If you're struggling with patellar tendonitis, chances are you've been told to do squat exercises to get back to running sooner. But have you ever wondered why they help? And do you know how to do them properly without worsening your injury?
Many runners do squats until the pain goes away, then go back to running only to find the pain returns soon after. Some people with patellar tendonitis do squats without any relief at all.
Squats are a great tool for treating patellar tendonitis, but knowing how to do them properly is key.
This article discusses why squats work, how to adapt them properly for the best results, and what pitfalls to avoid so you can get back to running pain-free again.
Why the squat exercise can help with patellar tendonitis
When injured, your patellar tendon loses some strength, meaning it can't tolerate loads as well as before. Injured patellar tendons are also very sensitive to compression, stretch, and sudden load increases.
Considering these factors and the current research, the most important exercises for patellar tendonitis are those that 1) strengthen your tendon and restore its capacity to cope with your sporting loads and 2) be adaptable, allowing you to carefully balance each element of stress (compression, stretch, and sudden loads) as your tendon heals.
Squats work well because they meet both of these needs.
But, as useful as squats may be for patellar tendonitis rehab, they can slow your progress or worsen your injury if you're not doing them correctly.
That's why it's crucial to know how to adapt your squats to match your stage of recovery.
How to adapt your squats correctly
During your patellar tendon strengthening program, you'll need to adapt your squats to meet your unique goals at each phase of your recovery.
There are different ways to do this, including:
By looking at each in more detail, you'll better understand how to modify your squat during rehab.
Type of contraction: Isometric, isotonic, or plyometric?
Different types of muscle contractions place different demands on your tendon. So, the first thing you need to consider when adjusting your squats is the type of contraction you’re using.
The different types of contractions are:
Isometric contractions are most effective for early-stage tendonitis when your tendon is very sensitive to load.
Isometric squats or exercises involve holding the contraction in different positions rather than moving through a range of motion.
- These are lower-load exercises, so they are less likely to aggravate the tendon as much as the other types of contractions
- They are easy to control
- They are good for early-stage rehab
- They have been shown to help reduce patellar tendon pain
Isotonic contractions place more load on your tendon, and you should usually only start them once it can tolerate isometric exercises and your tendon’s irritability has started to decrease.
Isotonic squats or exercises usually involve moving through a range of motion rather than holding in one position. So your muscles and tendons shorten and lengthen as you move, making these exercises more challenging for your tendon.
- Isotonic contractions are good for building strength in both directions (as the tendon lengthens and shortens)
- They resemble the movements you do in your daily life and sport
- They strengthen the tendon through its full range of motion
Plyometric contractions (jumping and hopping) are the most advanced types and should only be done once you’ve restored a good base level of strength in your tendon via heavy loaded isotonic exercises.
Plyometric exercises involve explosive movements that place high demands on your tendon.
- Plyometrics are good for training your tendon to cope with high-level forces
- They are vital in the later stages of rehab to get your tendon ready for jumping and running sports
Range of motion
The more you bend your knee, the higher the load on your patellar tendon. When your tendon is very sensitive, it may not tolerate deep squats where your knee has to bend fully.
That's why it's best to start your strength training in positions where your knee doesn't bend too much. For example, you can do a high wall sit exercise for isometrics or high box squats for isotonics.
You should gradually increase the depth of your squat as your tendon becomes stronger and less sensitive until you reach a full-range squat without pain.
Research shows that running and jumping can place a level of force up to several times your bodyweight on your legs.
So, when rehabilitating your patellar tendon, you need to expose it to more and more loads. This way, you'll restore your tendon’s full strength and prepare it properly for returning to your sporting activities.
It's crucial to build this tolerance gradually.
Any weight or load you add to your squats should match your tendon’s current strength and sensitivity. Increasing the weight too suddenly can worsen your injury.
A typical weight progression for squats involves:
- Starting with double-leg exercises and bodyweight only
- Adding weight to double-leg squats
- Later, progressing to single-leg squats
- And finally to plyometric exercises like squat jumps
The app is designed to apply all these principles of progression when selecting your exercises. It helps you to do the most appropriate exercises at each stage of your recovery.
Common pitfalls with squat exercises
There are several ways to progress your squats, but sometimes people get it wrong, which sets their rehab back. Here are a few common mistakes to avoid:
Not pitching or progressing your squats correctly
People often do too much too soon or don't progress their exercises soon enough. In both cases, you risk not getting the full benefit of the exercise or aggravating your injury.
You should avoid sudden load increases and always start with light loads. Once your tendon has fully adapted to these, you can aim to increase them gradually.
Knowing when you're ready to move to a higher load level and when you should stay at the same level is essential for progressing safely through your exercise program. The app uses your feedback after workouts to help you better manage your workout intensities.
Using poor form during your squats
Another common mistake is using poor form or technique when doing squats. Whether your hips, knees, and ankles are not aligned properly, or you’re doing the exercise too quickly, it can put unnecessary strain on your patellar tendon and worsen your pain.
In our article about how to perform a bodyweight squat with good technique, you can learn more about preventing this. The app also provides clear instructions and videos to help you get into the right position and maintain good form throughout your exercises.
Doing your exercises too often
Your body requires a recovery period after exercise to repair and strengthen itself. If you train too often and don’t allow it to fully recover, you can make your injury worse.
The recovery time you need depends on the type of exercise you do and increases as you start doing heavily-loaded and plyometric exercises. The app takes this into consideration when it suggests your ideal training plan.
Not understanding your pain
It's important to know that some pain is expected and OK when recovering from patellar tendonitis.
Fearing and avoiding pain at all costs, or ignoring and pushing through it, will only delay your recovery or worsen your injury.
The good news is that you can use pain to guide you through rehab. It's all about knowing your baseline pain levels and what pain ranges are safe for you to work in.
If you want to learn more about managing your patellar tendon pain and using it as a guide, our patellar tendonitis pain management article has all the advice you need. The app uses your feedback about your symptoms to adjust your exercises, which helps keep your recovery on the right track.
Patellar tendonitis is a common overuse injury in runners that you can treat effectively with the right exercises. Squats are one of the most important exercises as they help restore the tendon's capacity and are highly adaptable to the individual.
There are a few pitfalls to avoid when doing squats, but by knowing how to pitch and progress your exercises correctly, using good form, and understanding how to use pain as a guide, you can stay on the path to recovery.
The patellar tendonitis rehab program in the app is a great resource for any runner trying to overcome this injury. It considers all of the principles discussed in this article and provides a step-by-step guide to help you get better.