What is Patellar Tendinopathy?

The patella, also known as the kneecap, is connected to the lower leg by a stringy structure called the patella tendon.

Jumper's knee, also known as patellar tendinopathy, is an injury where the patellar tendon gets overworked due to too much stress over time.[ 1] The patellar tendon is put under a lot of stress when jumping, landing, starting, and stopping. When these activities are done too often with a lot of force, the patellar tendon begins to change its structure in a way that causes pain.[ 1] If you want to read more about jumpers knee refer to our previous blog here.

Evidence For Decline Squats

Many studies have shown that lowering yourself down during a squat (called an eccentric movement) on a decline surface is effective for treating patellar tendinopathy. This is likely because for the same amount of work, there is more loading on the patellar tendon, compared to the thigh muscles, when in the decline position[ 2]. As long as the decline squat is completed in a controlled manner and not over-done, loading the tendon improves its function.[ 3]

Regular Squats vs Decline Squats: One study that looked at regular squats vs. decline squats in 17 patients found that decline squat training caused less pain and lead to a faster return to full function in daily life compared to regular squats.[ 4]

One-legged Decline Squats vs One-legged Step Squats: A one-legged step squat is where the back leg is elevated on a step and the front leg is lowering the body. A study completed on 17 volleyball players found that one-legged decline squats were more effective than one-legged step squats for improving pain and the players score on a knee function test after 12 months.[5]

Horizontal Surface vs Decline Surface: One study completed on 13 people showed that eccentric squats on a decline board worked the patellar tendon 20-25% more than eccentric squats on a flat surface.[ 6] This demonstrates that a decline surface is better at strengthening the patellar tendon.

Protocol For Decline Squat Program or how many and how often should I do decline squats: One study that researched the best guidelines for treating patellar tendionpathy found that decline squats must be included in the program to help patellar tendinopathy.[ 3] The researchers suggested decline squats should be done twice a day for 3 sets of 15 repetitions based on the results they gathered from 7 other research papers.[ 3] The article found that adding resistance slowly over time helps improve the patellar tendon's function as long as the exercise is done with control, and not done excessively.[ 3]

Our next blog post will be a video on how exactly to do decline squats at home with instructions on how to progress.


[ 1]: Peers K, Lysens R. Patellar Tendinopathy in Athletes: Current Diagnostic and Therapeutic Recommendations. Yearbook of Sports Medicine. 2005;35(1):71-87.

[ 2]: Frohm A, Halvorsen K, Thorstensson A. Patellar tendon load in different types of eccentric squats. Clinical Biomechanics. 2007;22(6):704-711.

[ 3]: Rutland M, O’Connell D, Brismée J-M, Sizer P, Apte G, O’Connell J. EVIDENCE–SUPPORTED REHABILITATION OF PATELLAR TENDINOPATHY. North American Journal of Sports Physical Therapy : NAJSPT. 2010;5(3):166-178.

[ 4]: Purdam, C. R., Jonsson, P., Alfredson, H., Lorentzon, R., Cook, J. L., & Khan, K. M. (2004). A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy. British journal of sports medicine, 38(4), 395-397.

[ 5]: Young M, Cook J, Purdam C, Kiss Z, Alfredson H. Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. British Journal of Sports Medicine. 2005;39(2):102-105.

[ 6]: Kongsgaard M, Aagaard P, Roikjaer S, et al. Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats. Clinical Biomechanics. 2006;21(7):748-754.