Physical Therapy Exercise Program After Patellar Tendon Rupture

Knee Range of Motion

Your knee is a hinge joint, and its main motions are to bend and straighten. (There is also some slight rotation in your knee joint.) Your physical therapist may prescribe exercises to improve the way your knee bends and straightens.

Heels slides may be done to improve knee flexion ROM. To do this:

1. Lie on your back with your injured knee out straight.
2. Place a small towel under your heel so it slides easily on the floor.
3. Slowly bend your knee up, sliding your heel towards your buttocks. You may feel a slight strain in the front of your knee when you do this. Bend as far as possible.
4. Slowly return to the starting position.
5. Repeat 10 to 15 times.

Your PT may also have you perform supine static knee flexion. To do this:

1. Lie on your back with your buttocks facing a wall.
2. Place both feet on the wall, and allow gravity to slowly allow your knees to bend. Bend as far as possible; you should feel a slight stretch in your knee.
3. Hold the bent-knee position for 30 seconds.
4. Slowly straighten your knee by sliding your foot up the wall.
5. Repeat 5 times.

During the initial immobilization period, your knee will be kept straight to prevent excessive strain on your patellar tendon. Therefore, your knee will likely have full extension ROM. In some cases, a slight loss of knee extension may occur. To improve knee extension range of motion, you can perform the prone hang exercise.

To do the prone hang:

1. Lie on your bed on your stomach.
2. Slide your body towards the foot of the bed, and allow your leg to hang over the edge. You should feel a slight stretch in the back of your knee.
3. Hold this position for 30 to 60 seconds.
4. Slide back onto the bed so your knee is supported.
5. Repeat the exercise 5 times.

Quad Sets

One of the main goals of rehab after patellar tendon rupture is to restore normal function to the quadriceps muscle. Your PT may prescribe an exercise called the quad set to do this.

To properly perform a quad set:

1. Lie on your back.
2. Place a small rolled-up towel underneath your knee.
3. Gently press the back of your knee into the towel. You should feel your quad on the top of your thigh tighten.
4. Hold the tightened quad position for 5 seconds.
5. Slowly release the contraction.
6. Repeat 10 to 15 times.

Sometimes the quad set is performed with electrical stimulation called neuromuscular electrical stimulation (NMES). The electricity helps to create a more robust contraction, helping to re-educate the muscle into functioning properly.

Quad sets are typically done in the early stages of rehab when gentle, isometric contractions are indicated. This gets your quad functioning while still protecting the injured patellar tendon.

Short Arc Quads

Once the quad set has become easy, you can progress to the short arc quad. This is a great exercise to improve quad function, and is usually done to help start the straight leg raising progress that comes along later in the rehab exercise program.

To perform the short arc quad:

1. Lie on your back with your leg out straight.
2. Place a small bolster underneath your knee. A basketball or large coffee can wrapped in a towel work great.
3. Slowly straighten your knee. The back of your knee joint should remain in contact with the ball.
4. Once your knee is all the way straight, tighten your quad by doing a quad set, and hold for 5 seconds.
5. Lower your leg down slowly. Repeat 10 to 15 times.

Straight Leg Raise Progression

Straight leg raises are a great way to strengthen your hips and thigh muscles, and they may be a staple of your patellar tear rehab exercises.

To perform the straight leg raise:

1. Lie on your back with one knee bent and your injured leg straight.
2. Tighten your quad muscle by doing a quad set.
3. Slowly lift your straight leg up about 12 to 15 inches.
4. Hold it in the raised position for three seconds, and then slowly lower.
5. Repeat 10 to 15 times.

If your knee unlocks and bends slightly, it means that you do not (yet) have the strength and muscular control for this exercise. Revert back to the quad set and short arc quad exercise until your strength allows you to do the straight leg raise with a fully extended knee.

You can make the straight leg raise more challenging by adding a cuff weight to your leg. Start light with a 1- or 2-pound weight, and place the weight around your thigh first. As you get stronger over the ensuing weeks, the weight can be moved down your leg, lengthening the lever arm and making the exercise more challenging.

Straight leg raises can be performed on your back, or your physical therapist may have you lift your leg on your side or your stomach. These altered positions strengthen the gluteus muscles of your hip. Research has shown that proper glute function is essential for normal walking and running.

Mini Squats

Once you have worked for a few weeks on regaining normal range of motion and strength around your knee, it may be time to progress to more weight bearing exercises. The mini squat and wall squat are great ways to progress with that.

To start your squatting routine:

1. Stand with your back against a wall.
2. Make sure your heels are about 15 inches away from the wall.
3. Slowly bend both knees and lower yourself down a few inches. Only lower down to the point where your knees are bent about 60 to 90 degrees.
4. Hold this position for 3 seconds, and then slowly raise yourself up.
5. Repeat 10 to 15 times.

Once the wall squat has become easy, your PT may prescribe squats from a seated position. To do this:

1. Stand up with a chair placed behind you.
2. Slowly lower yourself down until your buttocks just barely touch the chair.
3. Raise yourself up.
4. Repeat the exercise 10 to 15 times.

Balance Exercises

Your balance and proprioception may become impaired after an injury or surgery to your knee that requires immobilization. (Proprioception is your body's ability to determine where it is in the environment.) Part of your patellar tendon rehab may be to improve proprioception and balance to regain normal safe walking ability.

Balance and proprioception exercises may include:

• Single leg standing
• Single leg standing with eyes closed
• Tandem standing
• Standing on various squishy surfaces
• Using balance exercises tools like a BAPS board or wobble board

One of the challenges of balance training is that you must create situations that may be unsafe to improve your balance. Your balance systems must be challenged, and this may increase your risk of falling. Be sure there is something stable to hold onto or grab while performing balance exercises. Your physical therapist can give you suggestions on improving balance while remaining safe.

Plyometric Exercise

If you are planning on returning to high level athletics, your physical therapist may have you work on plyometrics. This form of exercise requires that you jump and land, accepting a force through your leg and returning that force in a safe way.

Plyometric exercises may include:

• Hopping
• Forward and backward jumping
• Lateral jumping
• The drop jump exercise
• Single leg hopping for distance

Plyometric exercise can place high levels of stress through your knees and lower extremities. You must make sure you progress slowly and properly with plyometric exercise. Your therapist can ensure that you are performing the jumping and landing properly to minimize injury risk while maximizing benefit.

Bicycle

Your physical therapist may have you ride a stationary bicycle as part of your patellar tendon rehab exercise program. Benefits of biking after patellar tendon tear may include:

• Improved ROM
• Improved cardio-respiratory function
• Improved lower extremity endurance
• Happiness (aerobic exercise has been shown to improve mood and feelings of well-being.)

Once you have progressed with safe, indoor stationary biking, your PT and healthcare provider may allow you to use a bike outside. This can help you recover fully and get back to an enjoyable (and beneficial) exercise activity.

Return to Full Function

Your progression through patellar tendon rutpure rehab should take about eight to 12 weeks. Your physical therapist can make sure you slowly and steadily gain range of motion and strength, balance, and full mobility.

One part of your rehab program may be working on getting back to full function. This may mean working on stair climbing, walking, running, or on any other functional task that you may encounter during your day-to-day activities. The goal of PT after patellar tendon rupture is to help you recover fully so you can enjoy your normal work and recreational activities.

A Word From Verywell

A patellar tendon tear can be a painful injury that limits your ability to walk normally. It can prevent you from enjoying your normal activities at home and work. Working with a physical therapist is a great way to safely regain mobility and function. That way, you can quickly return to your prior level of function.