Load It or Lose It: Fix Patellar Tendinopathy the Smart Way
Have you ever been cruising down a hill toward the end of a tough workout, just to feel some pain start to creep in just below your kneecap? Or maybe the morning after a run, those first few steps down the stairs feel stiff and sore in the front of your knee. Maybe you already use patellar straps, kinesiotape, or the classic rolled-up pre-wrap trick that you learned from your athletic trainer in high school, but chances are you are dealing with patellar tendinopathy.
What Is Patellar Tendinopathy—and Why Runners Get It
Patellar tendinopathy, aka jumper’s knee, typically happens in runners with sudden increases in volume or intensity. The tendon connects the kneecap to the tibia via the tibial tuberosity, that bony bump at the top of your shin bone. Taping and straps work by helping to offload the tendon. Think about a pulley system with a rope. Too much tension? Add a pulley, and you decrease the load on the rope and keep everything running smoothly. In the case of your patellar tendon, external implements can help, but may not fully solve the problem.
Why Taping Helps (But Isn’t the Fix)
Tendons respond to load, both positively and negatively. If it hurts, you can rest—unload the area—and it will feel better. But if you try to run again without strengthening first, you are likely to experience the same symptoms as before because rest is only part of the equation. Loading the tendon via strength training makes it more resilient and better able to withstand running farther and faster.
Start with Isometrics to Build Pain-Free Strength
So, how do you load it? To start, isometrics are the best way to manage pain and increase strength. Think about wall sits; you are loading through the quads and the tendons, but there’s no movement involved. A good set/rep scheme for isometrics is 5 sets of 45 seconds with 90-120 seconds of rest between sets. This is important, don’t skip the rest!
Next Step: Controlled Movement with Squats and Lunges
Once you have that down, you can try loading through the range of motion with exercises like squats, lunges, and step-ups. At the beginning, there should be more of an emphasis on eccentric loading—loading while lengthening. Being slow and controlled in the descent of your squats and lunges, and focusing more on the step down (rather than up). You will also be working the concentric—shortening—phase. But keep in mind, the eccentric should be slower and more controlled, and you can be a little quicker with the concentric. Sets and reps for strength and hypertrophy should be around 3 x 8 with plenty of rest. Each set should feel good and clean, not like you are struggling. Once your symptoms are under control, then you can take it to the next level.
Final Phase: Plyometrics That Prepare You for the Trail
The last phase is plyometrics. Start with double-leg landing and hopping, and progress to single-leg work. I like to start with landing to absorb the force, then add in hopping to increase the load through the tendon. Think about stepping off a box or step and controlling the landing (think eccentric loading, but with more speed). This will transfer directly over to your running gait. When it comes to plyometrics, less is more, so don’t overdo it—that’s what got you here in the first place!
Can You Still Run with Jumper’s Knee? Maybe—Here’s How to Know
The biggest question with injury is always, “Can I still run?!?!” And the answer is almost always, “Maybe!” It may also depend on your definition of running. If you consider a walk/run progression to still be running, then we’re on the same page. Every case is different, so if you’re unsure, reach out to your local PT or provider, and they can help you navigate the process.
Dr. Brett Clingerman, DPT, OCS is a physical therapist with 10+ years of experience. He graduated from Shenandoah University in 2012 and moved to North Carolina in 2015. He has spent most of his career treating Soldiers and Airmen, including being the lead PT for the women’s ten-miler team at Fort Liberty. Brett is board-certified in orthopedics through the American Board of Physical Therapy Specialties. Certifications & Services include dry needling, Graston technique, spinal manipulation/ joint mobilization, kinesiotape, and FMS/SFMA.
Contact: resilient.running@gmail.com
