Written by Bede Christey

Patellar Tendinosis

Patellar Tendinopathy strengthening techniques

Figures show that up to 40% of jumping athletes, and 14% of recreational athletes have experienced patellar tendinopathy at some point in their sporting career. The site of tenderness is usually just below the patella (kneecap): the bone-tendon junction where the patella tendon inserts onto the lower portion of the kneecap.

The word tendinopathy basically refers to a degenerative tendon. What happens is in the early stages the tendon becomes sensitive to load (jumping/sprinting), and if left untreated can progress into a chain reaction of changes to the collagen matrix (or makeup) of the tendon until it becomes degenerative. Some of you may have previously heard the term patella ‘tendinitis’ which is now obsolete as many studies show the absence of inflammatory cells within the tendon itself.

There are 3 stages of a tendinopathy (outlined below). It is important that your physiotherapist determines which stage the tendon is in, as this will determine the correct form of management (each stage needs to be managed differently). It will also give us an idea of healing timeframes & how long your rehab will take. It may be neccessary to get an ultrasound scan (doppler) to determine the exact stage your tendon is in.

Tendinopathy Stages:
Normal tendon -> Reactive tendon -> Tendon disrepair -> Degenerative Tendon

It should be noted that pathological changes in the tendon are not easily reversible: once in the degenerative stage, very few get back to normal! This is because once in the degenerative stage the collagen matrix is so disrupted & unorganised; potentially leaving it prone to rupture.

The ‘tipping point’ that turns the tendon into a degenerative state is when “neovascularisation” is seen on a doppler ultrasound scan, this is where there is small blood vessels growing into the tendon itself. A normal healthy tendon should be avascular (no blood vessels)!

In terms of management, a number of different studies have shown that strengthening exercises have a positive outcome on Patella Tendinopathy. There appears to be two current schools of thought in terms of strengthening, both are outlined below & take 12-weeks to complete.

Long periods of unloading are not good (the tendon likes load). Thus – just resting will not cure your tendon!! On average – a patient presenting with a painful persistent PT for the first time may take 3-6 months to fully recover. If it is a longstanding injury it will likely take a good 6-12 months to return to sport painfree without recurrence.

Below are the examples of a research-based strengthening programme for a patellar tendinopathy. It is advised that you have your knee assessed before beginning this strengthening as the stage of your tendinopathy needs to be determined first, plus also any faulty movement patterns & instability (that may have contributed to the injury) also need to be addressed!

Eccentric Exercise Programme on a 25-deg Decline Board: (Purdem et al 2004).
3x 15 reps of eccentric single legs squats on a 25-deg Decline board

  • Twice daily (morning & night) for 12 consecutive weeks
  • Load should be increased incrementally using a loaded backpack or holding a dumbbell
  • Spend approx. 3-seconds doing each repetition, 2-min rest period between sets.

Mild pain during exercises is acceptable, but pain & discomfort was not to increase following cessation of training.

This YouTube clip shows Bede performing this exercise:

Heavy Slow Resistance Training: (Kongsgaard et al, 2009).
3 sessions per week only, ideally 1x session is supervised by physio.

  • Each session consists of 3 bilateral exercises: Squat, Leg Press, and Hack Squat
  • Complete 4 sets in each exercise with a 2-3min rest between sets
  • All exercises performed to maximum 90-deg knee flexion
  • Spend 3-secs completing each of the concentric + eccentric phases (ie. 6-secs per repetition)

Pain during exercise acceptable, but pain & discomfort not to increase following cessation of training.

The amount of repetitions/load varies throughout the 12-week program:

  • Week 1: 15 rep maximum (RM)
  • Week 2-3: 12 RM
  • Week 4-5: 10 RM
  • Week 6-8: 8 RM
  • Week 9-12: 6 RM

If you have any queries or think that you may have patella tendinopathy, consider booking a session with one of our pain physios.