Conditioning: Phase 1

The following is the first of four phases that will guide you from Patellar Tendonitis/osis toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Tendonitis: Start at Phase 1 (Below) / Tendonosis: Start at Phase 2

Duration: 1 Week (at least)
Goal: Reduce pain through minimal loading
Frequency of Exercises: Phases 1a & 1b are twice per day. Phase 1c is once per day. Conditioning should be done without pain. Begin with one of the phases below based on your pain scale.

a. HIGH PAIN

START HERE if pain is >7/10 with squats and/or running
Goal: Reduce Inflammation. Do not run. Refrain from exercises that increase pain.

Tape: Help support tendon.
Short Arc Quads: 2 x 20 reps, 2-3 per day until pain decreases. On your back, place a foam roll or pillow under your knee. While keeping your knee resting on the pillow, bring your foot off the ground for 2 seconds then back down. Purpose: improve circulation and mildly load tendon to start healing.
Offset Bridge: 3 x 10 reps. Place your injured leg’s foot away from the body. This will decrease load on the affected limb. Bring your hips up and down. If it is too painful on the injured knee, then bring the foot further out or put less pressure on the foot. You should feel your hip and thigh muscles working. Purpose: begin glute strengthening with mild load on patella tendon.
Single Leg Balance: 3 x 30 seconds (each leg). Ideally, complete this in front of a mirror. Stand with both hands on your hips while your feet are directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Hold that position. Purpose: improve hip, knee, and ankle joints stability.
Calf Stretching: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: improve calf mobility to decrease strain on the knee.
Walking: If minimal or no pain, walk throughout the day in 5-10 minute intervals on a flat surface. Purpose: maintain some loading of the knee.
Ice: 10 minutes, after exercise. Place around the knee to reduce pain and inflammation.

b. MODERATE PAIN

START HERE if pain is 4-6/10 with squats and/or running
Goal: Continue to reduce pain. If any exercise increases the pain then refrain from it.

Tape: Help support tendon (see video above)
Double Leg Bridges: 3 x 10 reps. Place your legs shoulder width apart with knees bent. Bring your hips up and down. If it is too painful on the injured knee, bring your feet away from your body. Should feel muscles working on the hips and thighs. Purpose: begin glute strengthening with mild load on patella tendon.
Clamshells: 3 x 16 reps. Lying on your side with your knees bent (hips to 45 degree angle), bring your top knee up and hold for 3 seconds, then back down. Repeat until 16 reps or fatigue. Should feel muscle work in the hips. For an additional challenge, you can add a Resistance Band around your knees to increase demand (recommended). Purpose: begin strengthening the glute muscles to reduce knee caving in.
Rose Hips: 3 x 16 reps. On your side with your body straight, bring your lower leg up for stability. Your top leg, with toes biased downward, goes up and down slowly to recruit muscles on the side of your hip. Be careful not to let your top hip come forward (easiest to do this along a wall to prevent compensation). Purpose: increase hip strength to reduce knee caving in.
Walking and/or Biking: (light resistance) Perform with seat higher to reduce pressure on the knee. Walk on flat surfaces as tolerated.
Massage (Cross Fiber to Tendon): 3-5 minutes. Some pain is okay. The pain may increase at first, but then subside and get numb with time. You should feel localized pain to the area. Purpose: reduce scar tissue adhesions and increase stimulation of the tissue and blood flow.
Calf Stretching: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: improve calf mobility to decrease strain on the knee.
Ice: 10 minutes, after exercise. Place around the knee to reduce pain and inflammation.

c. MILD PAIN

START HERE if pain is < 3/10 with squats and/or running
Goal: Work toward starting Run/Walk Progression.

Single Leg Glute Bridges: 3 x 8 reps. On your back with one knee up. Bring hips up and down slowly. You should feel muscle work on the thigh and hips. Purpose: increase demand on glute muscles with mild load on tendon to stimulate healing.
Shallow Squats: 50% of depth (mild pain okay) with Resistance Band (if accessible). 3 x 8-10 reps. With knees shoulder width apart, slowly come down into mild pain (<3/10), and come back up. If able, place a band around your knees to recruit your glutes with the squat. Perform shallow squat to prevent excessive loading. Purpose: begin loading the patellar tendon to increase tensile resilience.
Rose Hips: 3 x 16 reps. On your side with your body straight, bring your lower leg up for stability. Your top leg, with toes biased downward, goes up and down slowly to recruit muscles on the side of your hip. Be careful not to let your top hip come forward (easiest to do this along a wall to prevent compensation). Purpose: increase hip strength to reduce knee caving in.
Walking and/or Biking: Light resistance (raised seat), very slight discomfort okay.
Massage (Cross Fiber to Tendon): 3-5 minutes. Some pain is okay. The pain may increase at first, but then subside and get numb with time. You should feel localized pain to the area. Purpose: reduce scar tissue adhesions and increase stimulation of the tissue and blood flow.

Stretching: 1 minute (per side). Purpose: reduce compression forces on knee.
- Quads: With one leg on the table/couch/bed, the other leg is off the table. Grab a belt or two (or strap) and hook one end on your foot that is on the table. With your body aligned up straight, begin to pull your heel towards your hips until you feel a moderate stretch in the front of the thigh. Hold for at least one minute. If pain increases, place a towel under your thigh to pre-stretch the quad.
- Calves: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight.
- Hip Flexors: In the kneeling position with your arms supported against the wall, engage your abdominals by doing a posterior pelvic tilt (i.e. low back is flattened with a limited curve). Engage your glutes on your kneeling side and keep your body as a unit until you feel a stretch in the front of your hip. You may increase your stretch by leaning away from the side.
Ice: 10 minutes, after exercise. Place around the knee to reduce pain and inflammation.

TO GRADUATE TO PHASE 2

Required: Pain is < 3/10, and when aggravated does not linger for more than 1 minute
Required: Can do a squat x 10 reps with pain < 3/10 for at least three exercise sessions
Required: Can sleep without waking up from pain in the knee
Note: If you begin at Phase 1.a., before graduating to Phase 2, be sure to progress in turn through Phases 1.b. and 1.c.

Principles of Patellar Tendonitis/osis: A Review

CAUSE – overloading of the tendon
NEED – reduce tendon pain and strengthen quads
PLAN – once pain is managed, progressively load the tendon to increase strength, especially in the quads

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.