If you have tried the eccentric exercise protocol outlined in this website, please provide feedback on whether it was successful or not. Please provide specific details.
Thank you,
Sigfus
I suffered from severely painful patellar tendinitis for 5 years. Now I can complete 100-mile bike rides pain-free. I credit my success to "eccentric exercise." Through trial and error, after reviewing the medical literature, I found a regimen that helped me eliminate knee pain. Do not do these exercises if you have inflammation and until you consult with medical professionals to determine whether these exercises are appropriate for you.
Table of Contents
- Will eccentric exercise cure you?
- What exactly are eccentric exercises?
- The reason for this website
- Other treatments I tried
- Healthy and injured patellar tendons
- Exercising with patellar tendinopathy
- Medical journal articles
- Why few doctors know about this treatment
- Tendinitis, Tendinosis, Tendinopathy
- Video demonstration
- Importance of daily stretching
- My Eccentric Exercise Protocol
- The secret to the protocol
- Required equipment
- Questions I've received
- Prevention
- The importance of diet
- Other Sources on Tendinopathy
- Treatment for inflammatory tendinitis
- Your feedback
- About Me
Photos of Iceland
If you like this website...
Eccentric Exercise for Patellar Tendinopathy
On a slant board with a backpack with weights
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29 comments:
I'd like to add my experience to your notes here because I think it may benefit others to know it.
Due likely to extremely weak legs I developed patellar tendonitis in both my knees and began your program about 4 months ago. At the time I started, my legs were so weak I did not have the strength to go beyond a half squat so I went as far as I had thought comfortably safe, which would ony be between 25-50% of a full squat.
Within 2 weeks I went from chronic knee pain to being nearly pain-free all the time. Encouraged by my results and by the increased strength I began squatting deeper and deeper over an extended period of time, eventually reaching between 50-85% of a full squat, when the pain under my knee cap seemingly abruptly, had fully returned. I struggled from here on in, and it seemed as though I had completely relapsed. Any further strengthening exercises of this type seemed to cause inflamation rather than healing/growth. It took me a while to realize the only variable was the depth at which I was squatting, which was never a concious focus for me during the initial stages and thus easily overlooked.
Doing research I discovered an interesting nugget of wisdom which stated that it is safer and healthier to increase the resistance and maintain the range of your squats if they are working for you than it is to increase the range of your squats, at least in the beginning.
I have since returned to performing the squats at 25-50% of a full single-legged squat on the slant board, and low and behold, I am seeing the progress I saw initially. I am currently at the point where I can perform the squat at 25-50% with 20 reps fairly easily and I am now able to add more resistance.
I believe this is important to note for people interested in starting your program for the first time.
I have found through trial and error that adding more weight and remaining between 25-50% of my squat allows me to strengthen my quad and promote bloodflow to the knee without going deep enough to enflame the tendon, and it is in fact the only quad/knee exercise that has shown any results what-so-ever for me.
I would recommend doing more full squats with both knees and using a physio ball in order to suplement the above exercise, in order to ensure you're getting your full range of motion in when exercising your knees.
I'd have saved myself a lot of grief if I'd had this knowledge before and think it's useful for your readers.
-DM
Ok so I´m in a bit of a situation here and any help would be greatly appreciated. Just like many here I suffer this terrible injury. It all started playing football in high school where it developed to a chronic state. I thought with mere rest the problem would die down. But, after 4 years here I am I´m still hurting really bad.
About six months my knee wasn´t giving me too many problems. However, I wasn´t doing a whole lot either. But, I was offered a new job outside the country and of course accepted. My work requires that I walk great distances almost everyday. I´ve put on a couple pounds and on top of that I have to carry around a couple books with me all day. So with all those factors given my pain has increased significantly and I just need some help.
When I found this website the first thing I did when I got home was find a decline of 25% and do three sets of 15 for each leg. Well, after 3 or 4 days of that my pain was absolutely terrible and I realized the need to ramp up slowly. so I waited a week and tried again only doing 5 squats or so and after three or four days I was again in alot of pain. So I guess I just have a couple questions.
First, can this treatment still be effective for me if I´m going to continue walking alot everyday? second, If my pain increases how long should I wait? and lastly, what do you think about jumproping to lose a couple pounds and take some weight off my knee? I´m in a bit of a tricky situation but I´m willing to do whatever to decrease my pain. Again, any advice would be greatly appreciated.
snibb --
In answer to your questions:
Unfortunately, walking great distances is not advised for people doing the eccentric protocol. And, walking long distances everyday just makes matters worse. Ideally, you would start the protocol after a number of weeks (or longer) of not doing much walking at all. Given that walking is part of your job requirement, the protocol may not be appropriate now for you.
2)I do not recommend jump rope at all for you. Patellar tendinitis/tendinosis is also called Jumper's Knee because excessive jumping can trigger the condition.
I'm not sure if you ever tried patellar knee straps, but these may help reduce your pain. They won't cure you, however. There are a variety of types sold over the internet and in sporting goods stores. You may need to try a variety to find one that works best for you. Ones I like include the Cho-Pat Dual Action knee strap and the BioSkin Q-Baby strap.
Good Luck!
Before I read your website I had started on a programme. Morning and night I went straight to 1 legged squats and increased to 70 (standing flat) over 4 weeks. Then on the incline board I got up to a straight 90 after a further 2 weeks, adding 10 pounds the following week. So at week 7 I was doing a straight set of 90 in the morning and another 90 with a 10pound pack at night.
I dont have constant pain but do get pain when sitting and driving.
Having read your blog it seems I have went for too much too soon. the question is now that I can do it should I continue or back off?
The injury was brought on by running and I have had it for a year, and havent run at all for the past 5 months.
I dont have daily (constant) pain as such but sitting or driving can bring on discomfort.
Having read your blog I think I will avoid the morning, and go for 3 sets of 25 with the 10 pounds at night. Will let you know how it goes.
Sigfus,
I was wondering if you know what causes the pain when seated? Would it be wise to try and keep my leg straight as often as possible? Thanks
-Snibb
Snibb,
When I suffered with patellar tendinitis, sitting was often painful. Sitting puts pressure on the tendon by causing it to be forcefully pulled for a prolonged period.
To see what I mean, try this experiment -- First, extend a leg. Then hold a length of tissue paper (20 cm or 8 inches should do) centered at the knee cap, on the leg. Firmly hold the top and bottom of the tissue paper with your left and right hands. So, one hand will be at your shin, the other at your thigh. Now, bend the leg into a seated position. If you did this experiment, you will see that the tissue paper became very taut and may have broken into two pieces. While your tendon is much stronger than tissue paper, you can appreciate the force on the tendon from bending your leg.
When I had patellar tendinitis, I felt much better when I kept my leg straight. When sitting at a desk at home, I would often extend my bad leg on the desk. At work, I built a platform to extend my legs under my desk.
I recently broke my leg, a spiral fracture which required that a rod be inserted into my tibia. To do this, the surgeon cut the patellar tendon lengthwise. I now have symptoms of patellar tendonitis and am wondering if this is the best way to treat it. I've been told this will be a long term problem from this surgery and the rest of my leg will heal well. This exercise is similar to something my physical therapist had me do, basically stand on a stair and tap down to the floor with my bad leg. Very painful. What do you think?
1) Your situation is different from most others who have chronic patellar tendinitis. In most cases, it is due to an overuse injury from sports. (While your spiral fracture may have been caused by a sports injury, your patellar tendinitis was related to a surgical procedure.)
2) You also indicated that you have a lot of pain when you do a physical therapy exercise that has similarities to the eccentric protocol.
Because of items 1) and 2), I cannot recommend the eccentric protocol to you at this time. I am concerned that the surgical cut to the tendon may have put it in a particularly weakened and vulnerable state and that you may not yet be ready for eccentric exercise. I am also concerned that you have a lot of pain when you do the physical therapy exercise.
In your case, I would encourage you to speak to your surgeon and seek out additional physical therapist opinions on how to proceed. Do they all agree that the physical therapy exercise you are given should elicit a lot of pain? Is that normal? If not, perhaps they can make modifications or change the exercise.
When could you begin the Eccentric Protocol? At some point in the future you may experiment slowly under medical supervision. Stop if it creates pain.
Sigfus,
Just recently found this website and am going to give your routine a try. I've been suffering from this for about a year and half now. I just wanted to ask you if you feel your condition is "cured" or if you still think it's not 100%. I see you've been doing this for years now so just curious. Thanks.
Joshua,
I am cured. In fact, last year (2009) I did a 100 mile bicycle ride in one day and had no patellar tendinopathy symptoms that day or in the days after. This was 5 years after the problem originally started.
Good Luck!
I am happy to have found this website and am tentatively starting out trying eccentric exercise by doing two sets of 10 squats with both legs. I still have not tried a slant board. My question is regarding meniscus surgery. After years of running, about 10 years ago I had lateral meniscus surgery on my right knee which created a bone-on-bone situation in that area. Up until about a year and a half ago my knee was fine for walking and hiking (but not running). Then I started getting pain and stiffness after sitting for long periods of time which evolved into pain during and after walking or hiking. My problem is that I don't seem to be capable of doing a one legged squat because I get crunching of that bone-on-bone situation. When I go down on both legs the crunching doesn't happen. Will doing two-legged squats be enough to cure me of patellar tendinitis, or do I need to find some way to work up to single-legged squats?
T.K. --
Given your prior meniscus surgery and continued problems relating to it, I highly recommend you consult a physician / physical therapist to determine if this exercise is appropriate for you. If it is appropriate, then I believe you may benefit to some degree even if you do a two-legged squat. You may need to make adjustments to the protocol. For example, the treatment might take longer to achieve success. Given your issues, I would be concerned with whether you use much, if any, weight at all as you do the exercise.
Let us know of your progress. Good Luck!
Dear Sigfus,
After following your program do you think that the tendon comes back to strength where it won't be affected by vigorous exercise. Next year I am supposed to be playing soccer for a national championship contending college. I am going to start your program after five monthes of conservative treatment, and 2 autogolous blood injections. Also after your tendon feels better can you start doing regular sqauts and olympic lifts? Do you think that the tendon can ever get back to the point where you can push yourself without having to worry about your knee. I would really appreciate a response on your thoughts because I value your advice.
Thank You,
Cody
Cody,
The severity of your patellar tendinopathy may determine whether the tendon's strength can ever return to where it was pre-injury. My view is that even following the best protocols and eliminating pain completely may not lead to the tendon getting back to 100% of its strength, but perhaps it can get can close. Once you have longstanding patellar tendinopathy, you are at greater risk for it returning in the future. When engaging in any sport or activity, ramp up carefully. You may have to experiment at low levels of mileage, weights, etc... to see what you can do. So, you probably need to be careful. But, there are examples of professional athletes who have rebounded from patellar tendinopathy to become top players in their sport.
Best of Luck!
Sigfus.
I've started doing the eccentric squats about 2 weeks ago. I've been really conservative and have only been doing about 4 sets of 5 single legged squats per leg spread throughout the day.
I had taken a break from any and all activity 3 - 4 weeks prior to this, so at the time of starting I had virtually no pain doing normal activites, such as bending over or sitting up from a chair. I imagine that if, at this time, I had tried doing any sports, the pain would have returned immediately.
As of right now, my knees feel pain when bending or standing from a sitting position. But its different than before. Before, the pain was sharp and concentrated. Now, the pain is spread out more and just feels like the tendon is sore. Kind of how a muscle feels the day or 2 after you get a good work out in.
When standing from a sitting position, I feel pain, but yet somehow feel like I have more strength and support when performing the action.
Is all of this common when starting the eccentric decline squat protocol?
I've tried to take it easy and slow by only doing 5 reps for each set, and not even doing a full 60 reps each day. I also never feel like the pain is horrendous during the squats. There is some discomfort, but definitely manageable. I assume some discomfort is expected since we are, afterall, trying to "re-damage" the tendon in a controlled fashion to help heal the area in a proper fashion.
Just curious if what I'm feeling so far jives with what others have gone through on the road to success.
Jeff --
After starting eccentrics a couple of weeks ago, your pain is no longer sharp and is less concentrated. You wonder if this is typical. In general, some people do start feeling improvement after only a couple of weeks.
You also mention that the eccentrics try to "re-damage" the tendon in a controlled fashion. I would use a different word choice than "re-damage". I would simply say "heal" the tendon, although there is a lot of science still to be done on how and why the eccentrics work.
And, if you haven't already, I'd advise you to consult with medical experts on your condition and whether the protocol is appropriate for you.
Thank you and good luck!
I have a question regarding the eccentric squats you do--do you push through your heels or toes when you're doing the squats? Or both? Do you keep your weight 'centered' when going up and down or are you leaning forward at all? Thanks
Michael,
You are mostly using the area from the toes to the balls of the feet. You also try to stay centered.
Good Luck.
Dear Sigfús ,
I am very thankful for your blog!
Im doin the Eccentric Exercise now for 8 weeks and my pain level in the jumpers knee definitely decreased.
Walking stairs is no longer a problem! but of course i am also trying to get back to my sport! So i will continue to do the squats on a daily basis.
Since one week i feel a little pain in my VMO area, i. e. in inner area above the knee. It feels like this pain comes from the permanent load. I cant really tell whats affected. Maybe the muscle is just exhausted.
Did you also felt this pain sometimes??
Throughout my protocol i stand on a decreased board ( in the gym), sometimes also on a big book ( at home). Almost the same angle.
Do you think this varying methods affect my protocol?
THANKS FOR YOUR BLOG AND HELP!!
Best Regards
Sebastian
Sebastian.
I did not have any pain in the VMO that I can recall. Perhaps, you can try to reduce the load and/or take a break. Please also consult a physical therapist who can help your situation. As for the slant angle, it does matter. A larger angle is tougher. Try to keep the angle constant and similar to the angle shown in the website.
Good luck!
Hello,
I was very happy to discover your website. I have recently been diagnosed with patellar tendinopathy which resulted from a traumatic injury six months ago (a fall while hiking). The first physiotherapist I saw a month after the injury had me doing exercises which did more damage than good, and so two months after my injury I took to my couch and rested for a month in an attempt to get better. The month of rest resulted in my right leg muscles atrophying dramatically. I am now working with a physiotherapist in an attempt to rebuild those atrophied muscles without further aggravating my tendon. Should I wait to start the eccentric protocol when my right leg is rehabilitated? Or can I start the gradual program (eg. a single squat at night, with both legs, on a flat surface, building up according to your protocol). At the moment my condition is severely affecting my simplest daily activities. I went from long distance backcountry hiking, to not being able to walk the length of a mall without setting myself back.
Any suggestions you have would be greatly appreciated!
Rachel
Rachel,
Since you are working with a physical therapist, I wouldn't advise doing the protocol unless your therapist thinks it would work with the exercises they are already having you do. But, I would mention eccentric exercise to see if they think it can be incorporated into your current regimen.
Best of luck!
Sigfus
Hi Sigfús!
I`m a professional soccer player and I`ve struggled with my jumper`s knee almost two years. We have tried everything with my doctor and physio but nothing have really helped. I had operation in January but the pain is still there. I rested last month and the pain was totally gone but when I tried to play again it came back worse than ever. Now I`m thinking to try your eccentric protocol as a final option but there is few questions that bothers me:
How can I now when is the right moment to start your protocol?
Is it OK that the knee is painful when I do eccentric exercises?
Can I do any aerobic training during first couple of months?
Thank you for your excellent sites! (sorry about the language :))
Hi Joner --
Especially since you recently had an operation, make sure that any knee protocol you are following is appropriate. I would consider starting the protocol only if your doctor and physical therapist believe it is appropriate for you at this time. Ideally, you will work closely with a physical therapist who has used eccentric exercise to treat patellar tendinopathy in other patients.
If these exercises increase your pain while doing them, you should stop. Remember to start very slowly.
I would avoid aerobic training that involves your knee during first couple of months.
Good Luck!
Hi Sigfús ,
I just found your excellent blog after weeks of research into Patellar tendinopathy. As the last comment was back in 2013, I hope you are still able to rceive this.
In short, I have patellar tendinopathy in both knees (bilateral) since April 2014. I am just beginning my eccentric rehab program so expect I have many months ahead of me. I had my tendons scanned via ultrasound just 2 weeks ago. According to the consultant, they are not in bad shape (but clearly not good either). I stopped any of my active fitness (weightlifting, cycling) back in late November. That said, whilst I have established a baseline whereby my pain is not reducing anymore (level 1 or 2 out of 10) anything simple will cause it to flare up: a long walk with the family, swimming or just a busy day walking about doing stuff.
Both my consultant sports medicine doctor and my physiotherapist have recommended eccentric squats to reverse the degenerative tendon. It is good that they recommended this before I did any web based research. Since then I have spent many hours researching various sites. I saw your blog and it has given me great hope I can recover back to leading an active life again. I have just bought a slanted board to help with this but will start with very low level loading on a leg press.
My question is this: like many others who have commented on this condition, I am struggling to get started with the rehab. 2 weeks ago, even doing 12 eccentric squats, just the bodyweight, was too much and caused a flare up the next day. As such, the consultant sports doctor I am seeing here in the UK has recommended starting my eccentric loading on a leg press machine with the lowest weight possible:
Use 2 legs to push up to an extended position, then 1 leg to lower down into an eccentic squat.
Obviously, this will not be using the slanted board initially. The hope is I can gain enough tendon strength to be able to use the slanted board in a month or so from now, or whenever I feel ready.
I am waiting for a recent flare up to cool off before I start this program.
Are you aware of anyone who started their eccentric program in such a fashion? I assume that having your foot on a flat plate initially - as opposed to a decline board - will deliver some benefit to the tendon....?
Hi Stuart,
I am not aware of others doing the eccentrics using a leg press machine.
A leg press machine can cause problems if the force you use is too much.
I might try at first using BOTH legs for BOTH the up and down motions. It will reduce the force by spreading it across both legs. So, before I would do anything with one leg, I'd use both and try that, whether on a slant board or a leg press machine.
If you use a leg press machine, I'd also start with the LOWEST weight possible or NO weight at all and wait a day to see if you have problems and only SLOWLY add weight after that, again waiting a day. So, one day on the machine and one day off. If you have any problems, I'd speak with your doctor and add a second day of rest in between. Keep your doctor frequently up to date on your progress or lack thereof.
Best of luck!
Sigfus
Thanks Sigfus.
I agree. My knees are clearly very very sensitive. This is a little different to October, where the exercises my physio prescribed were a little too aggressive (Bosu ball squats, split lunges, light cardio). I feel that had I started eccentric squats back then, my knees woudl easily have handled 1x10 eccentric decline squats per day.
Well, I guess that doesn't matter now. Do you think that if I can get through, 1x10 reps of eccemtric squats on the leg press with 20kg weight (this is the lowest. Zero weight still lifts one plate, which starts at 20kg's) and I have no reaction, do you feel even at this low weight it will be enough to kick start the collagen synthesis? I know that takes 12 weeks minimum to get improvement. I just feel I am at the lowest ebb. 6 months ago I was squatting 60kg's and now I can't even do 10 bodyweight squats without a flare up. It feels desparate and I don't knkw where to begin. Half of me feels just like starting with 3 reps on the flex n go board. Ah....I just don't know
Stuart,
In any event, whether you start on the leg press machine or slant board, I would start with 2 reps the first day and very slowly add every other day as long as there is no real flare up. Too bad the leg press doesn't start at a lower weight.
The leg press machine adds variables of which I have limited familiarity.
Separately, you may want to consider wearing a patellar knee strap on both of your knees for a month or more when walking. I would also avoid long walks, which can flare things up. I would not wear the knee straps all day long because that could lead to knee irritation and other problems. But, some people find the straps helpful to reduce stress on the tendon. The straps are not a cure and you don't want to get too reliant on them.
Best,
Sigfus.
Sigfus,
Thanks very much for the support. You have no idea how helpful this is. I'll report back with an update.
Stuart
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