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!