Patellar Tendonitis Treatments That Actually Work


Setbacks, conflicting advice, and stagnation: The treatment for patellar tendonitis can be long and frustrating.

In this article I will show you which treatment options exist and how effective they are.

About The Author

My name is Martin Koban and I’ve been helping people with patellar tendonitis since 2011, after suffering through a serious case myself. I’ve worked with professional as well as recreational athletes and all my publications are 100% evidence-based.

Treatment Options for Patellar Tendonitis

Patellar tendonitis is an overuse injury of the patellar tendon and the longer the overuse continues, the more the injury progresses.

In the early injury stages resting and activity modification are often enough to achieve a full recovery, but if the knee has been painful for more than a few weeks a passive approach (i.e., doing nothing) is usually no longer enough to get rid of pain permanently.

The following treatment options exist.

Physical Therapy Exercises

Once patellar tendonitis has become chronic only a handful of treatments actually work [1]. The most effective approach is supported by decades of evidence in academic research:

Stimulating positive tendon adaptation through progressive loading with slow strengthening exercises [2].

Let’s take this concept apart so that you can understand how to use it with your physical therapy exercises. We’re going to talk about the specific exercises in a moment.

Positive tendon adaptation happens when you do an exercise that is not too light and not too heavy for how strong your tendon is at the time. You also need to do the right number of repetitions and you have to leave a certain number of rest days in between these workouts.

Negative tendon adaptation happens when you rest for long periods of time [3] or – arguably worse – use too heavy weights, do too many repetitions, or train too often.

Progressive loading means you need to increase the resistance and volume you expose your tendon to in safe increments. Put differently, you need to do heavier exercises as your knees permit. This is necessary so that the adaptation process continues to the point where your knees are strong enough for your sport.

Slow strengthening exercises are those exercises that can be executed slowly, thereby allowing you to safely place the tendon under a long time under tension.

In other words, the training variables (resistance, volume, and training frequency) need to be within what your tendon can handle at the time. Once established you can then carefully increase resistance and volume in increments that your knee can tolerate.

Which treatment exercises work for patellar tendonitis?

Through my books and courses I’ve been helped thousands of people get rid of their tendonitis and the exercises that have worked best for this particular purpose are:

  • The slow squat [4]
  • The slow leg press
  • Holds on the leg extension machine [5] (isometric)
  • Wall Sits (isometric)
  • The Spanish Squat (isometric)
The best treatment exercises: slow squat, slow leg press, leg extension holds, and wall sits.

The follow-up question to this list usually is “which exercise works best?” But there is no one exercise that works perfectly for everyone [6]. Usually starting with isometric exercises works well, but I’ve also had people that only made progress with the slow squat. Just like some folks did well on the leg press while others couldn’t get it to work for them.

One thing is sure though:

Plyometrics and explosive lifting are not useful in the first two treatment stages [7] because the time under tension is too low and the force on the tendon is too high.

You also want to avoid all exercises and movements that cause tendon irritation. Risk factors for tendon irritation include deep knee flexion, forward knee movement, and direct pressure on the tendon like you get when you’re kneeling.

Patellar tendonitis stretches can also cause irritation if the tendon is not yet strong enough. In that case stretching needs to wait until the tendon can handle it.

Your treatment plan can also benefit from self-massage to reduce muscle tension. Improving movement mechanics through biomechanical exercises is beneficial [8] for preventing pain from coming back in the future.

Other Treatment Options

If you’ve had patellar tendonitis for more than a few weeks, chances are you’ll look for what else you can do, other than exercises. There has to be a faster way to get back into sports, right?

This desire for a shortcut contributed to the development of a large number of adjunct treatments for patellar tendonitis. Unfortunately most of them are not supported by strong evidence in academic research [9]. Here’s the list:

Icing can be useful for pain management, especially during flare-ups, but didn’t show long-term treatment benefits [10]

Patellar tendon straps can also be used for short-term pain reduction [11], but they don’t deliver long-term improvements

Ultrasound therapy provided inconsistent results [12] and has failed to provide any benefits in several studies [13]

Cortisone injections can lead to a short-term reduction of pain [14], but they increase risk of relapse [15] and over the long-term cause weaker tendons[16] that are more prone to tearing [17]

PRP injections showed little evidence of an effect greater than placebo injections [18]

Prolotherapy and dry-needling are also not supported by strong evidence [19]

Surgery is a last resort option for refractory cases of patellar tendonitis. Rehab time from surgery is 6 – 12 months, but long-term results in these cases are promising.

How much Treatment Time Can You Expect?

Recovery from patellar tendonitis can happen in just 4 weeks, but it can also take up to 12 months and even more.

The treatment time depends on several factors including how far the injury has progressed and how well you can solve the many problems that happen during treatment, as it’s not a straight-forward process.

In fact, you’ll often read about people that have suffered from patellar tendonitis for years. However, if you do the right things at the right time and avoid costly mistakes you can shorten your recovery time by several months.

While we’re on the topic of mistakes, here’s probably the biggest one:

Running or cycling during treatment?

It sucks if pain side-lines you from your sport and as an athlete I understand why so many people train through pain. I’ve done it myself so many years ago.

And yet training through pain is one of the major reasons why treatment often takes much longer than necessary. If running or cycling are causing pain, you need to put these activities on hold until your knees are strong enough to tolerate them without a pain response. Here’s a video about this:

Patellar Tendonitis Treatment PDF Download

Click here to download a PDF of this article about exercises and treatment options. Or better yet, keep in touch with me. Here’s how:

Complete Recovery in 4 Weeks?

Some of the people I worked with were able to get back into sports without pain after just 4 weeks. These results are not typical of course, but if you want to recover as quickly as possible you need to use the right treatment strategy right away.

I want to help you with that so I’ve put everything you need to know to get back to 100% into my free email course about patellar tendonitis. I’ll also send you my best future articles and videos to help you stay on target. Let’s do this together!

Back to sports in just 4 weeks?
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Dear Martin,

I just wanted to thank you very much for all your work in this field. I enjoyed your pattelar tendonitis book and your emails.

I’ve struggled with PT for 1 1/2 year now, but I’m now finally eyeing a return to my beloved soccer. Season starts in late august and I’m very hopefull that I’ll be able to play by then.

At this point I can run 5 km and do intervals without problems. I can also play soccer on my own in my garden for 10-15 mins without any pain. So I guess I’m close.
— Thomas C., Copenhagen”




[1] Peter Malliaras, Lower Limb Tendinopathy Course (London, 31.10.2016), pp. O5.[2] D. I. Clark et al., “Physiotherapy for anterior knee pain: a randomised controlled trial,” Annals of the rheumatic diseases 59, no. 9 (2000); L. J. Cannell, “A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper’s knee in athletes: pilot study,” British journal of sports medicine 35, no. 1 (2001); Peter Malliaras, Lower Limb Tendinopathy Course (London, 31.10.2016); Peter Malliaras, “That elusive biological magic bullet for tendinopathy,”, accessed September 2017.

[3] J. L. Cook and C. R. Purdam, “Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy,” British journal of sports medicine 43, no. 6 (2009): 409; E. Yamamoto, K. Hayashi, and N. Yamamoto, “Mechanical properties of collagen fascicles from stress-shielded patellar tendons in the rabbit,” Clinical biomechanics (Bristol, Avon) 14, no. 6 (1999); James H.-C. Wang, Qianping Guo, and Bin Li, “Tendon Biomechanics and Mechanobiology—A Minireview of Basic Concepts and Recent Advancements,” Journal of Hand Therapy 25, no. 2 (2012): 138; J. A. Hannafin et al., “Effect of stress deprivation and cyclic tensile loading on the material and morphologic properties of canine flexor digitorum profundus tendon: an in vitro study,” Journal of orthopaedic research : official publication of the Orthopaedic Research Society 13, no. 6 (1995); Yu-Long Sun et al., “Temporal response of canine flexor tendon to limb suspension,” Journal of applied physiology (Bethesda, Md. : 1985) 109, no. 6 (2010); F. R. Noyes, “Functional properties of knee ligaments and alterations induced by immobilization: a correlative biomechanical and histological study in primates,” Clinical orthopaedics and related research, no. 123 (1977); De Boer, Maarten D. et al., “Time course of muscular, neural and tendinous adaptations to 23 day unilateral lower-limb suspension in young men,” The Journal of physiology 583, no. 3 (2007): 1091.

[4] M. A. Young, “Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players,” British journal of sports medicine 39, no. 2 (2005).

[5] L. J. Cannell, “A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper’s knee in athletes: pilot study,” British journal of sports medicine 35, no. 1 (2001).

[6] Håvard Visnes and Roald Bahr, “The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes,” British journal of sports medicine 41, no. 4 (2007).

[7] Sebastian Bohm, Falk Mersmann, and Adamantios Arampatzis, “Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults,” Sports medicine – open 1, no. 1 (2015); Falk Mersmann et al., “Muscle and Tendon Adaptation in Adolescence: Elite Volleyball Athletes Compared to Untrained Boys and Girls,” Frontiers in Physiology 8 (2017).

[8] E. Witvrouw et al., “Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study,” The American journal of sports medicine 29, no. 2 (2001); Peter Malliaras et al., “Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations,” The Journal of orthopaedic and sports physical therapy 45, no. 11 (2015): 895; I. N. JANSSEN et al., “Predicting the Patellar Tendon Force Generated When Landing from a Jump,” Medicine & Science in Sports & Exercise 45, no. 5 (2013): 933.

[9] Peter Malliaras et al., “Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations,” The Journal of orthopaedic and sports physical therapy 45, no. 11 (2015): 894.

[10] P. Manias and D. Stasinopoulos, “A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy,” British journal of sports medicine 40, no. 1 (2006).

[11] A. de Vries et al., “Effect of patellar strap and sports tape on pain in patellar tendinopathy: A randomized controlled trial,” Scandinavian journal of medicine & science in sports 26, no. 10 (2016); Adam B. Rosen, Jupil Ko, and Cathleen N. Brown, “Single-limb landing biomechanics are altered and patellar tendinopathy related pain is reduced with acute infrapatellar strap application,” The Knee 24, no. 4 (2017); Gali Dar and Einat Mei-Dan, “Immediate effect of infrapatellar strap on pain and jump height in patellar tendinopathy among young athletes,” Prosthetics and Orthotics International 43, no. 1 (2018).

[12] Brett M. Andres and George A. C. Murrell, “Treatment of tendinopathy: what works, what does not, and what is on the horizon,” Clinical orthopaedics and related research 466, no. 7 (2008): 1542.

[13] Rachel Chester et al., “Eccentric calf muscle training compared with therapeutic ultrasound for chronic Achilles tendon pain–a pilot study,” Manual therapy 13, no. 6 (2008); S. J. Warden et al., “Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial,” Rheumatology (Oxford, England) 47, no. 4 (2008); Maria E. H. Larsson, Ingela Käll, and Katarina Nilsson-Helander, “Treatment of patellar tendinopathy—a systematic review of randomized controlled trials,” Knee Surgery, Sports Traumatology, Arthroscopy 20, no. 8 (2012): 1645.

[14] Brett M. Andres and George A. C. Murrell, “Treatment of tendinopathy: what works, what does not, and what is on the horizon,” Clinical orthopaedics and related research 466, no. 7 (2008): 1542.

[15] L. Bisset et al., “Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial,” BMJ 333, no. 7575 (2006); U. Fredberg et al., “Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper’s knee and Achilles tendinitis: a randomized, double-blind, placebo-controlled study,” Scandinavian journal of rheumatology 33, no. 2 (2004).

[16] M. Kongsgaard et al., “Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy,” Scandinavian journal of medicine & science in sports 19, no. 6 (2009); Brooke K. Coombes et al., “Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial,” JAMA 309, no. 5 (2013).

[17] Ronald Hugate et al., “The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons,” The Journal of bone and joint surgery. American volume 86-A, no. 4 (2004); Jianying Zhang, Camille Keenan, and James H.-C. Wang, “The effects of dexamethasone on human patellar tendon stem cells: implications for dexamethasone treatment of tendon injury,” Journal of orthopaedic research : official publication of the Orthopaedic Research Society 31, no. 1 (2013); Laurent Baverel et al., “Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?,” JSES Open Access 2, no. 1 (2018).

[18] Dennis A. Cardone, “Is Platelet-Rich Plasma an Effective Healing Therapy?: Scientific American,”, accessed July 2013; Micheal P. Hall, James P. Ward, and Dennis A. Cardone, “Platelet Rich Placebo?: Evidence for Platelet Rich Plasma in the Treatment of Tendinopathy and Augmentation of Tendon Repair,” Bulletin of the Hospital for Joint Diseases 71 (2013): 57; Alexander D. Liddle and E. C. Rodríguez-Merchán, “Platelet-Rich Plasma in the Treatment of Patellar Tendinopathy: A Systematic Review,” The American journal of sports medicine 43, no. 10 (2015); Franciele Dietrich et al., “Effect of platelet-rich plasma on rat Achilles tendon healing is related to microbiota,” Acta Orthopaedica 88, no. 4 (2017); de Vos, Robert J et al., “Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial,” JAMA 303, no. 2 (2010); Nasir Hussain, Herman Johal, and Mohit Bhandari, “An evidence-based evaluation on the use of platelet rich plasma in orthopedics – a review of the literature,” SICOT-J 3, no. 1 (2017).

[19] O. Morath et al., “The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy-a systematic review including meta-analysis,” Scandinavian journal of medicine & science in sports 28, no. 1 (2018); Lane M. Sanderson and Alan Bryant, “Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review,” Journal of foot and ankle research 8, no. 1 (2015); O. Chan, “Outcomes of prolotherapy for intra-tendinous Achilles tears: a case series,” Muscle, Ligaments and Tendons Journal 7, no. 1 (2017); Ulrike H. Mitchell et al., “The Construction of Sham Dry Needles and Their Validity,” Evidence-Based Complementary and Alternative Medicine 2018, no. 5 (2018); F. A. Chaudhry, “Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review,” European Journal of Orthopaedic Surgery & Traumatology 27, no. 4 (2017): 446.

About the author

Martin Koban
Martin Koban

About Martin Koban

I’m Martin Koban and I help people with knee pain get back to living a normal life. I’ve worked with professional athletes, recreational athletes, and regular people from all around the world.

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