Physical Therapy Exercise Program After Patellar Tendon Rupture

A patellar tendon tear can be a painful injury that can limit your ability to walk, run, and engage in normal work and recreational activities. You may benefit from a physical therapy (PT) program if you have torn your patellar tendon. One important component of your patellar tendon rehab is an exercise program. The right PT exercise program for your patellar tendon tear can help you quickly and safely regain range of motion (ROM) and strength. More importantly, the exercise program for your patellar tendon can help you return to your normal functional mobility.

Anatomy of the Patellar Tendon

The patellar tendon is actually a ligament; it attaches your kneecap (patella) to your shin bone (tibia). By definition, a ligament is a structure that attaches two bones together. But the patellar tendon is called a tendon because it is really an extension of the quadriceps tendon. Your quadriceps muscle (quads) is the large muscle that courses down the front of your thigh. It crosses over your patella, first as the quad tendon, and then as the patellar tendon. It then attaches to the front of your shin. The quads are primarily responsible for extending, or straightening, your knee joint.

How Does the Patellar Tendon Rupture?

The patellar tendon typically ruptures after some sort of trauma. Usually, a fall onto your knee or a jump from a significant height causes overloading of the tendon and leading to a tear.

There are two types of patellar tendon tears: partial or complete. In a partial tear, only part of the tendon is torn. Treatment for this usually involves immobilization in a splint or cast, and then a course of physical therapy to regain ROM and strength in your leg.

A complete patellar tendon rupture usually requires surgical repair. During surgery, your doctor will reposition the torn tendon and then suture it in place. The post-operative recovery period is about eight to 12 weeks and involves a period of immobilization with a period of gradually restoring ROM and strength. Your physical therapist can help you with this rehab process.

Initial Care

If you suspect you have torn your patellar tendon, you must seek medical care right away. Your doctor can examine your knee and properly diagnose your condition.

Symptoms of a patellar tendon rupture include:

  • Pain your knee
  • Swelling around the front of your knee
  • Difficulty walking
  • Difficulty fully extending your knee joint
  • Redness near your knee cap.

If your doctor suspects you have torn your patellar tendon, diagnostic studies like X-ray's or magnetic resonance imaging (MRI) may be done to confirm the tear and to rule out other problems with your knee. Then, a decision will be made to perform surgery or to immobilize your knee and allow the tendon the heal non-surgically.

Initial care for a patellar tendon tear includes the R.I.C.E. principle:

  • Rest
  • Ice
  • Compression
  • Elevation

After a few weeks of healing, gentle motion can be initiated, and then more progressive loading can occur to help you regain strength and return to your previous level of function. Your physical therapist can guide your rehab.

Starting PT after Patellar Tendon Rupture

Your first PT session for your patellar tendon rupture will be an initial evaluation. During this appointment, your physical therapist will interview you about your injury, your current health status, and your prior medical history. They will get an idea of your pre-injury status as well; this helps to understand how this injury has affected your lifestyle and helps to set realistic functional goals for your rehab.

Measurements will be taken. These may include measures of:

  • Pain
  • Range of motion
  • Strength
  • Balance
  • Functional mobility
  • Scar tissue mobility (if you have had surgery)

Once the evaluation is complete, your physical therapist will have a good understanding of your condition and what specific exercises need to be done to help you fully recover.

Your PT may also choose to use specific techniques and modalities to help augment your rehab program. These may include:

Keep in mind that passive modalities are not considered the best use of time in the PT clinic, as many of them have not been proven to be effective. Your rehab program should always include an active component of exercise and movement that can help you regain functional mobility.

Exercise Program for Patellar Tendon Rupture

The exercise program that your physical therapist prescribes for your patellar tendon rupture should be specific to your needs. It should also be specific to the stage of healing that the tendon is in; too much, too soon may be a recipe for disaster and re-injury to your patellar tendon. Your PT exercise program will likely include movements that improve ROM and strength, and then progress to include gait training, balance exercises, jumping and landing exercises, and return to full functional mobility.

Do not start this, or any other exercise program, until you have gotten clearance from your doctor or physical therapist to do so.

1

Knee Range of Motion

Heel slide

Westend61/Getty Images

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.
2

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.

3

Short Arc Quads

short arc quads
Ben Goldstein

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.
4

Straight Leg Raise Progression

Straight leg raise
Ben Goldstein

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.

5

Mini Squats

Wall squat

SrdjanPav/E+/Getty Images

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.
6

Balance Exercises

balance training
Learning balance training early in life will add years to your life as you age.

Getty Images

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.

7

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:

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.

8

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 doctor may allow you to use a bike outside. This can help you recover fully and get back to an enjoyable (and beneficial) exercise activity.

9

Return to Full Function

Two male running friends running in front of Brooklyn bridge, New York, USA VIEW DETAILS Two male running friends running in front of Brooklyn bridge, New York, USA
Cultura RM/Corey Jenkins/Cultura/Getty Images

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.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopaedic Surgeons. Patellar tendon tear. Updated February 2016.

  2. ABIM Foundation Choosing Wisely. Physical therapy: Five treatments you probably don't need. 2015.

  3. Brund RBK, Rasmussen S, Nielsen RO, Kersting UG, Laessoe U, Voigt M. The association between eccentric hip abduction strength and hip and knee angular movements in recreational male runners: An explorative study. Scand J Med Sci Sports. 2018;28(2):473-478. doi:10.1111/sms.1292

  4. Hearing CM, Chang WC, Szuhany KL, Deckersbach T, Nierenberg AA, Sylvia LG. Physical exercise for treatment of mood disorders: A critical reviewCurr Behav Neurosci Rep. 2016;3(4):350–359. doi:10.1007/s40473-016-0089-y

  5. Belhaj K, El hyaoui H, Tahir A, et al. Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25 patients. Ann Phys Rehabil Med. 2017;60(4):244-248. doi:10.1016/j.rehab.2016.10.003

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