Eric Tannenbaum, MD

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Patellar Tendinitis

Tendons get stronger when they are loaded progressively. Holding exercises (isometrics) often ease pain, and slow, heavy strengthening rebuilds the tendon. Total rest usually does not help. Expect steady progress over about 12 weeks.

Prepared by Dr. Eric Tannenbaum, MD · Board-certified orthopedic surgeon, Southern Indiana Orthopedics

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Use this program for

  • Patellar tendinopathy (jumper's knee)
  • Patellar tendinitis
  • Pain just below the kneecap with jumping or squatting

Before you start

  • Check with Dr. Tannenbaum or your physical therapist that this program fits your condition.
  • Warm up with 5 minutes of easy movement.
  • Move slowly and with control. Quality matters more than speed.
  • Use the pain guide below to decide how hard to push.
0 to 3 out of 10Safe. Keep going.
4 to 5 out of 10Acceptable if it settles by the next morning. Otherwise ease off.
Above 5, or worse the next dayToo much. Reduce the reps, range or weight.

Phase 1: Isometrics

Weeks 0 to 2

Reduce pain with holding exercises.

1Wall sit (isometric)

  1. Stand with your back against a wall and slide down until your knees are bent.
  2. Hold the position with weight even on both feet.
  3. Slide back up to rest.

5 repetitions, hold 30 to 45 seconds, once or twice a day

Choose a depth where pain stays at 3 to 4 out of 10 or less. Isometrics often ease tendon pain.

2Quad set

  1. Sit or lie with the leg straight and a small towel roll under the knee.
  2. Tighten the thigh muscle to press the back of the knee down into the towel.
  3. Hold, then relax.

10 to 15 repetitions, hold 5 to 10 seconds, 2 to 3 times a day

You should see the kneecap move up slightly as the muscle tightens.

Phase 2: Slow, heavy strength

Weeks 2 to 8

Rebuild tendon strength.

3Slow split squat

  1. Stand in a long stride with the sore leg in front.
  2. Lower straight down over 3 seconds until the back knee nears the floor.
  3. Rise over 3 seconds.

3 to 4 sets of 6 to 10, every other day

Add a backpack or dumbbells as it gets easier. Slow and heavy builds tendon strength.

4Single-leg decline squat

  1. Stand on the sore leg on a slant board or wedge, heel higher than toes.
  2. Slowly bend the knee over 3 seconds, keeping the trunk upright.
  3. Use the other leg to help you back up.

3 sets of 15, once a day

Tendon loading is expected to be mildly uncomfortable. Stay at 4 to 5 out of 10 or less.

5Calf raise

  1. Stand holding the back of a chair.
  2. Rise up onto your toes, then lower slowly.
  3. Progress to one leg at a time.

3 sets of 15, once a day

Take 2 to 3 seconds to lower.

Phase 3: Spring

Weeks 8 and beyond

Prepare the tendon for jumping and sport.

6Forward step-down

  1. Stand on a low step with the sore leg.
  2. Slowly lower the other heel toward the floor in front of the step.
  3. Lightly touch, then straighten back up.

3 sets of 8 to 12, once a day

Watch in a mirror that the knee stays in line with the second toe.

7Hops

  1. Once you can balance and do single-leg calf raises without pain, start with small hops in place on both feet.
  2. Progress to single-leg hops forward and side to side over a line.
  3. Land softly with the knee bent.

2 to 3 sets of 10 to 20 hops, every other day

Do these only after your balance and strength have returned, usually in the final phase.

Avoid for now

  • Jumping and sprinting until phase 3
  • Completely resting the tendon; it needs load to heal
  • Stretching as the main treatment

When to move ahead

Tendon exercises may cause pain up to 4 to 5 out of 10, as long as it settles by the next day. Add weight only when the current load is comfortable.

Stop and call our office at (812) 376-9353 if you have

  • Pain that is getting worse week to week, or severe pain at night
  • New numbness, tingling or weakness
  • Significant swelling, redness, warmth or fever
  • A joint that locks, gives way or will not move
The research behind this program
  1. Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277–1283.
  2. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790–802.
  3. Breda SJ, Oei EHG, Zwerver J, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021;55(9):501–509.

Need more help?

Work with our physical therapists

Our physical therapists at the SIO Physical Therapy & MRI building, 745 Schnier Street in Columbus, work alongside Dr. Tannenbaum and can tailor this program to you.

Request an appointmentCall (812) 376-9353

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