Jumper’s Knee: 61 Things I’ve Learned [Fix Patellar Tendon Pain]

Break a bone? Everyone knows what to do.

Pull a muscle? Everyone knows what to do.

Hurt a tendon? Nobody has a clue.

Here are 61 Things I’ve learned rehabbing myself, others, reading research, and talking to world experts on Patellar Tendon Pain:

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1) Don’t Jump Through Pain. You’re Compressing Injured Collagens (VIDEO)

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2) Rest Assured: Collagen Turns over Fast, Not Slow (VIDEO)

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3) You Can Do Multiple Sessions Per Day for Tendon Health (VIDEO)

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4) Make Sure Your Foot Accepts Load by Restoring Pronation and Ankle Dorsiflexion (VIDEO)

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5) Do Spanish Squats if You Have No Gym (VIDEO)

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6) Give Your Pelvis and Ribcage What They’re Missing (VIDEO)

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7) Don’t Use Bilateral Squats as Your Primary Means of Patellar Tendon Load (VIDEO)

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8) Train Your Soleus. It’s Protective for the Patellar Tendon (VIDEO)

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9) Split Squats > Squats (VIDEO)

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10) You Don’t Need 36-72 Hours Between Sessions Like This Graph Says. Use Common Sense (VIDEO)

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11) Jumping is More Stressful Than Landing (VIDEO)

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12) A Flared Up Tendon Can Return to Normal if You Give it a bit of Rest (VIDEO)

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13) Lift Heavy to Adapt Your Patellar Tendon (VIDEO)

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14) Load Your Tendon First in the Session (VIDEO)

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15) Train Your Rectus Femurs for Length (VIDEO)

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16) Train Your Healthy Side to Strengthen Your Unhealthy Side (VIDEO)

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17) Try Single-Leg Sissy Squats if You Don’t Have a Leg Extension (VIDEO)

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18) Train Your Quads for Both Strength & Endurance (VIDEO)

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19) Warm-Up Effect: Use it to Load Heavy (VIDEO)

20) Do Isometrics Before Squats to Make Squats Better (VIDEO)

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21) Get Your Calcaneus to Evert (VIDEO)

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22) Try RPR for Tight Quads if You Want (VIDEO)

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23) You Stress Your Tendon More With Approach Jumps Than With Standing Jumps (VIDEO)

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24) Your Quadriceps Tendon is More Loaded in Deep Knee Flexion. Your Patellar in Shallow Knee Flexion (VIDEO)

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25) You Can Clean Up Tendon Degeneration With Straight Heavy Isometrics (VIDEO)

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26) Your Patellar Tendon is Best Targeted Using a 60-Degree Knee Angle on the Leg Extension (VIDEO)

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27) You Need to Do More Than Seated Calf Raises for the Soleus (VIDEO)

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28) Do the Foam Roller Bridge for Your Soleus (VIDEO)

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29) Offload Your Patellar Tendon by Smoothing Out Landings (VIDEO)

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30) Don’t Obsess Over Your Imaging (VIDEO)

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31) ISOs and Lifting Don’t Prepare You for Sport (VIDEO)

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32) Pain Tomorrow Matters More Than Pain in Training (VIDEO)

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33) You Should Be Doing a Variety of Jumps (VIDEO)

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34) Your Posterior Tendon is Most Affected in Patellar Tendinopathy. Use a 60-Degree Knee Angle to Hit it (VIDEO)

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35) How to Run the 4-Stage Process (VIDEO)

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36) Stop Jumping but Keep the Achilles in Tip-Top Shape with Hops (VIDEO)

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37) Stop Jumping but Keep the CNS Fired Up with Flying Sprints (VIDEO)

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38) Make Sure it’s not a Plica (VIDEO)

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39) Make Sure it’s not Patellofemoral Pain – 7 Signs (VIDEO)

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40) Pay Attention to Patellar Tendon Compression (VIDEO)

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41) How You Can Rehab In-Season (VIDEO)

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42) What is Working to Decrease Your Pain? Brain, Muscle, Tendon Adaptation Time Frames (VIDEO)

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43) Differential Diagnosis is the First Step. Patellar Tendinopathy is Often Confused With Other Things (VIDEO)

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44) How to Rehab In-Season for Adolescence (VIDEO)

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45) Your Ankle is Overloaded when Landing with Patellar Tendinopathy (VIDEO)

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46) What’s Missing in Your Patellar Tendon Rehab (VIDEO)

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47) Make Sure it’s Not a Fat Pad Impingement (VIDEO)

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48) If Lifting Hurts, Slow Down the Tempo (VIDEO)

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49) Don’t Change Loads Suddenly (VIDEO)

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50) Train Both Sides Because Both are Probably Degenerative (VIDEO)

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51) Light Up The Brain for Less Pain and More Performance (VIDEO)

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52) Follow an Achilles Progression to Protect the Patellar Tendon (VIDEO)

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53) Your Anatomy Could Make You More Likely to get Patellar Tendinopathy (VIDEO)

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54) Put the “Heavy” in Heavy Slow Resistance (VIDEO)

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55) Regain Knee Bending (VIDEO)

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56) How to Progress Back in to Jumping (VIDEO)

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57) Don’t Lockout Reps When Lifting Slow (VIDEO)

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58) Do Band Assisted Jumps to Get Back to Jumping (VIDEO)

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59) Find Hip and Knee Balance (VIDEO)

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60) Pathomechanics: What Went on that Lead to You Overloading Your Tendon? (VIDEO)

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61) Reactive vs. Degenerative: When You Should Rest (VIDEO)

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REFERENCES

1. Cook JL, Rio E, Purdam CR, et alRevisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?British Journal of Sports Medicine 2016;50:1187-1191.
2. Cook JL, Purdam CRIs tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathyBritish Journal of Sports Medicine 2009;43:409-416.
3. Smeets JSJ, Horstman AMH, Vles GF, Emans PJ, Goessens JPB, Gijsen AP, et al. (2019) Protein synthesis rates of muscle, tendon, ligament, cartilage, and bone tissue in vivo in humans. PLoS ONE 14(11): e0224745. https://doi.org/10.1371/journal.pone.0224745
4. Paxton JZ, Hagerty P, Andrick JJ, Baar K. Optimizing an intermittent stretch paradigm using ERK1/2 phosphorylation results in increased collagen synthesis in engineered ligaments. Tissue Eng Part A. 2012 Feb;18(3-4):277-84. doi: 10.1089/ten.TEA.2011.0336. Epub 2011 Dec 22. PMID: 21902469; PMCID: PMC3267962.
5. Rio, Ebonie PhD^*,†; Purdam, Craig M Sports Phys^*,‡; Girdwood, Michael M Physio Prac^*,†; Cook, Jill PhD^*,† Isometric Exercise to Reduce Pain in Patellar Tendinopathy In-Season: Is It Effective “on the Road”?, Clinical Journal of Sport Medicine: May 2019 – Volume 29 – Issue 3 – p 188-192 doi: 10.1097/JSM.0000000000000549
6. Magnusson, S., Langberg, H. & Kjaer, M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol 6, 262–268 (2010). https://doi.org/10.1038/nrrheum.2010.43
7. Rosengarten SD, Cook JL, Bryant AL, Cordy JT, Daffy J, Docking SI. Australian football players’ Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study. Br J Sports Med. 2015 Feb;49(3):183-7. doi: 10.1136/bjsports-2013-092713. Epub 2014 Apr 15. PMID: 24735840.
8. Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Med Open. 2015 Dec;1(1):7. doi: 10.1186/s40798-015-0009-9. Epub 2015 Mar 27. PMID: 27747846; PMCID: PMC4532714.
9. Docking SI, Ooi CC, Connell D. Tendinopathy: Is Imaging Telling Us the Entire Story? J Orthop Sports Phys Ther. 2015 Nov;45(11):842-52. doi: 10.2519/jospt.2015.5880. Epub 2015 Sep 21. PMID: 26390270.
10. Breda SJ, Oei EHG, Zwerver J, Visser E, Waarsing E, Krestin GP, de Vos RJ. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021 May;55(9):501-509. doi: 10.1136/bjsports-2020-103403. Epub 2020 Nov 20. PMID: 33219115; PMCID: PMC8070614.
11. Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. J Orthop Sports Phys Ther. 2015 Nov;45(11):887-98. doi: 10.2519/jospt.2015.5987. Epub 2015 Sep 21. PMID: 26390269.
12. Rio E, Docking SI. Adaptation of the pathological tendon: you cannot trade in for a new one, but perhaps you don’t need to? Br J Sports Med. 2018 May;52(10):622-623. doi: 10.1136/bjsports-2016-097325. Epub 2017 Jul 19. PMID: 28724715.
13. Hannington M, Tait T, Docking S, Cook J, Owoeye O, Bonello C, Emery C, Pasanen K, Edwards S, Rio E. Prevalence and Pain Distribution of Anterior Knee Pain in Collegiate Basketball Players. J Athl Train. 2022 Apr 1;57(4):319-324. doi: 10.4085/1062-6050-0604.20. PMID: 34329433; PMCID: PMC9020603.
14. Mersmann F, Laube G, Marzilger R, Bohm S, Schroll A, Arampatzis A. A Functional High-Load Exercise Intervention for the Patellar Tendon Reduces Tendon Pain Prevalence During a Competitive Season in Adolescent Handball Players. Front Physiol. 2021 Mar 10;12:626225. doi: 10.3389/fphys.2021.626225. PMID: 33776790; PMCID: PMC7987778.
15. Xu, Datao & Lu, Zhenghui & Siqin, Shen & Fekete, Gusztáv & Ugbolue, Ukadike & Gu, Yaodong. (2021). The Differences in Lower Extremity Joints Energy Dissipation Strategy during Landing between Athletes with Symptomatic Patellar Tendinopathy (PT) and without Patellar Tendinopathy (UPT). Molecular & Cellular Biomechanics. 18. 10.32604/mcb.2021.015453.