Today I’m going to show you how you can heal your patellar tendon.
We’ll cover the how, the why, and the what-ifs, with a new video I shot just to share with you today.
Let’s recap what we did so far.
In step #1, you released tension from your quadriceps muscle by applying the stick massage. This “feeds slack” to the patellar tendon, which releases pain and allows healing.
In step #2, you learned about 5 roadblocks that will prevent healing, unless you’re aware of them. Without this rare knowledge, any attempts at healing would be useless, which is why it’s worth Millions for professional athletes.
Today, I’ll show you the exact exercise academic research found to be as effective as tendon surgery for healing and I will tell you everything you need to know about its proper application, to get you started.
Let’s go!
I want to help you get rid of your knee pain so you can go back to being active the way you want. I’ll share other techniques for faster healing in future emails. So keep an eye on your inbox.
If you want to learn everything I discovered about healing knee pain and want to work with me directly, you need to enroll in my Total Knee Health video course when I next open enrollment. I’ll tell you more about it in the future.
Until next time,
Martin Koban
Frequently Asked Questions
What can I do if eccentric squats are painful?
To make the exercise easier, do isometric wall sits instead. Sit against a wall with 90-degree angle between your hamstrings and calves. Hold for 30 to 60 seconds. Repeat 2 to 3 times per day, unless it increases pain.
When can I use weight or do the single-leg version?
Write down your pain scores every day at the same time. Use your pain scores as guidance for adjusting your training. Once your knees tolerate a certain number of weekly repetitions, increase it slowly by no more than 10% per week.
Once you can do 5 sets of 15 of the two-legged variation without an increase in pain, you can try progressing to using a little weight (start slowly!) or transition to placing more weight on one leg.
How long will it take until I can get back to [insert sport]?
Expect a minimum time off from sports of at least 2 to 3 months. That’s the absolute bare minimum for repairing a damaged tendon. More advanced cases will take longer.
Remember that if you don’t fix hidden biomechanical causes for patellar tendonitis, pain will always come back.
How can I heal as fast as possible?
As counter-intuitive as it sounds, progressing slowly through your rehab is the fastest way to heal patellar tendonitis. This is because pushing too hard will cause setbacks that add more weeks or even months to your recovery time.
I’ve written more about this here: https://www.fix-knee-pain.com/patellar-tendonitis-treatment/
How can I prevent pain from coming back?
Do two things:
1) Increase the stress you place on your knee very slowly, probably slower than you feel is comfortable or needed for safety. This applies for progressing the eccentric squats, but it also applies to transitioning from rehab back to training.
So if you are a runner for example, start with one short run of low intensity per week and build up from there. You’re looking for a minimum level of training that you can do safely and once you have that, stay at that level for a few weeks to let your body adapt. Only then should you increase the training variables one at a time (i.e., more miles at same speed or same mileage at higher speed, but not more miles at higher speed).
2) Keep working on the hidden biomechanical causes for patellar tendon overload. I’ll share more on this in future emails, because I don’t want to give you more information than necessary at this point. We’ll get to those things, I promise, but right now, working with what I shared so far is all you need.
Do I really need a slanted board?
In my own experience, doing slow squats on even ground works as well. My understanding of the science and the changes inside the tendon is that as long as the movement is very slow, the type of exercise you use to load the patellar tendon is less important.
For example, the setter of the German National Team told me that she found slow leg extensions beneficial for reducing the pain. Also, recent research showed that heavy slow resistance training with heavy squat-type movements also compared well to eccentric squats.
But a slanted board is still extremely useful for stretching your calves and for adapting ankle mobility drills for patellar tendonitis. Tight calves and lack of ankle mobility are two other biomechanical causes for patellar tendonitis.
I recommend the slanted boards made by Flex-N-Go.com. I feel very safe on them, which is important to me since the one I had before broke while I was exercising on it.
How many repetitions should I do?
Three to four times per week, do the eccentric squats on a slanted board. Start with the two-legged variation and do 3 sets of 10 repetitions. Work your way up to at least 5 sets of 15 repetitions before progressing to the single-leg variation.
My knees cave to the inside/outside. What should I do?
If your knees cave to the inside, squat with an elastic band around your thighs, just above your knee. We’ll do other corrective exercises for this problem in future emails.
If your knees cave to the outside, place a rolled-up blanket between your knees and hold it in place with your knees as you squat. Your knees should be in alignment above your toes as you do this.
You can also activate the required muscles while standing. Look down at your knees and consciously rotate them so the point towards the midline of the body and to the outside. You’ll feel muscles in your hip working. If your knees normally point to the inside, rotate them to the outside and hold for a few seconds. Repeat as needed. Do the opposite for knees that point to the outside.
Academic Research
Alfredson, H.; Pietilä, 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.
Andres, Brett M.; Murrell, George A. C. (2008): Treatment of tendinopathy: what works, what does not, and what is on the horizon. In Clin. Orthop. Relat. Res. 466 (7), pp. 1539–1554. DOI: 10.1007/s11999-008-0260-1.
Jonsson, P. (2005): Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. In British Journal of Sports Medicine 39 (11), pp. 847–850. DOI: 10.1136/bjsm.2005.018630.
Larsson, Maria E. H.; Käll, Ingela; Nilsson-Helander, Katarina (2012): Treatment of patellar tendinopathy—a systematic review of randomized controlled trials. In Knee Surg Sports Traumatol Arthrosc 20 (8), pp. 1632–1646. DOI: 10.1007/s00167-011-1825-1.
Purdam, C. R. (2004): A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy. In British Journal of Sports Medicine 38 (4), pp. 395–397. DOI: 10.1136/bjsm.2003.000053.
Tan, Suan Cheng; Chan, Otto (2008): Achilles and patellar tendinopathy: Current understanding of pathophysiology and management. In Disabil Rehabil 30 (20-22), pp. 1608–1615. DOI: 10.1080/09638280701792268.
van Usen, Carla; Pumberger, Barbara (2007): Effectiveness of Eccentric Exercises in the Management of Chronic Achilles Tendinosis. In The Internet Journal of Allied Health Sciences and Practice 5 (2). Available online at http://ijahsp.nova.edu/articles/vol5num2/van_Usen.pdf.
Young, M. A. (2005): Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. In British Journal of Sports Medicine 39 (2), pp. 102–105. DOI: 10.1136/bjsm.2003.010587.