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Quadriceps tendonitis exercises to avoid (and what runners should focus on instead)

A runner with quadriceps tendonitis doing exercises and wondering what to avoid.
Maryke Louw
Maryke Louw
Mar 20, 2024
Medically reviewed by
Kim Van Deventer
This article explains what exercises to avoid with quadriceps tendonitis (and why) and what to do instead for the best results.

How tendonitis affects your quadriceps tendon

Once injured, the quadriceps tendon:

  • Loses some of its strength and endurance
  • Becomes very sensitive to being stretched and compressed

Why it matters - This is why movements and activities that used to be OK now suddenly hurt.

Quadriceps tendonitis exercises to avoid (initially)

1. Quad stretches

Runners with quadriceps tendonitis are often told that their quads are too tight and to blame for their injury. But, the research doesn't support this advice, and these stretches often increase pain.

Why quad stretches cause trouble

Your quadriceps tendon attaches your quadriceps (front thigh muscles) to your kneecap.

Anatomy of the quad muscles and quadriceps tendon.

When you stretch your quads, you pull the quadriceps tendon tight over the lower end of the thigh bone, causing it to press against it - this often irritates an injured tendon, similar to pressing on a bruise.

Examples of stretch exercises to avoid

What to do instead

  • Strength training exercises (like those listed below) restore your tendon's strength and capacity to tolerate loads.
  • Progressing your strength training exercises from positions of low stretch to positions of more stretch also helps improve your tendon's tolerance to compression.

2. Deep squats (below 90-degrees knee flexion)

Squatting too low too soon can often increase your pain.

Why low squats cause trouble

The deeper you squat, the more your quadriceps tendon stretches and compresses against your thigh bone (pressing "the bruise" again).

Examples of deep squats

What to do instead

  • Start with shallow (high) squats
  • and slowly increase your depth as your tendon recovers.

We explain how to do this below.

You can add them later

You can add these exercises later in your rehab plan once your tendon has recovered enough to tolerate them.

The Exakt Health app simplifies managing quadriceps tendonitis and understanding your body's limits. The App, designed by expert physical therapists, offers personalized exercises and robust monitoring tools that help you determine your tendon's load tolerance and track your recovery progress.

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Evidence-based rehab plans for Quadriceps Tendonitis
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Male runner using the Exakt Health app's exercises to recover from quadriceps tendonitis.

The best exercises for quadriceps tendonitis

Strengthening exercises are best for recovering from quadriceps tendonitis.

General exercise guidelines

It is usually OK to feel a slight discomfort while doing the exercises (up to 3/10 on a pain scale as long as:

  1. The discomfort caused by the exercises settles back down shortly after you stop the workout
  2. AND it doesn't significantly increase your tendon pain in the 24 hours following the exercises.

Progress or adapt the exercise dosage accordingly:

  • If your pain flared up significantly, reduce the amount you do;
  • If your knee tolerated it well, continue with that level of exercise or even increase it slightly

Top tip

Check the instructions of the exercises for tips on how to adapt the exercises if they cause you trouble.

1. Isometric squats

With isometric squats, you maintain (hold) the squat position for several seconds.

Benefits of isometric squats include:

  • Reducing pain
  • Helping restore your quadriceps tendon's strength
  • Getting the tendon used to compression by lowering the position slowly over time

Start with:

  • High wall-sits - the more you flex your knee, the higher the load on the quadriceps tendon
  • Short duration holds - longer holds require better endurance
  • Using bodyweight only

You can progress the isometric squat exercise by:

  • Increasing the hold times
  • Lowering your position until your tendon tolerates holding it at a 90-degree knee bend
  • Adding or increasing the weights
  • Doing them on 1 leg instead
  • Doing more repetitions

Don't rush your progress

It's easy to flare your pain up if you increase your exercise load too quickly. For instance, instead of increasing the weight AND holding the position for longer, pick just one to increase.

How often can you do them?

How often you can do these exercises will depend on how well your tendon tolerates them:

  • Some people get better results when they do them daily (even with added weights)
  • Others find that their tendons require a day or two of recovery time between sessions
  • Test what works best for you

2. Isotonic squats

Isotonic squats are any squat exercise where you repetitively move in and out of the squat position.

Benefits of isotonic squats include:

  • Restoring your quadriceps tendon's functional strength (they mimic the movement we use when running and walking)
  • Gradually restoring your tendon's high-load strength
  • Restoring your tendon's tolerance to high compression forces

Start with:

  • High box squats - the box prevents you from accidentally squatting too low if your tendon's not yet ready for it
  • Bodyweight only
  • Supported on two legs

You can progress isotonic squats by:

  • Squatting deeper - although it's usually best not to squat below 90 degrees until you've fully recovered
  • Adding or increasing the weights
  • Doing them on 1 leg instead of 2
  • Doing more repetitions or sets

Remember, the best way to avoid flare-ups is to increase it slowly.

Leave at least 2 to 3 days between doing these exercises:

  • Isotonic squats (especially once you progress them) count as high-load exercises for your quadriceps tendon.
  • Meaning that your tendon needs more time to recover after them.
  • If you do them too often, you will likely overload your tendon and flare up your injury.

How much strength do you need?

How much strength your quadriceps tendon needs depends on your sporting and activity goals. For instance, someone who wants to get back into running must build more strength than someone only interested in walking.

3. Hopping and jumping

Plyometric exercises (hopping and jumping) mimic the squat action but use quick, forceful contractions. These exercises are only required if your ultimate goal is to get back to a running or jumping sport.

Benefits of plyometric exercises include:

  • Restoring your tendon's ability to tolerate the forceful contractions created by running and jumping

Start with:

  • Shallow jumps - the higher you jump, the higher the load
  • Jumping on 2 legs

You can progress plyometric exercises by:

  • Jumping higher
  • Jumping further
  • Jumping into different directions
  • Jumping on 1 leg instead of 2
  • Doing more repetitions or sets

Plyometric exercises also count as high-load exercises

To allow enough recovery:

  • Only do them once or twice a week
  • and leave at least 48 hours between sessions.

Be strategic about your training

If you do running and jumping sports, these are high-impact activities. Keep your heavy strength sessions away from high-load sports in your training diary to help prevent tendon overload.

How we can help

The Exakt Health app guides you through the rehab process step by step. It provides straightforward advice on when to progress, maintain, or take your exercises back a level — helping to minimize flare-ups and keep you on track with your recovery.

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Female runner using the Exakt Health app's exercises to recover from quadriceps tendonitis.
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Maryke Louw
Maryke Louw
Maryke Louw is the Medical Lead at Exakt Health and a chartered physiotherapist. She has a BSc in Physiotherapy and an MSc in Sports Injury Management and has been working with athletes of all abilities and ages for more than 20 years. Maryke combines her extensive knowledge of sports injury treatment with the latest research to provide effective injury treatment and prevention advice.
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