A Runners Guide to Patellar Tendinopathy

  • 07 Jan, 2023

A Runners Guide to Patellar Tendinopathy Rehabilitation


Patellar tendinopathy is a common condition seen in sports that involve running and jumping. Tendinopathy occurs when the load placed through the tendon (e.g. running) exceeds the tendons capacity (strength). Tendinopathy is a complex process however is essentially a breakdown of the collagen fibres in your tendon. This means it is regarded as a degenerative, rather than an inflammatory condition as previously thought (previously, “patellar tendonitis”).


Patellar tendinopathy is characterised by pain below the knee cap where the patella tendon sits. It is painful to touch and also can brought on by jumping, running or walking. Pain may improve after a runner “warms up” but there is often pain present the following day after a training session.


It was previously found by Taunton et al. 2002 that 4.8% of 2000 runners had patellar tendon pain. A rapid increase in training volume or intensity is a risk factor for patellar tendinopathy. Training on harder surfaces may be an additional risk factor.


Early sport specialisation has also been reported to be a risk factor for patellar tendinopathy


Interventions for Patellar Tendinopathy


The gold standard for patellar tendinopathy management is strength training; whether it be a heavy slow resistance program, eccentric (lowering / muscle lengthening phase only) or isometric (holding a muscle contraction).


Isometric exercise (such as holding a calf raise for 45 s x 4-5 sets) is an effective tool to decrease pain during competitive seasons for short term relief. Whereas heavy slow resistance or eccentric exercises are better suited for long term pain reduction and improvement in knee function (Lim et al. 2018). These exercises aim to enhance the remodelling of collagen fibres within the tendon, making it better able to adapt and respond to the stress placed through it with running.


Reducing load placed through the tendon is also important (i.e. decreasing training volume and intensity), however this doesn’t mean a runner needs to completely stop running. The general rule of thumb is keep pain >5/10 both during the run and in the 24hrs following. If the tendon is slightly sensitive this is generally ok as long as a runner is addressing the tendon with strength training.


Example of a Heavy Slow Resistance Program


A heavy slow resistance program is a way to progressively load the tendon. These programs typically last for a minimum 12 weeks, however changes in tendon pain are seen in as early as 4 weeks.


An example may be:


Select 3 Quadriceps dominant exercises, such as (but not limited to) a single leg press, knee extension and a Bulgarian Split Squat. In the early stages of rehabilitation be mindful of full knee extension as this may aggravate symptoms.


Week 1-4: 3 x 12

Week 5-8: 4 x 10

Week 9-12: 5 x 8


As the sets increase and repetitions decrease, more load (or “weight”) needs to be added.


If a runner is tolerating this program well then plyometrics (i.e. jumping exercises) may be incorporated in later stage rehabilitation.