Guys… patellar tendinopathy is not an issue with muscle length or strength, and often not even coordination/technique. Its an issue with tendon resiliency. Granted, you can check the above things, but only if addressing the tendon directly doesn’t work.
Tendon rehab involves three things:
1- Manage pain to continue training
2- Maintain if not increase heavy loading to increase collagen content of the tendon
3- Use some reactive/elastic exercises to stiffen the tendon
Managing pain to continue training
Isometric contractions of the quadricep desensitises the brain from the pain-sensitising input from the tendon. Basically, isometrics stop your knee from hurting. This effect lasts for around 45 minutes. It also helps contribute to collagen resynthesis in the tendon (part of reconditioning tendon).
These isometric contractions should be 30-60 seconds each, for 1-3 sets a time, 2-3 times per day. It is especially important to do this before lower body training so you can continue to squat heavy (a very important component of rehab).
Isometric exercises that work great are:
- Split squat hold with a floating heel (meaning heel off the ground, weight through balls of the feet)
- Single-leg squat with floating heel, support yourself with your hands for balance
- Single-leg leg extension at 45-60° of bend
- Sissy squat
- Reverse Nordic
Maintain if not increase heavy loading to increase collagen content of the tendon
Heavy loading (and the isometrics) strain the tendons, increasing collagen synthesis in the tendon. Keep your knee-dominant lower body exercises in, and keep them relatively heavy and close to failure (like you usually would). Basically, to start with this, don’t change your training at all
Use some reactive/elastic exercises to stiffen the tendon
A tendon needs to be somewhat stiff and have a lot of collagen. Heavy loading will make sure it has lots of collagen, but will not stiffen it. Stiffening a tendon requires plyometric/elastic/reactive activities.
One of the best options is to do pogo hops/rope skipping for 5-10 minutes immediately after your isometrics. So, again, 2-3 times daily.
Recap
- Isometrics for analgesia and to strain the tendon
- Heavy loading to strain the tendon
- Reactive loading to stiffen the tendon
The tendon recovers in ~6 hours, so if possible, do your isometrics and plyos up to 3 times daily. Continue training your lower body as normal.
Give this 8-12 weeks (approximate time for significant tendkn adaptation) then re-evaluate if you need other therapeutic changes like specific soft tissue work, muscle strengthening or coordination training