Treatment course6 min read
Treating patellar tendinopathy: why loading is essential
The most important conceptual shift in treating tendinopathy is understanding that rest is not the solution. Tendon tissue strengthens by adapting to load, and the programme aims to trigger that adaptation in a controlled way.
The isometric stage
Isometric work is used while pain is prominent. The quadriceps contracts with the knee at a fixed angle; with no movement, shear on the tendon is low.
These exercises also have a temporary pain-reducing effect. Applied before training or a match they can let an athlete play without pain.
Forty-five-second holds are done for five repetitions. This stage lasts from a few days to two weeks.
Progressive loading
As pain settles, work moves to slow-tempo heavy loading. The load must be heavy enough for tendon adaptation; light load does not provide sufficient stimulus.
Movement is slow: three seconds down, three seconds up. This tempo gives the tendon the time it needs to adapt.
Load is increased weekly. The criterion is pain not exceeding three out of ten during exercise and the next morning.
Jumping and return to sport
Jumping and landing work is added once strength is built. This stage prepares the tendon for the rapid loading the sport demands.
Hip strengthening continues throughout. With inadequate hip control, most of the jumping load falls on the tendon.
The process requires patience: clear improvement usually takes twelve weeks or longer. Sharing that at the outset prevents the athlete abandoning the programme early.
Key points
- Tendon heals through progressive loading, not rest.
- Isometric work temporarily reduces pain and can be used pre-match.
- Movement is slow: three seconds down, three seconds up.
- Pain criterion: must not exceed three out of ten.
- Clear improvement usually takes twelve weeks or longer.
Frequently asked questions
Should I have a steroid injection?
It is not routinely advised in tendinopathy. It can reduce pain briefly but has been reported to weaken tendon structure and worsen long-term outcomes.
Should I ice it?
It can be comforting when pain is prominent after activity. It does not contribute to tendon healing, however, and does not replace the loading programme.
Should I take a break from sport?
A complete break is unnecessary and not advised. Activities involving jumping and sudden stops are temporarily reduced, with the loading programme taking their place.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.