2 Important Steps to get back to Running after a Knee Tendinopathy Issue

Understanding Your Knee Tendinopathy Pain –

Runners Knee Management & Return to Sport || Battersea



Today we are going to take a deep dive into knee or patella tendinopathy issues. This is a problem that affects numerous runners, causes considerable pain and often prevents you completing the running training you had planned. So we will discuss the causes of your knee tendinopathy pain, and importantly why this may have started in the first place. Starting the right early intervention is important and so we have two key early phase rehabilitation exercises to help you settle your patella problem but also to begin to build tissue tolerance in your knee again. Finally, we are going to jump forward to the final stage of your knee rehabilitation traiing programme and help you understand if you are ready to return to running, or begin the process of starting your sports training again. It all comes down to good testing and we have a great but simple plan for you to follow. Get ready to get your knee tendinopathy issue on the right track and you back to the sports and activities you enjoy.

This condition is often defined as Runners Knee, or Jumpers Knee, and the pain will be at the front of the knee just underneath the patella or kneecap. The bone that sits and floats over the front of your knee joint, which has the patella tendon attached to it which runs down and attaches into your upper shin bone at the notched called the tibial tuberosity. So if this identifies as the area you feel your knee pain is, on the soft tendon area just below the kneecap, then it is likely you have a knee tendinopathy issue.

Our team of chartered physiotherapists have wokred hard to build a clear treatment pathway for knee related tendinopathy issues, including patella tendinopathy, ITB syndrome along with insertional hamstring tendinopathies. Review our pathway outline and find out how you can get back to the activities and sports you enjoy – Resolving Tendinopathies

So why has this happened to you? That is the million dollar question. There is rarely one reason for a patella tendinopathy issue beginning, it will generally have a multitude of issues that arise. Problems can occur related to increased in training intensity, increase in training volume, start of the season training, new shoes can change the biomechanics and cause loading issues that can set off knee tendon issues, along with this biomechanical loading issues can increase stress on the tendons, poor gluteal strength and activation can increase quad (front of the thigh) loading placing more stress on the patella tendon. It is worthwhile reviewing what you are doing now and the effect it might have on your knee loading.

You will tend to experience a localised dull ache on the patella tendon, that can be sharp in the morning on initially moving, will ease as you walk or move for a period of time. If you sit still for longer than twenty minutes you will find that it stiffens up again. Running and sport will create a sharper pain that is more acute, it may settle at first but with continued loading it will become a bigger problem, work on your strategy to resolve the knee problem not just training through it. Building tissue tolerance in your patella tendon will be the plan to get you on the road to recovery.

Settling down your pain is the first key step with any tendinopathy issue, and static loading of the tendon is the best way to begin the healing process, while managing your pain levels. In the video we go through two absolutely crucial starting points for your patella knee pain, namely the;

  1. Wall Squat – build up to 3 minutes of holding, but early on rest as you require. Get your angles right so you are 3 full steps from the wall, this will put you in a diofferent position to the traditional skiing wall sit exercise, decreasing the load on your kneecap and allowing you to improve your inside quadriceps muscle endurance.
  2. Incline Small Knee Squat & Holds – again build up to complete 3 minutes of training, but rest as you need while you buid the knee tissue tolerance and statically load the patella tendinopathy issue.

There are many different treatment options to address patella, or knee, tendinopathies and the options are discussed in more detail on our dedicated tendinopathy page , including a discussion on the wonderful effects of shockwave treatment to help settle your knee pain to start your journey to recovery.

These key exercises with soft tissue release work will really help begin to settle your knee pain down and allow you to begin to function better with normal daily activities. You will find that this stage can take anywhere from 3-10 weeks to move through but you must keep progressing so you do not remain static in your training. This will slow down your rehabilitation form your knee injury and means you are not moving foreward wiht your recovery.

It is important not to return to sport from a knee tendinopathy problem before your body has had time to recover and you are strong enough to avoid further injury or issues with your knee. Making this call is one of the hardest so we have put together a simple progressive assessment plan for you to evaluate where you are and if you are ready to return to running or your sport. This is all clearly laided out in the knee tendinopathy video attached but so you can see the plan and follow the structure the steps are as follows;

  1. Double Leg jump onto a step – asking the quadriceps muscles to work dynamically driving you onto the step but due to the loading plan reducing the initial stress on the patella tendon. This should be completed and pain free before you progress onto step 2.
  2. Double Leg Jump onto a step and immediately down onto the floor – asking your muscle to load dynmaically though the tendon and yhen immediately land on the knee increasing the loading forces through both the joint and the patella tendon.
  3. Double Leg Jump from a step down to the ground and immediately explode into a jump forwards – so asking your muscle and patella tendon to absorb the loading forces of landing down onto the floor and then to push through and dynamically take off again. This puts good stress levels through the patella tendinopathy issue and will test it is ready for sport and running.
  4. Single Leg Jump from a step down to the ground and immediately explode into a hop forwards – so this is the same but as most sport challenges the body to control and load during single leg events this has been added as the best option to test single leg loading.

When you have successfully completed this testing phase for your knee or patella tendinopathy recovery, you will be ready to return to both running training and your choosen sport safe in the knowledge that your body and injury have recovered and you will be able to build your return programme plan. It is important to develop your strength training programme especially for hip power and range of movement, this is crucial to protecting your knees long term from injury and problems.

Remember to follow the steps, go through all the knee tendinopathy recovery phases, spend the required time at each step to allow you body to build tissue tolerance and muscle strength and improve your movement patterns and control around the hip and back regions to reduce stress into your knee injury. We are here to help guide you and I suspect you will need the input of a physiotherapist, our team in Battersea as excellent at working with knee tendinopathy issues, to achieve the best results in a focused manner but you can get back to your sport again, and if work hard you cna be faster and more dynamic than before your injury.

Resolving Knee Tendinopathy Problems for Return to Sporting Success