What are some eccentric recovery exercises for patellar tendinopathy besides decline squats?

Eccentric Recovery Exercises for Patellar Tendinopathy Beyond Decline Squats

Eccentric cycle ergometer training is the most effective alternative to decline squats for patellar tendinopathy, demonstrating superior strength gains, improved daily activity levels, and greater quadriceps muscle hypertrophy when initiated early in rehabilitation. 1

Primary Alternative: Eccentric Cycle Ergometer

• Eccentric cycle ergometer training produces greater strength gains, better daily activity levels, and increased quadriceps muscle hypertrophy compared to traditional rehabilitation when started at 3 weeks instead of 12 weeks after injury. 1
• This modality shows beneficial effects persisting up to 1 year with no adverse effects on pain or swelling. 1
• Progressive eccentric exercise using a recumbent eccentric ergometer has been validated in multiple studies for lower extremity tendinopathy rehabilitation. 1

Flywheel Resistance Training

• Flywheel resistance training can be successfully used in patellar tendinopathy populations, offering the advantage of combined eccentric and concentric loading. 1
• Use moments of inertia ranging from 0.05 to 0.145 kg·m², with 6-8 repetitions for 3-6 sets, training 2 times per week. 1
• The mechanical work performed during the eccentric phase stimulates specific neuromuscular and morphological adaptations that support tendon healing. 1
• Flywheel exercises (e.g., squats, leg curls) should be progressed systematically with monitoring of mechanical outputs for optimal rehabilitation. 1

Open Kinetic Chain Exercises

• Seated knee extension exercises can be safely introduced at 4 weeks, starting from 90° to 40° of knee flexion, progressing to 90° to 0° by week 6. 1
• These exercises show no differences in laxity, strength, pain, range of motion, or functional activities when compared to delayed introduction. 1
• Monitor for anterior knee pain during progression, as this is a key indicator for load adjustment. 1

Leg Press with Eccentric Component

• Leg press exercises initiated at 3 weeks can improve subjective knee function and functional outcomes in patellar tendinopathy. 1
• Include both eccentric and concentric components during the movement. 1
• This exercise provides benefits for faster recovery without compromising stability. 1

Isometric Quadriceps Exercises

• Static quadriceps contractions and straight leg raises can be safely prescribed during early rehabilitation (first 2 postoperative weeks for post-surgical cases, or early acute phase for non-surgical tendinopathy). 1
• These exercises confer advantages for faster recovery of knee range of motion without compromising stability. 1
• Isometric exercises are particularly useful when eccentric exercises are too painful initially. 1

Exercise Prescription Principles

Loading Parameters

• Exercise should be performed with some level of discomfort—training into tendon pain rather than avoiding it entirely produces better outcomes. 2
• Most effective programs are home-based with twice daily training for 12 weeks. 2
• Athletes should be removed from sports activity during the intensive rehabilitation phase. 2

Progression Strategy

• Progress intensity and volume systematically, ideally with monitoring of mechanical outputs. 1
• Load progression should be monitored alongside anterior knee pain levels. 1
• Maintain adequate protein intake (≥1.6 g/kg body mass) during rehabilitation to prevent muscle loss and support tendon healing. 3

Important Clinical Considerations

Common Pitfalls

• Avoid complete immobilization, as this leads to muscular atrophy and deconditioning—tensile loading stimulates collagen production and guides normal alignment of newly formed collagen fibers. 1
• Do not rely solely on one exercise modality; combine different eccentric exercises with other suitable training methods. 1
• Avoid drastic reductions in energy intake during rehabilitation, as metabolic demand of tissue recovery is high. 3

Treatment Timeline

• Most patients (approximately 80%) with patellar tendinopathy fully recover within 3-6 months with appropriate conservative treatment including eccentric exercises. 1, 4, 5
• Physical therapy with eccentric exercise programs remains the mainstay of treatment for patellar tendinopathy. 6
• Surgical evaluation is warranted only if pain persists despite 3-6 months of well-managed conservative treatment. 4, 5

Adjunctive Therapies

• Cryotherapy provides acute pain relief through 10-minute applications of ice through a wet towel. 1
• NSAIDs (oral or topical) offer short-term pain relief but have no effect on long-term outcomes. 1
• Corticosteroid injections may provide short-term relief but increase risk of tendon rupture and should be used with caution. 1, 6