Patellar Tendon Pop

Hi BBM,

I’ve been dealing with patellar tendinopathy for a few years now and decided to follow the advice from the BBM Guide to Tendinopathy with good results. I’ve been able to decrease my pain substantially in daily activities and have begun to load the tendon more in decline single leg squats. After my warm up today, trying to pick up my shoes I felt a sudden pop where the patellar tendon attaches to the tibia. The little bony point. I can bear weight, straighten my knee with no pain. But if I try to even perform a body weight squat it get strong stinging pain at the same bony part. I don’t suspect a tear but I was wondering if this was of any concern? Is this typical during the rehab process? Is this just a sudden flare up? I wish it had at least happened at some new increased load so I can conclude I just went too far, but it happening after my warmup leaves me puzzled.

Thank you,
Jose Lopez Renteria

Unfortunately it’s quite difficult for us to give a confident assessment via the forum here without a more detailed conversation. If you can bear weight and move/straighten the knee fully without any pain or limitation, that is reassuring that there has not been a complete rupture of the tendon.

It is common for there to be ups and downs in the rehab process, and sometimes quite abrupt flare-ups like this without a clear reason or explanation. I’d be curious whether you’ve experienced it calming down a bit since you initially made this post.

Thank you for the response!

The very next morning the pain had disappeared completely, as if it never happened. That morning I tried a few bodyweight squats with no pain. Jumped a few times full force and still no pain.

I decided to redo the warmup from the previous day:
3 x 45s wall sits.
3 x 10 step-downs on a 25-degree decline board, 3-0-3 tempo.
No pain.

A bit of background on this years-long issue:

6 years ago, during a months-long cycle of high-volume squats, I started to feel the patellar tendon pain. I tried pushing through it at first but couldn’t sustain the workout schedule. Completely quit working out.

For the next few years, I’ve repeated a similar cycle trying to rehab it, start squatting → pain returns → I completely quit for a year or so → come back and attempt it again.
3 years ago, I got a warehouse job where I averaged 35k steps a day, 4 days a week. During this time, the pain completely went away, no daily pain. I never attempted to exercise, but daily pain with walking subsided.

Last October, I started playing tennis. At first the pain was barely noticeable, and because I was limited by cardiovascular endurance I never got to the point of a flare-up. Months went by and the pain went away completely. I was averaging 2-hour sessions without any pain. I thought it was cured. Then I started running and after a few weeks I got up to sessions of 3 miles at 10 min/mile pace, no pain. Then one run I tried for a mile best and there was a major flare-up, the pain returned to the level of the first flare-up. The run was a mere 15 seconds faster than my previous best from the previous week. Seemed weird for this to cause a flareup.
For the past few weeks, I’ve attempted to rehab it with good results until this incident.

Here’s the plan I’m following now:

3–4 times per week:

Isometric holds: 3 x 45s wall sits or decline isometrics

Decline single-leg squats: 3 x 10 reps each leg, slow 3–0–3 tempo

Double-leg barbell squats: 3 sets of 5 reps adding 5–10 lb every week as tolerated, slow 3-0-3 tempo.

I’m using the 24-hour pain response rule: no more than mild discomfort during, and no pain increase the next day.

Does this look like an appropriate progression? Can I add deadlifts? If not at the beginning when? Single Leg Romanian Deadlifts? I am just going through the case studies in the “The Barbell Medicine Guide to Tendinopathy” article and finding my routine bare.

When do I know if a certain flare up has caused permanent damage or do I just find a new entry point at the point of the flareup and just restart the process?

Thank you, and sorry for the huge reply!

Jose,

Sorry to hear about this. I’m sure that’s frustrating, especially with how long this has been going on. To directly answer your question, yes, I am concerned by the symptoms you describe and the acute onset related in this story. I don’t know that anything “new” is wrong vs. some increased sensitivity and guarding. As you can imagine, diagnosing people over the internet is challenging. If it were me, I’d see how it evolves over the next few days, e.g. symptoms, pain, etc. That would help me determine next steps.

I think this would be a great time for our pain and rehab team to step in and help. Please reach out to them at support@barbellmedicine.com.

-Jordan