Table 2.

Patellar Tendinopathy Management Strategies^a

Phase	Symptom Management and Load Reduction	Recovery	Rebuilding	Return to Unrestricted Sport Participation
Time	Wk 0–4	Wk 2–6	Wk 4–12	Wk 12+
Load management
Visual analog scale score	<5 cm	<5 cm	<3 cm	<1 cm
Sport participation and volume	<25%	<50%	<75%	100%
Goal	Understand condition, training loads, and pain tolerance to ↓ stress on patellar tendon	Gradually ↑ physical activity and introduce progressive loading programs	Continue to ↑ patient load capacity during physical activity and exercise program	Symptoms should be minimal to none during physical activity and progressive-loading phases
Activity modification	Replace jumping, squatting, etc, with cycling or aquatic therapy	Begin integrating submaximal jumping and squatting into exercise regimen	Begin introducing maximum jumping and moderate plyometric training	No restrictions
Exercise paradigm and progression	Complete exercises daily Isometric quadriceps activation (“quad sets”) sitting on table in full knee extension: 5 reps, ↑ time from 30 to 60 s each Isometric quadriceps contractions with leg-extension machine: 5 reps, ↑ time from 30 to 60 s each Spanish squat: 5 reps, ↑ time from 30 to 60 s each	Complete exercises daily Concentric double-legged knee extensions: 3 × 10 at tolerable weight, ↑ to 3 × 15, guided by pain-monitoring models as tolerated 25° Double-legged decline squats: approximately 30-s count; monitor tolerance and progress to single-limb loads guided by pain-monitoring models as tolerated	Exercises 3–5×/wk 25° Single-legged decline squats: approximately 30-s count with progressive load ↑ Squat: 4 sets × 15 RM Leg press: 4 sets × 15 RM Hack squat: 4 sets × 15 RM Progress patients to 6 RM using the pain-monitoring models as tolerated.	Exercises 2–3×/wk 25° Single-legged decline squats: approximately 30-s count with progressive load ↑ Squat: 4 sets × 6 RM Leg press: 4 sets × 6 RM Hack squat: 4 sets × 6 RM Progress to greater loads as strength capacity ↑
Adjuvant therapy	Quadriceps-stretching exercises Noxious transcutaneous electrical nerve stimulation Low-powered laser therapy or iontophoresis	Quadriceps-stretching exercises Patellar tendon strapping during activity	Quadriceps-stretching exercises Patellar tendon strapping during activity	Quadriceps-stretching exercises

Abbreviations: rep, repetition; RM, repetition maximum.

^aExercises, timing, and load-management strategies are provided as an example and may require individualization based on the patient's symptoms, function, and goals.