Conditioning: Phase 4
The following is the final of four phases that will guide you from Patellar Tendonitis/osis toward healthy running. From here, you should be ready to return to full running.
Duration: 2 Weeks
Goal: Plyometrics and Functional Training
Purpose: Increase tensile load tolerance of the patellar tendon at higher functional levels.
Frequency of Exercises: 3 x per week
Warm Up: For at least 5 minutes before activity (e.g. Pre-Run Warm up).
- Side Step Jump Holds: 3 x 12 reps. In a semi-squat position, bring yourself to the side on one leg and hold for 2 seconds, and then go to the other. The main point is to stick the landing, absorbing the forces with your hips and quads. Purpose: increase load on knee (resilience) with increasing demand on hips to reduce risk of knee caving in.
- Single Leg Squat (Against Wall): 3 x 8 reps (slowly, 3 second down, 3 second up). With your foot near wall with the other leg off the ground, slide your body down slowly. This will place more pressure on your knee and quad. Then slowly come back up. The emphasis should be slow, with pressure and tension for a prolonged period of time for tissue adaptation. Purpose: increase demand on loaded knee.
- Single Leg Balance (On Toes): 3 x 30 seconds. Stand with both hands on your hips with your feet directly under you. Keeping your pelvis stable, bring one leg up without causing your pelvis to tilt or rotate. Once stable, come up on your toes as best as you can. Purpose: improve calf/ ankle stability and strength.
- Jump Squats: (on box first, then on ground) 3 x 8-10 reps. Legs shoulder width apart, bend down by bringing hips back and knees bent, and then come back up. As you land, try to make the landing quiet indicating shock absorption. If too loud, then you are not landing with enough knee bend/hip bending. Do this one at a time at first, then do intervals over time (sets of 3, 4, etc.). Purpose: increase loading capacity of knee.
- Up and Backs: 3 x 30 seconds. Go up and back in a running pace. This will increase load capacity on the knee, and get back into more sprinting type activities. Do this for 30 seconds, then add time as endurance improves. Purpose: increase IT Band resilience through running.
- Single Leg Calf Raises: 2 x 25 reps (each side). 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: reduce compression on knee by reducing knee flexion.
- Run/Walk Progression.
- Front Plank: 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.
- 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 FROM PHASE 4
No pain with exercises, plyometrics, and running. Continue to implement exercises from previous phases as needed or desired to maintain form.
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
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