Address safety, settle excessive irritability and maintain useful movement.
What to do
Reduce jump/sprint volume to tolerable level
Maintain strength with isometrics or reduced-range resistance
Explain that complete rest often reduces capacity
Exercise dosage
Spanish squat or knee-extension isometric: 5 x 30–45 seconds if tolerated
Maintain pain-monitored daily activity
Progress when
Daily function is stable or improving.
No new red flags or progressive neurological deficit.
Exercise response returns to baseline by the following day.
Phase 2 — Mobility, Strength & Capacity
Restore the specific strength, mobility and control required by the condition.
What to do
Progress heavy slow resistance or eccentric-concentric loading
Build quadriceps and hip strength
Introduce low-level energy-storage drills when strength tolerates
Exercise dosage
Squat/leg press: 3–4 x 6–12, 2–3 days/week
Progress load when technique and next-day response acceptable
Progress when
Target movement and resistance are tolerated with good quality.
Functional capacity is improving without sustained symptom flare.
Progression is based on objective performance and patient goals.
Phase 3 — Functional Restoration & Return to Activity
Rebuild real-world, occupational or sporting capacity.
What to do
Progress hopping, jumping, landing and sport-specific volume
Increase intensity and volume separately
Monitor tendon response over 24 hours
Exercise dosage
Plyometrics: 2–4 sets of 5–10 contacts
Jump/sprint exposure 2–3 times/week with recovery
Progress when
Condition-specific return criteria are met.
Full task exposure is completed progressively.
No clinically meaningful deterioration during the following 24 hours.
Manual Therapy — Role & Application
Manual therapy may address coexisting mobility issues but does not remodel tendon by itself.
Avoid aggressive painful tendon friction.
Modalities — Use / Avoid
Taping/straps may offer temporary symptom relief in selected athletes.
Passive modalities should not replace progressive tendon loading.
Return / Discharge Criteria
Repeated heavy knee extension tolerated
Hopping and jumping completed with acceptable symptoms
Full training volume and next-day recovery demonstrated
Common Clinical Mistakes
Only eccentric decline squats for everyone
Increasing jumps and running simultaneously
Using imaging to dictate symptoms or clearance
Clinical Pearls
Progressive loading is the foundation; select isometric, isotonic and plyometric stages by capacity.
A tendon may remain structurally abnormal after function improves.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
