Let me preface this by reminding you that I’m not a medical professional—I’m just a guy with well-used knees who’s coached a lot of athletes with well-used knees. If you have a serious injury or severe tendinopathy, go see a professional.
Don’t sit around and wait for your tendinitis to get worse—start taking care of it the day you notice it. Prevention is always best, but immediate correction will save you a lot of time, pain and lost training.
Here is my protocol for clearing up early tendinitis. Note that the longer you’ve let it go and the more severe it is, the longer and more drastic treatment will be required, up to and including complete rest—this is exactly what we’re trying to avoid by immediately handling the problem. Don’t do what I did with my elbow and wait over a year without changing my training, then have to spend a year rehabbing, including cortisone, 3 PRP injections and an exosome injection. Long, expensive and stupid… and usually totally unnecessary.
See the embedded video below for demonstrations of the various exercises and stretches.
Figure Out the Cause
The first step when you start feeling the old knees is to figure out what changed—You didn’t have tendinitis before, so why now? Did you jump into way too much training volume and/or intensity too quickly? Did you add unfamiliar exercises you’re not conditioned for, especially jump training? Did you change the way you’re squatting or switch shoes?
Temporarily eliminate or reduce whatever it is you determine to be the cause and once you’re healed, reintroduce it at a more gradual rate that prevents recurrence. In some cases, you may find you can’t reintroduce successfully, but more often than not, just being a bit more conservative and doing a better job warming up is all you need after coming back.
I don’t understand lifters being shocked by painful joints when they do little to no warming up. Who could have seen that coming?
Specific to the knees, spend a few minutes on a bike first with easy resistance, just getting a lot of blood flowing… and yes, literally warm the knees up.
Next, get on the foam roller and go to town on your quads, especially along the midline. 10-20 passes should be plenty.
Run through a good dynamic warm-up
with plenty of leg swings that lengthen the quads and hip flexors, knee circles, and throw in some unloaded squats for good measure. The idea is pretty simple—get the knees moving and warm, and loosen up all the tissues that pull on the joint.
In my experience, tightness in the rectus femoris—the quad muscle that runs down the midline of the thigh and crosses both the knee and hip—is responsible for a lot of this kind of knee pain in weightlifters, so it deserves extra attention. Stretch the quads and hip flexors before and after training, but also in between sets in your workout. You really can’t do too much.
Probably the biggest help for tendinitis in my experience is slow eccentrics. They encourage healing and strengthening of the tendon well beyond what regular strength work does. In severe cases, you may need to be doing basically all squatting and leg work (at reduced volume and intensity) with slow eccentrics and higher reps, but since you’re smart and you’ve started attacking the problem right away, leg extension negatives should be plenty without changing much if anything else in your program.
Do 3 sets of 10 reps with a 5-6 second eccentric 3 days/week at the end of your workout. Use a weight that’s moderately challenging by the end of the sets, but don’t try to blow yourself out here—we’re trying to stimulate healing, not create a limp.
It’s also a good idea to throw in 3 sets of 10-15 reps of hamstring curls 2-3 days/week. Both exercises should be done unilaterally either on a machine (preferred) or with a band.
Cross friction massage the painful area of the tendon daily for 3-5 minutes. You can use one thumb or use both, with the second just backing up the first, to apply moderate pressure and simply move back and forth against the tendon perpendicularly to the direction of the fibers (i.e. from left to right on the patellar tendon).
No, I’m not going to recommend ice, for a couple reasons. First, I don’t have any objection to inflammation… if inflammation were counterproductive to healing, your body probably wouldn’t be doing it (let’s stick to non-autoimmune stuff here). Second, I don’t really care about the pain. You can handle it. So icing isn’t going to help here.
However, hot/cold contrast has nothing to do with reducing inflammation or pain management directly (it does both indirectly by helping you heal). The purpose is to pump as much blood, nutrients, and fun physiological healing stuff through tissue with limited blood flow. We’re just causing alternating vasoconstriction and vasodilation to push fluid through and try to magnify the body’s inherent healing mechanisms.
Finally, quit taking NSAIDs. No more eating ibuprofen like Tic-Tacs. As I mentioned above, inflammation exists for a reason and preventing it is usually not the wisest decision. NSAIDs have been shown to reduce or at least slow tissue healing, so it's not just unhelpful, it's counterproductive. If the pain is so excruciating that you can’t live without anti-inflammatories, you need legitimate medical intervention and a serious change in your training. Reserve this stuff for brief periods of time when you really can’t change your training, or you need to get through an important competition and the pain without it is going to limit what you can lift, physically or mentally.