Conditioning: Phase 3

The following is the third 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: Progressive Loading and Mechanics
Frequency of Exercises: 3 x per week (day off in between)
Warm Up: For at least 5 minutes before activity (e.g. Pre-Run Warm up).

Split Squats: with weight if too easy, load to mild pain (<3/10); 3 x 8 reps (slowly: 3 second down, 3 second up). Standing with one leg forward and the other leg back, come slowly straight down towards the ground by bending your knees. Your body should not lunge forward during the movement. Come slowly back up and repeat movement. Purpose: increase loading and tensile capacity to the patellar tendon.
Captain Morgans: along wall; 3 x 30 seconds (each side) or 3 x 8-10 reps. Near a wall, stand straight and bring your knee up nearest the wall; you can use a ball, but if you don’t have one you can just use the wall. Keeping your torso straight with hands in front, begin to squat down by bringing hips back then bending knee. Without standing knee caving in, push knee into ball/wall hard. If it’s too easy, it can go up and down slowly. Should primarily feel hip and thigh muscles working. Purpose: increase demand on glutes to reduce knee caving in.
Single Leg Calf Raises: with weight, on step; 3 x 12-16 reps (each leg). 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. Purpose: increase calf strength to support the knee when loading.

Side Planks (Leg Up): 3 x 30 seconds (with leg up, 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 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.
Jump Roping: 3 x 30 seconds to begin plyometric loading.
Single Leg Balance (Running Man): 3 x 30 seconds. Stand with both hands on your hips with your feet directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Bend the standing leg slightly, and go through a running motion with the other side by bringing the leg backward and forward. Purpose: improve balance and stability.
Cross Fiber Massage: 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.
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.

TO GRADUATE TO PHASE 4

Required: no pain with split squats x 10 reps for four consecutive exercise sessions.
Required: no pain with touching (palpation) the knee tendon.
Ideal: can hold a side plank for 1 minute (each side)
Ideal: able to complete 20 x single leg calf raises
Ideal: quad flexibility to hips – able to bring heel to hips with minimal stretch while you’re lying on your stomach (see “Quad Length Stretch” video above).

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.