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Exercise effective for patella tendinopathy?

5th Dec, 2022

Key Points

  1. Patella tendinopathy is pain over the patella tendon
  2. It usually affects athletes who jump, land and are involved in sports with changes in direction 
  3. Isometric exercise is particularly helpful in reducing patella tendon pain 

What is patella tendinopathy?

Patella tendinopathy is prevalent in sports which require frequent jumping, landing, and changes in direction and most commonly presents as localised pain at the bottom of the knee cap. There are currently few successful in-season loading protocols, as an eccentric exercise that has been shown to be helpful in several rehabilitation studies can be provocative when added to the already high loads during the competition season. 

How is patella tendinopathy usually treated?

Heavy slow resistance (isotonic) and isometric exercise have been shown to reduce pain and allow continued sports participation with high adherence. Isometric exercise has been shown to reduce patellar tendon pain immediately as well as immediately improve muscle performance and strength.

What is the problem when you travel for a game?

Practically, a reduction in pain (and functionally an improvement in quadriceps maximal voluntary contraction) means that isometric exercise may have the potential to be used immediately before your games and training sessions without causing deficits in muscle performance. However, one of the challenges during the competitive season is access to strength training equipment when you are playing “away” or travelling because facilities may not be available.

Therefore, while strength training, and in particular isometric exercise has been shown to be beneficial in-season for patellar tendinopathy, it may not be feasible to complete regularly if the equipment is not available i.e. a knee extension machine. So what exercises can be done when you are on the road and without any equipment?

A study by Rio and colleagues was done in 2019 to test the effectiveness of an isometric Spanish squat exercise that can be performed in teams who regularly travel, without access to gym equipment.

Athletes were advised to complete 5 repetitions of a 30-second double-leg squat using the rigid belt.

No sham condition was offered because these athletes were in-season, had pain, and were looking for symptom relief because these teams were travelling and couldn’t afford a sham treatment while on the road. 

Isometric Spanish squats to reduce patella tendon pain

What did they find?

There was a 49% reduction in pain when they performed their single leg descent squat, which is very important!

This study demonstrates that a simple, double-leg isometric squat exercise using a portable rigid belt reduced patellar tendon pain in a real-world sporting environment across different sports. These results have immediate clinical applicability for athletes in-season, where there is a dearth of loading protocols to reduce patella tendinopathy pain and enable continued sports performance.

How does this information help me with my patella tendinopathy?

This study demonstrates that an isometric squat exercise offered in-season in athletes with patella tendinopathy, has good adherence and reduced pain across different sports and schedules. Although it would not replace a comprehensive rehabilitation that includes progressive strength, energy storage, and release activities than sports- specific functions (reserved for the off-season), it does provide you and your treating Physiotherapists with a practical in-season option, given the challenges around time, pain, equipment, and the inability to complete thorough rehabilitation during the competitive season. Further, given that the exercise is easy to perform and requires minimal equipment, it may be helpful to you and your Physiotherapist who do not have access to specialised equipment. This isometric squat exercise may be especially beneficial for sports in which travel schedules limit access to more conventional means of a knee extension.

Unsure of what to do with your patella tendinopathy when you’re experiencing pain in the front of your knee? Contact us to speak today for an appointment with our Physiotherapist, who will be able to determine the source of your pain and treat it as soon as possible! We will also be able to prescribe the most appropriate exercise for your patella tendon pain. 

DISCLAIMER: This advice and exercise should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercises should be carefully selected to suit your condition.


Rio E, Purdam C, Girdwood M, Cook J. Isometric Exercise to Reduce Pain in Patellar Tendinopathy In-Season: Is It Effective “on the Road”? Clin J Sport Med. 2019 May;29(3):188-192.

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