(Click here to listen to the interview I mentioned. It starts at around 5:50 minutes in.)
This video is about the exercises I recommended to help former NBA player Boki Nachbar go from very bad tendonitis to feeling “95% better” in just one off-season. He even won an MVP award soon after.
I’m going to show you the exact exercises we used and how you can do the same thing at home. No fancy gyms, no crazy equipment necessary. Think about it:
This approach worked for someone who’d been on those hardwood courts for 17 brutal years, through seasons of running, cutting, and jumping, game after game, night after night. If this can work for a guy who put his knees through the kind of punishment that only professional athletes know—years and years of it—then I’m telling you, this WILL work for you, too.
I’m also going to let you in on one of the biggest breakthroughs I discovered while reading research to update my Tough Tendons course. It’s a game-changer, plain and simple, but first, let’s focus on strengthening those tendons.
Here’s How It Works
Patellar tendonitis is an overuse injury of the patellar tendon. This tendon connects your kneecap to your shinbone, so you use it thousands of times per day. Every time you straighten the knee, whenever you run, jump, kick, or squat.
Now here’s the reason why resting doesn’t fix tendonitis.
The tendon is made out of tiny collagen fibers. Like the strands that make up a rope, these collagen fibers bear the load whenever you put force on the tendon, but in chronic tendonitis, the fibers in some parts of the tendon are longer well aligned.
Instead, they’re more like a worn, heavily used, old rope with frayed, disorganized areas.
And these changes make the tendon weaker, and a weaker tendon makes future overuse more likely.
The problem is that resting doesn’t fix this collagen misalignment problem. Resting usually reduces pain, sometimes even to zero, but it will not fix collagen misalignment, so it will not fix a weak tendon.
That’s why, if you use resting to get better, you may get rid of pain, but as soon as go back to running, jumping, or even just hiking, you will overload the tendon again and pain will come back.
That’s why resting doesn’t work. Instead, we need to find a way to strengthen the tendon by fixing collagen misalignment. The best way to do that is with slow strengthening exercises.
Tendons absolutely love slow training. Research has shown this to be true again and again.
All you need to do, is find an exercise that allows you to put force on the tendon, for a long duration, we’re talking at least 5 seconds per repetition and at the very minimum, 4 minutes of total time under tension per training session.
If you’re a professional athlete like Boki Nachbar, you can use slow leg presses or slow leg extensions. You can also hold the weight in place to do isometric holds. Studies show this can reduce pain in professional athletes even DURING the season.
At home you can do similar exercises that work just as well by doing wall sits or Spanish squats. In a wall sit you’re sitting against a wall, with your knees at an angle. The lower you go, the more difficult it will be. In Spanish squats, you need a strap to pull against your calves. Again, the lower you go, the more difficult it will be.
A good starting point is 5 sets of 45 second holds, done every other day.
And by the way, research says having a small amount of pain during these exercises is okay. Now let’s get to my big breakthrough.
Every couple of years I read the new research about patellar tendonitis to update my Tough Tendons course. Last time I did this I discovered something very interesting.
When you start doing tendon exercises like the leg press or slow squats, one question will come up, no matter what: How much weight should you use? How heavy should you lift?
Here’s where this new study comes into play.
In it, researchers compared the rehab results of two groups. The first group did tendon exercises with heavy resistance. The second group only used medium resistance. To put some actual numbers on this, the heavy group used a weight they could only lift 4 times. In contrast, the medium resistance group used a weight they could theoretically lift 25 times. That’s a huge difference in terms of how hard you have to work to move the weight.
Here are the results of this study. In each measured category, the medium resistance group improved their pain levels just as much as the heavy resistance group. The researchers went on to conclude that that heavy resistance training showed “no superior effect”. That’s great news for 3 reasons.
First, it means you don’t have to kill yourself during training by working super hard. If you want to use heavier weights, you can do that, but you don’t have to.
Second, it also means you don’t have to increase resistance every week, as long as you’re training twice per week with at least 4+ minutes of time under tension, per training session.
And third, if you can’t use heavy weights, for whatever reason, you know that you can still get a great strengthening effect for your tendons with medium resistance.
I love that research is still making progress and giving us new facts, we can use, to make our tendon training even more effective. I was skeptical about this since I had already read close to 800 research papers when I first created the Tough Tendons course. That’s why I was so happy when I found this particular study.
To recap, you can start your tendon strengthening work with the leg press, the leg extension, wall sits, or Spanish squats, by doing 5 sets of 45 second holds, at a medium to high resistance. Train two or three times per week.
That’s the key part of the approach I recommended to Boki Nachbar and what helped him rebuild his tendons. It’s also the foundation for getting rid of tendonitis. Without this, you won’t make any lasting progress. Of course, there’s still a lot more you need to do to get your knees back to 100%, like eliminating setbacks by working on tendonitis risk factors, but that’s a topic for another day. For now, get started with the tendon exercises and do them twice per week. The rest comes later.
We’ll talk more soon.