Patellar Tendonitis and Running: Symptoms, Causes and Research-Backed Treatment Options

It’s that lower knee pain when running.

That old wives tale echoes through your mind, “running is bad for your knees”, but you know this sharp pain in below your kneecap is not because running is bad for us, but just because something is wrong.

Today we are going to explain what causes knee pain when running, what makes it worse, how to ease the soreness, and give you research backed treatment options to get you to return to running pain free as soon as possible.

Patellar Tendonitis

First, why do runners get patellar tendonitis?

The patellar tendon is a short but very wide tendon that runs from your patella (kneecap) to the top of your tibia.

The reason you have a kneecap in the first place is to generate a bigger mechanical advantage at the knee—this allows your quadriceps to create strong forces at the knee, which are important in any sport with running or jumping elements.

However, the result of this is that the patellar tendon has to absorb a lot of this loading, and as a result, it’s prone to injury in runners and jumpers; one study found that patella tendonitis accounts for just under 5% of all running injuries.1

Unlike many common running ailments, patellar tendonitis is somewhat more common in men than in women.

Patellar tendonitis usually begins with a stiff feeling in the patellar tendon, especially when running downhill or descending stairs.

Like most tendon injuries, it may go away once you get warmed up, but as the injury worsens, it will remain painful for the duration of your workout.

It is also important to distinguish patellar tendonitis from patellofemoral pain syndrome: patellar tendonitis does not hurt along the top or the side of the kneecap, and isn’t usually sensitive to the touch.

What Causes Patellar Tendonitis? What makes it worse? What’s going on?

Because the patellar tendon absorbs so much force, the long strands of connective tissue that make up the tendon can become injured.

As with Achilles tendonitis, the true problem seems to be not so much the inflammation, but the damaged and degraded tendon structure that results from chronic stress on the patellar tendon.

Unfortunately, this can result in patellar tendonitis becoming a chronic issue that persists for months.

  • Moreover, poor explosive leg strength may be related as well.
  • Additionally, weak thigh muscles might be unable to adequately slow down your descent during impact, subjecting your knee to greater loads.

Conceptually, this makes sense, as tighter upper leg muscles would increase the tension on the knee, making it more difficult to flex and extend the joint.

Research backed treatment options for Patella Tendonitis

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It’s a PDF with an outline of the conservative and aggressive treatment options to help you get through your patella tendonitis.

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While the causes behind patellar tendonitis are not as well-understood as other injuries, there is fortunately very strong evidence for a treatment protocol.

The treatment of choice, a program of eccentric decline squats, was inspired by the success of eccentric heel drops in treating Achilles tendonitis.

Hypothesizing that eccentric activity encouraged the body to gradually replace and realign the damaged tendon fibers, researchers turned to a program of one-legged squats to eccentrically load the patellar tendon.4

However, they found that they were not as effective as expected, since the calf instinctively assists the knee when squatting, which takes some load off the front of the knee and the patellar tendon.

To work around this, researchers devised the eccentric decline squat, 5 which is done on a downward-slanted surface to unload the calf.6

Interestingly, this may also be why running with patellar tendonitis hurts more on downhills!

In one small but very rigorous pilot study, Purdam et al. demonstrated that an eccentric decline squat protocol of three sets of 15 squats twice a day was vastly superior to an identical eccentric squat program done on a flat surface.

Like the eccentric heel drop protocol for Achilles tendonitis, subjects in the studies on eccentric decline squats were encouraged to continue doing the exercises even with moderate pain (though stopping if the pain becomes extreme), and to add weight with dumbbells or weights in a backpack once they could do the basic 3×15 protocol pain-free.

eccentric decline squat pattellar tendonitits

Unfortunately, eccentric decline squats do require some specialized equipment; namely, a slanted board at about 25° (which corresponds to a rise of one foot per two feet of horizontal distance).

If you have a calf stretching board on hand, it will work perfectly. If you’re handy with tools, they aren’t too difficult to build. But even if you aren’t, you can usually make do by leaning a wooden plank against the bottom step on a staircase or up against a curb (as pictured above).

To do one eccentric decline squat, stand on the decline board with your foot pointing “downhill.” While balancing on your injured leg, squat downward slowly to about 60° of knee flexion. Then use your good leg to rise back up to the starting position. Do not use the injured leg to return to the top!

Again, moderate pain with this exercise is okay. Just stop if it becomes excruciating. Once you can do the exercise pain free, you should add weight with a loaded backpack, again continuing into moderate pain.

Other possible treatment options

  • In addition to the eccentric decline squat protocol, it makes a lot of sense to take steps to address potential tightness in your hamstrings and quads. Stretching them a few times a day is a very good idea, as is using a foam roller to loosen them up. You may find that a harder foam roller or even a 3” diameter plastic PVC pipe works better on your hamstrings, especially if you have muscular thighs.
  • Some very new pilot studies have suggested that platelet-rich plasma injections, a therapy which involves injecting a concentrated form of platelets found in your own blood, and extracorporeal shockwave therapy, a souped-up version of ultrasound, may be able to stimulate healing as well.8, 9 As the patellar tendon has poor blood supply, and hence a reduced capacity to repair itself, the idea behind platelet-rich plasma (or PRP) injections is that growth factors in the platelets accelerate healing.
  • Likewise, extracorporeal shockwave therapy (or ESWT) aims to selectively break down tissue to accelerate healing. While evidence to date suggests that these are a fairly safe and effective treatment for very stubborn cases of patellar tendonitis, there’s no data on long-term effects, and you’re unlikely to have it covered by insurance. Consider talking to your doctor about a PRP injection or ESWT if you’ve had little or no success with conservative treatment for several months.

Outline of treatment options

Conservative treatments

These are cheap, easy to perform treatments that you can do it home in your own time. You should try to do as many of these as possible each day.

1. Eccentric single leg decline squats—3 sets of 15 reps, twice per day. It’s okay if the decline squats hurt somewhat, but the pain shouldn’t be excruciating. Once you can do all three sets without pain, add weight using a weighted backpack. Return the starting position using your good leg. You’ll need to find, construct, or improvise a decline ramp to do these on, but it’s well worth it, as decline squats are much more effective than squats on flat ground.

2. Icing after each run.

3. Gently stretch your hamstrings and quads a few times a day.

4. Massage your hamstrings and quads with a foam roller, PVC pipe, or The Stick

Aggressive treatments

These treatments are a little more expensive or time consuming and are only suggested for if you suffer from chronic patellar tendonitis pain and the conservative treatments are not working for you.

1. Consider running in a lower-heeled shoe to transfer some stress from your knee to your foot, calf, and ankle. Exercise caution if you have had foot or calf injuries in the past.

2. Ask an orthopedist about platelet-rich plasma (PRP) injections or extracorporeal shockwave therapy (ESWT).

Cross Training While Injured and During Recovery

Cross training is recommended while you're injured and as you slowly return to running.

The best form of cross training for this injury is Aqua Jogging. Studies have shown that aqua jogging can enable a well-trained runner to maintain running fitness for up to 4-6 weeks.

Aqua jogging is a form of deep water running that closely mimics the actual running movement.  Your feet don’t actually touch the bottom of the pool, so it is zero impact and safe for almost any type of injury. In my experience, the only time to avoid aqua jogging is when you have a hip flexor injury, which can be aggravated by the increased resistance of the water as you bring your leg up. Because aqua jogging closely mimics natural running form, it provides a neuromuscular workout that, in addition to aerobic benefits, helps keep the running specific muscles active. The same can’t be said for biking and swimming. The only downside to aqua jogging is that you need a pool that is deep enough to run in without touching the bottom. If you’re lucky enough to have access to a pool of this size, aqua jogging should be your first cross training choice.

In one study, a group of ten runners trained exclusively with deep water running for four weeks and compared 5km race times pre deep water running and post deep water running.

The researchers found no statistical difference in 5k time or other markers for performance, such as submaximal oxygen consumption or lactate threshold.

In a second study, researchers measured the effects of aqua jogging over a six week period.

This time, 16 runners were separated into two groups – one who did aqua jogging workouts and the other who did over land running.

Using the same training intensities and durations, the researchers found no difference between the groups in maximal blood glucose, blood lactate, and body composition.

It get’s better:

Research has also demonstrated that aqua jogging can be used as a recovery tool to facilitate the repair of damaged muscles after hard workouts.

These findings make aqua jogging an important recovery tool in addition to being the best cross training method for injuries.

Need one more reason?

The calories burned aqua jogging are even higher than running on land, so if you want to avoid weight gain while you take time off from running, this is definitely the exercise for you!

Aqua Jogging Workouts For Runners

If you're interested in aqua jogging to rehab your injury, then the absolute best way is to use one of my favorite programs, Fluid Running.

First, it comes with an aqua jogging belt and waterpoof bluetooth headphones so you have everything you need to aqua jog effectively.

Second, they have an app that pairs with the headphones so you can get workouts, guided instructions on how to aqua jog properly, and motivation while you're actually pool running.

This has been an absolute game changer for me when I am injured.

I used to dread aqua jogging workouts because they were so boring and it took all my mental energy to stay consistent.

But, with workouts directly in my ear, it's changed the whole experience and I actually look forward to the workouts. So much so that I now use aqua jogging as a cross training activity in the summer, even when I am not injured.

Fluid running is an awesome deal when you consider it comes with the belt (highly recommended for better form), the waterproof headphones (game changer for making pool workouts fun), a tether (to add variety to the workouts you can do) and the guided workout app (to make your cross training structure and a whole lot more interesting).

That's why we've partnered with them to give you 2 additional running-specific workouts you can load into the app when you use the code RTTT .

Check out the product here and then on the checkout page, add the code RTTT in the coupon field and the workouts will be added to your order for free.

If you'd rather do the aqua jogging workouts on your own, here are some great ideas to get you started!

Medium Effort Workouts

The Pyramid

10 minutes easy warm up - 1:00 hard, 30 seconds easy - 1:30 hard, 30 seconds easy - 2:00 hard, 30 seconds easy - 2:30 hard, 30 seconds easy, go to 5:00 in 30 second intervals and then come back down the pyramid (4:30 hard, 30 easy, 4:00 hard, 30 easy etc). Finish with 10 minutes easy cool down.

Wave your hands in the air like you just don’t care

10 minutes easy warm up, 1 minute medium (87-92% of maximum heart rate or what feels like tempo effort), 1 minute sprint (95-100% of maximum heart rate or all out sprint), 30 seconds hands in air (keep moving your legs in the running motion, but put your hand above your head), 1 minute rest, Repeat 10-15 times. 10 minutes easy cool down.

Hard Workouts

One of the difficulties of cross training is replicating those truly lung-busting, difficult workouts.

So, if you’re going to be pool running quite a bit due to injury or limited training volume, invest in a bungee cord designed for sprinters.

Tie one end of the resistance band to a sturdy object (pole, lifeguard stand, pool ladder) and bring the other into the water with you.

Put the strap around your waist and begin aqua jog away from your starting point.

You’ll begin to notice the bungee tighten and resist against you (depending on the length of your pool, you may need to wrap the bungee around the supporting object or tie it in knots to make it shorter to feel resistance).

Spend a few moments testing yourself to see how far you can pull the bungee.

This is a great challenge and a fun way to compete with yourself during an otherwise boring cross training activity.

Now for the hard part:

Pick a point on the pool wall or side of the pool that you feel stretches the bungee to a very hard sprint that you could maintain for 60-90 seconds.

This will be your “sprint” marker that you’ll use on sprint intervals (95-100% of maximum heart rate or all out sprint).

Now:

Find a point that feels like the end of a hard tempo run.

Mark this spot as your “medium” interval distance.

When you complete the hard workouts, you can use these reference points to ensure that you maintain a very hard effort.

The springboard

10 minutes easy warm up, 90 seconds easy (slowly moving out and stretching the bungee), 2 minute medium, 1 minute sprint, 1 min rest (let the bungee pull you back – this is kind of fun). Repeat 10 times. 10 minutes easy cool down.

The race simulation

10 minutes easy warm up, 90 seconds easy (slowly moving out and stretching the bungee), 5 minutes medium (focus and concentrate, just like during the hard part of a race), 30 seconds sprint, 2 minutes rest. Repeat 4 times. 10 minutes easy col down

The lactic acid

10 minutes easy warm up, 90 seconds easy (slowly moving out and stretching the bungee), 2 minutes sprint, 90 seconds rest. Repeat 12 times, 10 minutes easy cool down.

I guarantee that with the bungee, you’ll get your heart rate through the roof.

You can challenge yourself and make aqua jogging more fun by seeing how long you can stay at your maximum stretched distance or seeing how far you can push it.

Likewise, if you have a friend who is injured (or someone willing to be a good sport) you can try pulling each other across the pool for some competitive fun.

Cross training can be tough, especially when you’re injured or want to be increasing your volume faster.

However, I hope that providing a variety of workouts, either through the Fluid Running app (which also makes it easier to keep track of the workout while in the water) or on your own can add a fun challenge in the pool and you can emerge from your injury with minimal fitness loss.

Return to Running

The standard program of eccentric decline squats calls for 12 weeks of eccentric decline squats before returning to sporting activity.

But, one encouraging study of volleyball players who trained and competed while doing the rehab program and still had good success rates indicates that you may be able to return to running as soon as your patellar tendon is ready to handle the loads associated with training10 (which will likely depend on the severity of your injury.

This means a mild case may only require a couple days off, while a more severe case might call for a longer break from running).

We have some helpful advice about returning to running safely, but it is always best to work with a doctor or physical therapist if possible.

 

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References

1. Taunton, J.; Ryan, M.; Clement, D.; McKenzie, D.; Lloyd-Smith, D.; Zumbo, B., A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine 2002, 36, 95-101.
2. Witvrouw, E.; Lysens, R.; Bellemans, J.; Cambier, D.; Vanderstraeten, G., Intrinsic Risk Factors For the Development of Anterior Knee Pain in an Athletic Population: A Two-Year Prospective Study. The American Journal of Sports Medicine 2000, 28 (480-489).
3. van der Worp, H.; van Ark, M.; Roerink, S.; Pepping, G.; van der Akker-Scheek, I.; Zwerver, J., Risk factors for patellar tendinopathy: a systematic review of the literature. British Journal of Sports Medicine 2011, 45 (5), 446-452.
4. Cannell, L.; Taunton, J. E.; Clement, D.; Smith, C.; Kahn, K. M., A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper's knee in athletes: pilot study British Journal of Sports Medicine 2001, (35), 60-64.
5. Visnes, H.; Bahr, R., The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes. British Journal of Sports Medicine 2007, 41 (4), 217-223.
6. Kongsgaard, M.; Aagaard, P.; Roikjaer, S.; Olsen, D.; Jensen, M.; Langber, H.; Magnusson, S., Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats. Clinical Biomechanics 2006, 7, 748-754.
7. Purdam, C. R., A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy. British Journal of Sports Medicine 2004, 38 (4), 395-397.
8. Kon, E.; Filardo, G.; Delcogliano, M.; Presti, M. L.; Russo, A.; Bondi, A.; Di Martino, A.; Cenacchi, A.; Fornasari, P. M.; Marcacci, M., Platelet-rich plasma: New clinical application. Injury 2009, 40 (6), 598-603.
9. Wang, C.-J.; Ko, J.-Y.; Chan, Y.-S.; Weng, L.-H.; Hsu, S.-L., Extracorporeal shockwave therapy for chronic patellar tendinopathy. American Journal of Sports Medicine 2007, 35 (6), 972-978.
10. Young, M. A., Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. British Journal of Sports Medicine 2005, 39 (2), 102-105.

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58 Responses

  1. Nice run down! As someone who has suffered with this in the past, I have used all of these except PRP and I think they were helpful, however the thing that I felt was THE most beneficial was adopting a shorter, more midfoot stride. It would be nice to see the research on that, but I doubt any exists at this point. Great article!

  2. Hello there,
    I have just started to do these eccentric decline squats (1leg) however my issue is balance. I notice when I decline my knee/ leg gets out of alignment & tends to push inwards. To counter this I have been holding a chair for balance assistance only. I assume this is a lack of strength & will get easier? Can you comment on this as I know how important it is to keep your knees/ toes in alignment.
    Thanks!

  3. I am pretty sure this is what put me out of commission most of the winter. Is there any type of compression band that I should be wearing on the knee to reduce the chances of the tendonitis returning? Thanks and great article.

  4. Hey, I have tendonitis in both knees, so would I be able to do the eccentric decline squats since I have to balance on my strong leg, but both of my knees have tendonitis? Thanks.

    1. Hi Karina, sorry to hear about that. If you use both legs to raise your body back up, you should be okay. Just try not to raise up on either one of your knees. Hope this helps!

  5. Hello,

    I was curious, if doing these while beginning to run again, should they be done at a time separate from the run (i.e., run in the morning, eccentric decline squats at night)? Or could they be done immediately before or after at a gym? Thanks.

    1. Hi Neil, you could do them anytime really. We recommend twice a day, so it is likely to be sometime close to your run, but you should not need to go to a gym specifically to do them. Hope this helps!

  6. Will that discomfort in the patellar tendon eventually go away as you continue to do the eccentric decline squats every day?

  7. Hi,

    i am interested in how to strenghten the patellar quadriceps tendon. I want to use skipping technique when running downhill. It seems fast, and safe way to go down, but it gives an extreme load for that tendon, and gets painful. Can you reccommend some excercises for strenghtening that?
    Thank you!

  8. Hi, I have pattelar tendinosis for both knee, difficult even to go to office as it is hurt even for sitting more than 10 minutes, hurt while walking slowlymore than 20minutes. Many times I try to squat on the plain floor it is hurt. Will this exercise helps me?

    1. Hi Yenni, to ease your pain, your best bet is to do the exercises and treatment options we have covered in this post. This will help your knees feel better, and get you back to feeling good!

  9. I have had PT for six years and have scaring on the tendon. I just started physical therapy, am doing the eccentric squats on a slant board. Additionally, the therapist is using a technique called ASTYM to get rid of the scar tissue. This is supposed to accelerate the healing process. Are you aware of this procedure?

    1. Hi Dennis, sorry, we do not currently have any research on ASTYM, but we could look into it in the future. It would be best to just go for it, if it works, then that is great, and if it does not, then you have not lost anything in doing so. Best of luck with the healing process. Keep up the eccentric squats!

  10. Hi I had this same injury last year on only one leg and now I had it this year last year I was out till October to May and this time I have been injured since August and I still am injured I’ve been using those pattelar pattelar tendon Straps and knee supports should I bee using them and should I do the decline squats to help me heal. both of my kneeS have runners knee and I need some help to heal it up its going to be my senior year coming up and I was the best last year before I got injured I really wantEd to to go to states but I diddnt come true cause of this setback I need help and the doctorS gave me shoe supports called super feet

    1. Hi Brent, thanks for reaching out. Sorry to hear about your problems with patellar tendonitis. Have you been doing the exercises we recommended in this post? That would be your best bet to heal it over the summer so you can go into your senior year healthy! Hope this helps!

  11. Hello Coach Tina: I have slight, minor soreness at base of my kneecap (not on the kneecap) since a 5K race a couple of days ago so I’m thinking I may have a touch of patellar tendonitis. But I did run 3 easy miles today with no pain, but to be careful I’ve been icing and taking Ibuprofen. In your opinion (and I understand if you can’t answer this definitively) would it be OK to run easy as long as there is no pain while running or much pain afterwards (which there is not as of now)? Or should I cross train instead for a couple of days and see how it feels (and if so is riding a stationary bike and/or an elliptical safe to allow any inflammation to go down?) Thank you for any info you can provide!

    1. Hi Dave, thanks for reaching out. The knee is a very complex area of the body, with a lot of intersection going on around there. It would be almost impossible for us to diagnose exactly what is going on, and that is where a physician would come into play. You are right (and thank you for noting) that I cannot give you a definite answer, but yes, use pain as your guide. If it does not hurt during or after, you are probably okay o continue. If it does bother you, back off, and cross train, but only using exercises that do not irritate it, if anything does bother it, back off those too and just give it a few days of total rest. Take a listen to this podcast with Physical therapist Jeremy Stoker; he talks a lot about how to tell which pains to run through, and which to stop at https://runnersconnect.net/running-interviews/everything-need-to-know-injuries/

      Hope this helps!

      1. Thanks very much Coach Tina, your info does help and I’ll be sure to listen to the relevant podcast you reference (and listen to my body & focus on the long term)! Just wondering: in your opinion & generally speaking, would it be wise to start doing the eccentric single leg decline squats at this time, even though the soreness at the base of the kneecap is pretty minor at this time, or could this make things worse? I just want to get out on top of whatever this is so as to not let it progress. I’m a masters runner, and one of the toughest things is knowing when to back off or just deal with and run through the inevitable and not infrequent niggles and aches. Thanks again.

        1. Hi Dave, yes, I actually meant to answer that, but missed it somehow. It would be a good idea to start those eccentric squats. They will strengthen the muscles before it does get worse, and may even save you. I understand about being a masters, and you may enjoy some of the other podcasts too, as we have a lot of masters runners, and a lot of our recent posts have been focused on masters runners. Have you signed up for our newsletter? It is better to be safe than sorry, so you are doing the right thing!

  12. Hi Tina, Appreciate the info. I’ll give it a try and use pain as a or the guide. And yes, I receive your helpful newsletter. I’m data-driven and like how your articles are based on credible research distilled into layman’s terms.
    p.s. congrats on your 2:41:10 London Marathon!

  13. Oh, and I would be remiss if I didn’t ask you to thank John Davis for this excellent article and his other articles — all very helpful and much appreciated!

  14. Hi
    i really appreciate the info given here..
    it had many answers to my questions..
    how ever i just want to ask you that can i workout as i have patellar tendonitis for 10 days..
    I’ve been taking ultrasonic cold and heat treatments..
    is it ok to do uper torso workouts and core?? As i understand running is not an option for a long time..
    I do not want to increase healing period and also i cant sit home doing nothing..
    I’d really appreciate if you help me sort this out
    regrds

    1. Hi Swapnil, the best advice we can give you is what we have recommended in this post for your patellar tendonitis. Core and upper body work will not affect your knee, so it should be fine. if you follow our guide, you can get back to running as soon as possible. By doing these exercises you will not be sitting doing nothing, and will be helping your knee heal!

  15. Hi,

    I have had patellar tendonitis now for 1 month in one leg. I wasn’t diagnosed with it till last week though, so I have just learnt about exercises that will help it. My question is, have I stunted my recovery by just now starting the exercises? Also, I can’t seem to do the exercises or walk for 10min without there being significant pain. Do I continue with exercise & walking despite of pain? Or lower the number of sets I do? I’m concerned as it says if you rest too much it’s not good for PT, but if you push yourself too much it’s also not good. Lastly, my good leg now is feeling very sore & tender, a bit like my bad PT leg, so I’m concerned I may have developed some sort of hamstring strain in it due to putting so much pressure on it due to bad leg. Any advice as to what this could be?

    Thank you and sorry for the long questions 🙂

    Han 🙂

    1. Hi Han, it would depend if you have continued to run during this time. If you have been resting, your leg will have been healing, this will just help the recovery, and make sure you strengthen so it does not happen again. Unfortunately it is a delicate balance, and only you will know in your heart if the pain is more than what you should be experiencing. You are probably overcompensating with your other leg, but it may also be because the exercises are so new to your body. If you have not stopped running yet, it would be a good time to take a few days off and allow your body to catch up. Hope this helps! Good luck, and keep up the other suggestions we made in this post!

  16. Thank you for all the info on this page which is very useful. I’ve had this issue for a while and it prevents me from playing football and running. I’m keen to follow the exercises but I struggle to do the Eccentric single leg decline squats. When I start to bend my bad knee the pain starts and it buckles well before the I get to the recomended squat position. Should I just take it as far as possible without buckling? Also my physio has suggested acupuncture twice a week but I can’t see this recomended online. Are you aware if this can help? Thanks.

  17. Hi i have been struggling with this for a few months, i stopped running as i thought it was new trainers causing it and continued with my circuits class, i intially had private physio but this did little to help, now the other knee is the same and the nhs physio diagnosed patella tendonitis, he said to lay off squats then try a gentle run and ice 3 times daily, my question is, is there a safer way to do squats to avoid getting this again when im healed?

    1. Hi Helen, sorry to hear about your pain. Which squats are you talking about? The ones in the post? Those should only help your patellar tendonitis. It might be best to ask your physio about that question as they know your body better than we can see from your comment. The exercises we recommend in this post will prevent future knee problems, so hopefully they can help you!

  18. Hi,
    i was suffering from patellae tendinitis for last 1.5 years, but now pain has reduced and have small pain on knee some times. now i am also suffering from Achilles tendinitis. please advice me good way to cure this. also patellae tendinitis lead to present Achilles tendinitis?

  19. Hey I need some serious help I’m a Xcountry runner and mid distance guy for track. I’ve been having knee issues since may or april (its been so long I can’t even remember when I first got it. I’ve long stopped running to try to get it recovered, iced it so many times over a period of like 5-6 months, stretched it constantly and used a roller extensively, taken more medication in just this period than probably more than the rest of my life combine. I’ve gotten an MRI and they said the results were “Good” all there is is inflammation in the knee, but it still hurts and I know it shouldn’t take this long to heal up.

    1. Hi Mike, sorry to hear about your pain. We have two suggestions for you, either follow the recommendations in this post and that should help to move it forward, or talk to your athletic trainers at your school. It may just be that you are trying to return to running too quickly, make sure you are conservative with your approach. Hope this helps! Sorry we cannot do more, but it is impossible to recommend any more specific without seeing you in person! Good luck!

  20. Hi

    I have had this condition for about 6 months now, I have tried everything, from seeing a physio, loads of stretching, icing, hundreds of normal squats a day, total rest (I have not run for over 3 months now) and still I have pain. It is never really bad but always hurts whilst running enough to know it is a problem. Also, if I do a one legged squat on the flat it really starts to hurt as my knee bends.

    I recently bought a slant board to do the 1 legged eccentric squat exercises. I am not sure if they are doing more harm than good to be honest, I am doing 3 X 15 reps twice daily. Usually the first few hurt a lot, then as the tendon stretches out it gets better, by the end they are much less painful than at the start, I then have about an hour after this of my knee feeling fine, after this it goes back to “normal” of hurting a little whilst walking, and hurting quite a bit if I did a 1 legged squat on the ground, it also hurts after sitting down for long periods.

    in 2 weeks nothing positive has happened, if anything the pain is slightly worse when I walk around and it size’s up worse than before I started, Is this expected? Does it usually get worse before better? I am thinking of chopping it down to exercises every second day, what do you think?

    Steve

    Any help would be appreciated!

    Thanks

    1. Hi Steve, sorry to hear about your struggles with this. As long as you are following the instructions we gave for the exercises precisely, it should definitely be improving….slowly, but moving in the right direction. It might be time to see a different physiotherapist to see if they can see something else going on. Give the every other day exercises a try, to see if that helps. Unfortunately we cannot help much more than that without seeing you. You might find some comfort from listening to our latest podcast episode with Brad Beer, his book may ultimately make you feel a lot more positive about the future. Hope this helps (even a little) https://runnersconnect.net/rc80 let us know if we can do anything else for you!

      1. Hi all

        Just as an update – I started giving 3 x 15 eccentric squats twice a day, but only every second day as I was thinking.

        It was originally it was bordering on agony, but after about 3 weeks things seem to get better, indeed now (about 6 weeks after I started) things are certainly on the up. I’m on daily sessions, usually the first few are a bit painful on a morning but then they sort themselves out, much better. Indeed I went out for a 2 minute “tester” run yesterday – pain free (although it literally was 2 minutes) – I have not been “pain free” since before Christmas.

        I’m writing this as to try and give some other people hope, I really this was my running “career” over but Indeed I think I will be back. I cannot recommend a decline board enough, it is certainly doing what infinite normal squats could not.

        good luck to all suffering from this frustrating condition.

        regards

        1. Hey Steve,

          Just wanted to check in and see if the decline squats worked for you and ever got you back to running normally? I also started doing them, for a week now, and the pain is definitely still there/worse, but I was encouraged by the fact that you had the same experience and then seemed to be improving. Just wondering if you got back to normal.

          Thanks,
          John

  21. I am a 49 year old runner and was an All-American in 10K in college. I have in the past several years started to do triathlon and like to cross train to prevent injury. Recently I have been working with a coach and I have been running 4 days per week and I am getting faster and faster, but now have some symptoms of patellar tendonitis. I have had it in the past and the eccentric single leg squats were helpful. At this point, my knee is painful to the touch and I am wondering whether I should stop running completely or just cut down my mileage? I am also wondering what type of cross training might work and not bother it? I swam 4000 yards yesterday but now it seems more painful. Perhaps the kicking is bothering it? I am not sure. What about biking? I would like to stay in cardiovascular shape and not lose fitness if I decide to take time off.

    Thanks !

    1. Hi Pammy, thanks for reaching out. Sorry to hear about your injury. It would be best to ask your coach about your training, as they are going to know you the best to see what they would recommend. In our experience, it is always better to be conservative than push through and risk making it worse. Cross training will depend on the person,but if it causes you pain, stay away from that form. You might enjoy this podcast episode though as it will show you how you can maintain fitness if you do decide to take time off https://runnersconnect.net/crosstrain We would love to help you more, but we would need to learn more about you and your history. Hope this helps. If you do decide you need a coaching change, we would love to help you get back to health and fitness. Our community is very popular, and many of the runners are in a similar situation to you 🙂

  22. Hello I’ve had patellar tendonitis for awhile now I can’t remember how long it’s been. But I just started doing these eccentric one leg squats today and it seems to be doing good. It hurts when I first start out then after awhile it goes away. I’m trying to get back on the court ASAP. You think if I continue to do these twice daily i shall see a improvement before December?

  23. Really quick should I be doing these squats going all the way down. The lower I go the more they tend to hurt. Or should I be progressing going down as the pain goes away or should I just stay at one a certain level

    1. Hi Brandon, you only need to go as far as we do in the diagrams. It may hurt a little, but as we explained, a little pain is okay with the eccentric exercises, if you are doing them correctly.

  24. Hi, I’ve had this problem in my right knee for a while now, since march I think, from a rugby game.

    The physio I saw told me to rest it for a few months, which I’ve done, however it isn’t getting better. The pain often comes in stints, as it feels alright one day, and then aches significantly the next day.

    I’m going to begin doing the squats that you’ve recommended, however how long should i avoid running or sports for? I’m already missing some of the rugby season, and if i start doing the squats, how long do you think until I can get back to playing?

    1. Hi Michael, thanks for reaching out. Sorry to hear about your pain. We actually made that recommendation in the final paragraph in this post 🙂 we have a separate post for returning to running if you wanted more information on that. Hope you find the squats help, give them some time to start working, but make sure you are conservative in that return to running to prevent it coming back 🙂 https://runnersconnect.net/running-injury-prevention/returning-from-running-injury/

      1. hi, thanks for the reply

        Sorry i have one more question

        While I’m not doing any rugby I’m going to try and gain about 10 to 15 pounds at the gym, and i was wondering whether or not i could do weighted squats at the gym as well as the incline squats, or is that not a good idea? just wondering because I want to add a bit more muscle on my legs while I’m not playing

        thanks

        1. Hi Michael, we would recommend you stick to just the squats we recommended until your knee is a little better. The weighted squats will be putting too much pressure on your knee, and they could make it worse. Once it heals up, you can add them in. Hope that helps! Good luck with your healing!

  25. The knee has already been injured. The best treatment seems rest but not continues having stress on it. Has anyony healed your knee pain after this exercises and how soon?

  26. Hi, what an informative article. I’m sure it helps a lot of people suffering from Patella tendinitis. I got knee pain on my left knee four months ago after a skipping exercise. I got a small bump at the very top of the tibia ( similar to Osgood Schlatter symptom) but my doctor said my case is patella tendinitis because Osgood doesn’t happen on adult. (I’m 40). X-Ray and MRI are unable to identify the “bump” and therefore by deduction the doctor recommendation to take inflammatory medicine and have shockwave, plus some stretching, and muscle strengthens exercise. All are not helpful. I start to suspect whether my case is patella tendonitis? Appreciate if you could advise whether patella tendonitis would have a little bump on the tibia(shin bone) ? And I don’t feel painful at my tendon at all, my flexibility is good and my muscle is not tight or stiff. Thank you and sorry for the king passage.

  27. I’ve had patellar tendonitis for at least 9 months yet was still running 30-40 miles/week and running 5k – 10M races. The pain is most noticeable the first couple of miles, then nearly disappears as I speed up. But I notice the pain again once I slow down (after a race).
    Since being diagnosed a month ago, I’ve been doing eccentric exercises and eased up on my running.
    I really want to know if I can simply scale back my running (half my normal mileage), continue doing the eccentric squads or if any running at all will further damage my tendon.

  28. Hi there, thanks for a great article. I used to be super fit in my younger days, but then did not exercise for a couple of years. Now, months after quitting smoking and packing on 25kgs I started with a work out routine with a friend wich includes 5-6km of running every 2or 3 days. But with the past two running sessions I started feeling the pain and her husband being a doctor confirmed the patellar tendonitis. After this mornings run I am in serious pain. Do you think it will go away as I loose the weight? I feel that the 30% more weight is putting a lot of strain on my joints… and I don’t want to quit now as I am starting to loose weight and can see a difference… any suggestions besides not running? Will a patella strap maybe help?

  29. I have noticed swelling in my knee, and it feels stiff. It started randomly after I finished a run a few days ago. I’m not sure if this sounds like patellar tendinitis? Also should I see a doctor?

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