Conditioning: Phase 2

The following is the second of four phases that will guide you from Patellar Tendonitis/osis toward healthy running. Progress from each phase as instructed.

Duration: 2 Weeks (at least)
Goal: Introductory Loading and Strengthening
Frequency of Exercises: 3 x per week (day off in between)
Note: Mild pain (<3/10 on pain scale) that does not linger is both okay and expected with exercise. Yet, if the pain increases (>3/10) after exercises, then reduce load and/or intensity of exercise.
Warm Up: For at least 5 minutes before activity (e.g. Pre-Run Warm up).

Squats: 3 x 8 reps (slowly: 3 second down, 3 second up). Standing shoulder width apart, begin by bringing hips back, and then bend your knees. Perform this exercise very slowly, going into mild pain (<3/10). Bend to 90 degrees at knee or based on pain level. For an additional challenge, add a Resistance Band. Purpose: increase tensile loading capacity of the patellar tendon.
Single Leg Bridges: 3 x 12 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.
Single Leg Balance: 3 x 30 seconds (each leg). Stand with both hands on your hips and your feet directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Purpose: improve postural balance and stability.

Side Planks: 3 x 30 seconds (each side, or until fatigue). With elbow aligned with shoulders, come up on your side. Keep your body straight throughout. Purpose: improve hip strength and lateral core stability to reduce risk of knee caving in.
Front Planks: 3 x 30 seconds or until fatigue. On your elbows and knees, bring your knees off the ground and hold. Try to keep your body level throughout this exercises by keeping your hips level and engaging your abdominals and glutes. Keep your elbow below your shoulders and push up to engage your scapular muscles. Purpose: strength core and glutes for running form stability.
Double to Single Leg Calf Raises: 3 x 12 reps (each leg, or until fatigue). Place your toes on a step with heel off of the step. Come up and down, raising straight up in the air without moving forward. Do this with a slight knee bend to target the soleus muscle, but if more comfortable keeping knee straight then do so. If it is too easy with two legs then go to one leg. Purpose: increase calf strength to support the knee during loading.
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.
Walking and/or Biking, or can begin a Run/Walk Progression.

Stretching: 1 min. (per side). Purpose: improve mobility and decrease tensile strain.
- Quads: With one leg on the table/couch/bed, the other leg is off the table. Grab a belt or two (or an Exercise 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. Place around the knee to reduce pain and inflammation.

TO GRADUATE TO PHASE 3

Required: able to squat (no weight) x 10 reps with minimal pain (<1/10) for three exercise sessions.
Required: mild pain expected, but should be rare.
Ideal: mild tenderness to palpation of the tendon.

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.