Patellar Tendonitis Treatment: Do You Know These Secrets?

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

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

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


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

Treatment with Anti-Inflammatories like Ibuprofen Often Makes Patellar Tendonitis Worse

Did you take anti-inflammatories for your patellar tendonitis? Bad news: you may have made things worse!

According to Australian researcher Dr. Jill Cook, using non-steroidal anti-inflammatories such as ibuprofen can be a treatment option in the early stages of tendonitis, but it slows tendon repair once your injury has become chronic (Cook, Purdam 2009, p. 413).

In other words, if you have the pain for the very first time in your life and it hasn’t lasted longer than two or three weeks, you may use anti-inflammatories to treat your patellar tendonitis. You have to stop your training during that time and take a few weeks to ease back into it after your treatment has concluded.

Ibuprofen slows healing from chronic patellar tendonitisBUT, if you’ve already had patellar tendonitis several times in the past or you’ve been in pain for more than a month, you’ve progressed into the chronic injury stage and academic research says that taking Ibuprofen or other NSAIDs will slow down your healing (or even prevent healing altogether).

Anti-inflammatories slow down soft-tissue adaptation, which means it takes your tendons longer to grow stronger in response to physical training or rehab exercises. Consequently, your risk of soft-tissue injuries such as tendonitis increases when you’re taking anti-inflammatories.

Key Takeaways:

  • Ibuprofen and other NSAIDs slow recovery from chronic patellar tendonitis
  • NEVER, EVER, EVER (!!), do intense training while on Ibuprofen or other NSAIDs
  • Talk to your doctor about treating your patellar tendonitis without NSAIDs

 

Even With the Best Exercise Program, Full Recovery Takes Months

It took me a long time to understand that even with the very best exercise program full recovery still takes months. I’m not talking about being mostly pain-free. I’m talking about being completely pain-free and stronger than before your injury. Here’s why it takes so long.

In chronic patellar tendonitis, the fibers inside your patellar tendon are out of alignment, which decreases the amount of force the tendon can handle. It’s like the threads of steel cable that has become frayed.

Bad fiber alignment happened through a combination of excessive ballistic load (jumping and running), training too often, and bad motor control. To recover, you need to stop all activities that cause overload, go on a treatment plan based on slow strengthening exercises (more on that in a moment), and leave enough rest days between your rehab training.

The tendon heals in response to your rehab training: it grows stronger after the exercise, not during. If you interrupt this adaptation process by training again too soon, you will prevent healing.

How fast your tendon recovers is determined at the cellular level. You can influence this speed through your diet, lifestyle, and even medication. You can’t force faster healing by doing your treatment exercises and stretches very often or massaging your muscles more aggressively.

The collagen fiber alignment inside your patellar tendon normalizes over MONTHS in response to slow strength training exercises. The stretches and massage merely help to reduce excess stress, which prevents more damage, but they don’t actually heal the tendon directly.

Key Takeaways:

  • Rest alone will not heal chronic patellar tendonitis.
  • Slow strengthening exercises stimulate healing in your patellar tendon.
  • Successful treatment for full recovery requires the right combination of training and rest.
  • Stretching and self-massage help reduce excess stress on the tendon.
  • You CANNOT force faster healing by doing the rehab exercises very often or very aggressively.

 

For Fastest Healing, Progress Slower Than You Feel Comfortable

Readers often ask me how much time it takes to recover from patellar tendonitis. After years of helping people with this injury, I know that if this is the first question on your mind, your treatment will take longer. Here’s why.

If you’re in a hurry to get rid of patellar tendonitis, you won’t give your body enough time to heal. As soon as your pain goes down, you’ll rush back into your sport and pain will promptly return. I made that mistake myself and after helping people with patellar tendonitis for many years, I know that it happens to almost everyone.

The vicious cycle of interrupted patellar tendonitis treatment

The vicious cycle of interrupted patellar tendonitis treatment

The longer you stay in this vicious cycle, the more chronic your injury will become and the longer it will ultimately take to get rid of the pain. To break free from pain, you must be patient with your knees.

Key Takeaways

If you rush back into being active, you will cause setbacks and add months to your healing time. Get comfortable with the idea that treating your patellar tendonitis is a challenge you have to master before you’re safe to go back to enjoying your sport.

  • Only add 1 or 2 repetitions to your eccentric strengthening training each week
  • Don’t skip the rest days of your treatment plan
  • Do more demanding exercises ONLY when you’re pain-free or almost pain-free at your current training level

 

Don’t Trust Your Pain

Academic research showed that in tendonitis, tissue damage occurs before you feel pain (Huisman et al. 2013; Khan et al. 1998, p. 351). In fact, of tendons so degenerated that they’re close to rupture, two thirds were still pain-free (Kannus, Józsa 1991).

I can’t emphasize enough how important understanding this scientific fact is: being pain-free doesn’t mean your patellar tendon is healthy or strong enough for your sport! You MUST NOT trust your pain.

Instead, only use pain as an indicator to find a combination of treatment exercises and rest days that allows you to reduce pain from week to week. Next, you continue with the same slow progression until your pain is completely gone.

Finally, continue the same slow progression even further for at least a month or two after pain has already disappeared to make sure your tendon is strong enough for your return to sports. Return to your sport at a very low intensity and make sure to leave at least 3 rest days in between training sessions that are tough on your knees, because that’s how long it will take your tendon to adapt.

Key Takeaways:

  • Just because your tendon is pain-free doesn’t mean it’s strong enough for your sport.
  • Use your pain to optimize the intensity of your rehab exercises.
  • Continue your safe strengthening training for at least a month after pain is completely gone.

 

How to Treat Patellar Tendonitis (Summary)

In summary, to treat patellar tendonitis, you need to stop all activities that overload your tendon, such as running or jumping. After taking a week or two of rest, you can begin with slow strengthening exercises such as slow squats, if you’re in the chronic stage.

To prevent patellar tendonitis from coming back, you need to work on problem areas in your body such as ankle mobility, hip mobility, strength of your gluteal muscles, as well as motor control.

From my experience, I know that you probably haven’t heard about these hidden problems before, which may be the reason why you’re still struggling with patellar tendonitis.

To help you get rid of your pain, I share the exercises you need to do to fix these hidden problems in detail in my free email course on patellar tendonitis. I’ll also send you the two most important chapters of my book Beating Patellar Tendonitis as a gift.

Start healing your knees today: Get free instant access to my best treatment exercises for patellar tendonitis.

  – Martin Koban

Show Citations
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.

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.

Image Credit: Ice cream man, Happy Pill 2

Comments

  1. Pontus Modig says

    Hi Martin! Very interesting video.
    I have a question regarding that too much rest can neglect your healing of patellar tendonitis.
    3-4 times a week I do eccentric squats 3 sets and 10 repetitions and all those exercises in your book ‘Beating Patellar Tendonitis’ but after 5 weeks the pain score has not decreased. Before the injury I had a very active lifestyle and trained a lot but now I find little joy and are too often angry.
    My schedule of the week consist of 5 days of working at lunch restaurant were i stand and serve food to customers. At this time my when i’m stand somewhat still the pain score is the worst.
    But at afternoon the pain decreases.
    The pain score is lowest on the weekends. Since I’m not training like I used to do, spare time comprises of sitting in front of my computer or PS3 and not much anything else.

    The Question:
    What is too much rest? Am I an example of too much rest?
    Should you take several walks outside or something else?
    Where do i find the balance so my knees can heal.

    Would be grateful for an answer.

    • Martin Koban says

      Hello Pontus,

      You’re definitely not an example of too much rest. On the contrary, you may be doing too much. Moving forward, you should try doing the eccentric training only twice per week. If that doesn’t help you decrease pain, stop doing the eccentric squats and work with isometric wall sits (sit against a wall with your thigh parallel to the ground and your shin vertical) for two weeks. Do 2 to 3 sets of 30 to 60 seconds per day and see how that works for you.

      Also, make sure you’re massing your quads and hips daily. If you can stretch your quads.

      Observe how you stand at work. Are your knees hyperextended? Are your knees always slightly flexed? Each case has their own problems and it starts with working on your hip.

  2. Eleanor Shamowski says

    Hi just wanted to tell you I knee replacement and had fallen had another surgery I was doing ok then developed problems with my knee . doctor prescribed my breg brace that’s what I`m wearing now. would the exercise help me? I`m 77 years old and have RA and osteoartheritis .

    • Martin Koban says

      Dear Eleanor,

      For osteoarthritis, look into the supplement MoveFree. For rheumatoid arthritis, autoimmune problems need to be addressed. This is a huge topic that starts with getting rid of foods you don’t tolerate well (could be grains, dairy, fish, soy, or others) and optimizing sleep quality (no TV in the evening, pitch-black bedroom, no cellphones in the bedroom etc..). Combined with the MoveFree supplement and maybe a liquid fish oil supplement, it’s your best natural and non-invasive option.

      You also need to modify all exercises so they don’t aggravate your arthritis. Reduce range of motion and intensity appropriately.

      – Martin

  3. Daniel says

    Hi Martin
    I’ve had patella tendinitis for about five years now (extremely frustrating) and found I’ve given up with all exercise ( even more frustrating ) as all seems to give me pain . The pain is there mainly constant , even with no exercise so I never seem to be pain free to be able to start strength training . There seems no logic to it as even when there’s a day with no pain the pain will return for no reason . Should I start with massage and is this ok to do every day.
    Many thanks
    Daniel.

    • Martin Koban says

      Hey Daniel,

      The massage is safe for everyone except those with muscle injuries in the quads (which I don’t think applies to you), so you can definitely do it twice per day.

      Also, you may want to check into ASTYM treatment for scar tissue removal from your patellar tendon. It has helped some of my readers that were dealing with stubborn patellar tendonitis in the past and it’s certainly worth a try after 5 years. Go here to learn more: http://astym.com/Main // additionally (or alternatively, if there’s no ASTYM person in your area), find an SFMA-certified healthcare professional. They can help you find and fix movement dysfunctions that contribute to patellar tendonitis (you can find them here: http://www.functionalmovement.com/experts – be sure to select SFMA-certified).

      – Martin

  4. Roy says

    I was diagnosed with this about 5 or so years ago. Recently I’m having more flair ups. I play the drums and can’t find much information in relation to that, however I’m not sure what makes mine kick in. I work every weekend and have always worked through it. The last couple times I had to I was literally in total pain, my whole leg felt like it was on fire.

    I also have Plantar Fasciitis, which doesn’t help.

    Playing the drums, it’s mainly the foot against the bass drum pedal. I play with my heel up and come down on the pedal on the ball of my foot. People play with different techniques, but I pretty much use my whole leg. Some swivel their ankle, which I’ve never been able to do.

    I’m trying to find a way to accommodate for PT and figure out how to lessen my chances of it flaring up, and of course, having it not happen at all. I need to work! Thanks!

    • Martin Koban says

      Hey Roy,

      Sounds like you’re creating constant tension in your quads and patellar tendon (by holding the heel up). First things I’d try if I were you are thorough self-massage of the quads with a stick and stretching the quads.

      Since you mentioned plantar fasciitis, you have to check out this infographic I created after researching the causes of the three most common leg injuries (knee pain, plantar fasciitis, ankle injuries): http://www.fix-knee-pain.com/unbreakable/

      This article has several exercises and stretches you can use.

  5. Maree Sargeant says

    I have patellar tendonitis in both knees Have 2 total knee replacements. The pain goes away then returns Can I have the patellar strapped I think my kneecap is fixed I am doing strength training with not much progress this time Very frustrating because I cannot exercise
    Regards Maree

  6. Emily says

    Hi Martin,

    I’m so glad I found your website! I have been struggling with patellar tendinitis for 1,5 years but was misdiagnosed until a month ago. That was very frustrating for me since my rehab until now has been all wrong (long rest, attempted running, new pain and more rest, a slow return to running, aching). I finally got a second opinion, and the ultrasound showed that my patellar tendon was thickened on the injured side. The doc also talked me into a cortisone shot.

    Your reminder to not trust my pain really resonates with me. I was able to, after all of my resting, make a SLOW return to running (couch to 5K) without any pain while running. But after 3 months of building up to it, I started regularly running 4 km 2-3 times per week. Then I started noticing minor aching in my bad knee – not when I was running but at rest. That’s when I got my second opinion and diagnosis of patellar tendonitis.

    I’m 25, and originally not an active person (got injured after a long downhill while backpacking for the first time in years). My goal is to be able to backpack again, and train for it by running. But I got so discouraged when I got my ultrasound results – I had no pain to speak of but still a thickened tendon! And a new diagnosis after 1,5 years – what a waste of time and effort.

    My question – is there any hope for me? Have I completely sabotaged my chances for recovery by alternating rest and training?

    Thank you for all of your hard work on your website and course! I’m looking forward to training with you. -Emily

  7. David C says

    Hello Martin,

    Fisrt thing, thanks for being there sharing the progress and process of knee improvements. I have some questions regarding the excercises and what do to with some of them exactly because I really want to heal it 100%.

    Will I do the slanted board squads excercise every day eventually? or probably do the excercise with the ball on the wall and legs 90° in between the squats? I know, Right amount of training at just the right intervals. Just asking to know for the near future. I am taking days off in between the excercises these weeks.

    I am not adding pressure to the knee these weeks but I feel I put pressure in my knee by standing on them while doing a lower back excercise. There is cushion htough.
    I do the stretching for the quad in the chair, general massage and the foam roller for now. I am wondering if it is ok to do the the squads in the board feeling a little bit of pain. And also if I am allow to swimm to strength muscles during those weeks as well. Swimming is really good for the body in general.

    Thank you

  8. Gavyn says

    Hey I am 16 and play high school basketball. I am almost 6’5″. I am now a junior and I have had knee trouble since 7th grade. I am pretty confident tendonitis is my problem, but I don’t know what to do. My team works out, and I try to rest a while. Once my knees feel good, I start to work out my legs again, but it only increases my pain and I have to rest. Also, I can feel fine, but once I try to dunk, my knees feel intense pain for several days. Should I keep going to work out or should I avoid all leg exercises? I don’t want to skip out, but I get the feeling I have to do so.

    • Martin Koban says

      Hi Gavyn,

      In your situation, growth spurts likely contributed to your issue so until all growth is over, the problem may reoccur regardless of what you do. The safest route you can take is to avoid high intensity exercises until your knee feels significantly better. In the meantime, you can use self-massage and isometric exercises for your quads to strengthen the tendon.

  9. Jonathan says

    Hello Martin,

    I originally came to your website with patellar tendonitis and have basically healed my knees however I have a similar chronic ankle pain from the medial ankle ligaments on my right ankle. I was wondering if you knew any exercise I could do that would use the same philosophy as your knee pain program and the eccentric squat. I have had the ankle pain for about 3 years now, any help would be much appreciated.

    Thank you,
    Jonathan

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