.

      However, I did have two readers tell me that single-leg deadlifts increased their pain again. Granted, this may have been due to improper execution, but I’d still be careful when introducing these exercises. Always maintain a vertical shin (i.e., no squat-style swings).

      So my advice is to try it carefully and see what happens. My guess is that it’ll be ok to do.

  15. Stuart Box says

    I am 69 and had Patellar Tendonitis for at least eight years and your exercises I think are working.
    It would be nice just to go out for a long walk and come home with no pain.
    So thank you but I will not over do it.
    Regards Stuart

  16. Austin says

    I am 16 years old and have had tendonitis for about 5 months. Originally last year I pulled my left hamstring. I continued playing on it until it got bad, and went to PT for rehab. Eventually it healed and this spring I felt good as new ready to get back when I began feeling pain under my knees. I thought nothing of it continuing my baseball workouts, sprints, jumping, etc. until it got worse. I skipped playing baseball and decided tennis would be a better sport to play. Every single practice I came home barely able to walk, knees killing. By the end of the season I decided to quit and go to PT to see what it was. Unfortunately the damage had been done. I’ve been going to PT for about 3 months, and have seen incredible progression, but the pain is still there and I am timid to get back into sports. I’m so mad at the world for this injury, it’s pathetic, and this tendonitis has really done me in. When my tendons heal completely, will I be more prone to injury afterward? Can I ever get back to the physical state I was in last year?

    • Martin Koban says

      Hey Austin,

      Sorry to have to say this, but the only person you can be mad at is yourself for ignoring this problem and not “the world” :-(

      It sounds like you’re in a better state of mind now than you were when you first had this problem, at least you know to take it seriously. If you’re still working with your physical therapist, talk to them about heavy slow resistance training for tendonitis. You can point them towards this research paper: http://www.ncbi.nlm.nih.gov/pubmed/19793213 (there’s more research on this training modality for tendonitis already).

      In a nutshell, heavy-slow resistance training requires you to work the knee extensors with higher loads and slow repetitions (at least 3 seconds per concentric and another 3 seconds per eccentric).

      In my opinion it is possible to heal tendons back to their original tensile strength, but depending on the severity of the injury, it may take a long time, a lot of training, and using additional treatment modalities may be necessary (professional soft-tissue treatment, deep tissue laser treatment, etc.). The important point is to keep working towards this goal, even through the journey will be frustrating.

  17. Fred Lowe says

    Hi Martin,

    As a keen squash player with Patellar Tendonitis, I’ve been following your protocol(the book has been great!) and I’m pleased to say I’ve been making progress to the point that I was walking pain free, stairs were no longer an issue and I was looking to start eccentric exercises with the weights that you suggested.

    However I decided I could play tennis at the weekend(making error #3 that you describe!) and I caused a reaction – soreness, pain walking up and downstairs etc by doing so……its calming down now(3 days later). Question now is do I continue with the position I was at or do I need to revert back to the earlier phase in the protocol?


    • Martin Koban says

      Hey Fred,

      Sorry to hear about that setback. These things happen.

      About your question: you’ll have to see how your body reacts. Based on what you wrote I’d assume that going back to where you where in your rehab will be fine, but you really have to test this and see how your body reacts.

      Good luck :-)

    • Fred Lowe says

      Just by way of an update and to give others hope…..nearly another 3 weeks further on, and with no major flare ups the tendon is improving day by day. I look back at my diary and the difference between my knee a month ago and now is significant. Still going to be at least another month before I look to play some gentle squash but I can now see the end….just! :) Thanks Martin!

      • Martin Koban says

        Hey Fred,

        That’s really great news! Progress with this injury is slow and having to adapt your training can be challenging, but it’s worth it in the end.

        Good job on your healing!

  18. Mark styles says


    Thank you for the advise so far.

    I have been diagnosed with this and just want to get your thoughts. I have had this for about 4 months. I am a triathlete and was putting lots of work in on the bike. My knee starting hurting during some sessions and then ached for a long time after each session. I have now been resting for 3 months but still get aches a lot each day in the knee. Could this be anything else. I have stopped biking and running and now only swim.


    • Martin Koban says

      Hey Mark, yes it definitely “could” be something else, but with what little information I have I could only guess. I’m afraid you’ll have to go to your doctor to get a precise diagnosis.

      My speculation is that you’ve caused some cellular damage to your tendon while you were still biking and running, so now you’re experiencing the pain as a result of that. However, that’s just speculation and you should definitely get it checked out by a doctor.

      If you decide against seeing a doctor, you could try eccentric strengthening to see how your knee reacts.

  19. Rachael Palmer says

    I’ve play roller derby competitively for the last 2.5 years (which involves lots of explosive movements and squats). I’ve been struggling with patella tendonitis for approx a year and a half. It started on my right knee and disappeared for a while after some physio. It’s come back on my left knee and right knee. Aches most of the time and hurts when my quads contract. It’s never been extremely painful and I’ve still been able to skate which has made it more difficult to rest (and quantify pain levels to see a definite improvement). I’m now taking time out and doing all these exercises, including eccentric squats which I’ve just started. Hoping to see some improvement for next season.