Patella Tendon High Volume Injection
- Paul Williamson
- Oct 6, 2025
- 3 min read
Updated: Jan 19
Rehabilitation Guide
The high-volume injection for patellar tendinopathy is used to reduce pain by separating irritated tissues around the tendon and decreasing pressure from inflamed structures. This can help improve comfort, restore easier movement, and make the tendon more responsive to rehabilitation. A structured, gradual loading program is vital after the procedure, as it guides the tendon through safe strengthening and helps restore normal function.
Following your high volume injection we have created a guide to help you return to sport. Please feel free to use this outline in consultation with your own coach or physiotherapist to help you safely return back to your best.
Rehabilitation Exercise Overview
Phase One - Recovery
This initial phase focuses on rest and offloading to allow the tendon to settle, with only light daily activities and pain relief or ice as needed.
Phase Two - Early Loading
Here we begin very gentle reloading using yielding isometric exercises, helping manage pain and start reactivating healthy tendon function.
Phase Three - Progressive Strengthening
During this stage, we gradually increase load through yielding and moderate overcoming isometrics, progress into early hypertrophy work for the quadriceps, and introduce low-level plyometrics and early return-to-run drills when appropriate.
Phase Four - Heavy Slow Resistance
This phase builds tendon strength and capacity through heavy slow resistance training, with increased overcoming isometrics for tendon adaptation and continued yielding isometrics to assist with pain management.
Phase Five - Performance & Sport Integration
The final phase focuses on restoring power, speed, and movement control, preparing you to return safely and confidently to higher-level sport and functional activities.
Outcome Measures
Strength Symmetry (Isometric)
Pain
Phase One - Recovery
This initial phase focuses on rest and offloading to allow the tendon to settle, with only light daily activities and pain relief or ice as needed.
Days 0-3
Complete rest & offload
Activities of Daily Living
Analgesia / Ice as required
Phase Two - Early Loading
Here we begin very gentle reloading using yielding isometric exercises, helping manage pain and start reactivating healthy tendon function.
Days 4-7 (daily exercise)
Yielding Isometrics - pain<3/10
Additional Exercise Options
Bike - endurance based / low resistance
Walking as able
Upper strength as able
Lower strength - Posterior chain focus
Hamstring Curls / Bridges
Phase Three - Progressive Strengthening
During this stage, we gradually increase load through yielding and moderate overcoming isometrics, progress into early hypertrophy work for the quadriceps, and introduce low-level plyometrics and early return-to-run drills when appropriate.
Week 2-3 (3x per week)
Maintain Yielding isometrics 2 x per week for pain modulation if helpful on different days in
Split Squat position 4x30s
Overcoming Isometrics - pain <3/10
Ramped effort (build-hold-release)
Week 4-5 (3x per week)
Introduction to Hypertrophy & load progression
Additional Exercise Options
Bike & walking as able
Strength - Posterior chain focus
Week 3 - Initiate low level plyometrics
Week 3-4 Initiate return to run
Phase Four - Heavy Slow Resistance
This phase builds tendon strength and capacity through heavy slow resistance training, with increased overcoming isometrics for tendon adaptation and continued yielding isometrics to assist with pain management.
Week 6-10 (2x per week)
Continued load progression
Maintain Yielding isometrics 2 x per week for pain modulation if helpful on different days
Overcoming Isometrics - pain <3/10
Ramped effort (build-hold-release)
Phase Five - Performance & Sport Integration
The final phase focuses on restoring power, speed, and movement control, preparing you to return safely and confidently to higher-level sport and functional activities.
Week 10+
Maintain 2 HSR per week
Maintain 2 overcoming isometrics sessions per week @95% MVIC
Progress Plyometrics to high intensity
Progress speed sessions
Incorporate multi-directional drills (cutting, sprinting, sport specific)
Objective criteria for progression:
strength symmetry >90% compared to contralateral side
VISA-P >80
Pain <2/10 during sports specific activities
Return to Run
This guide should be tailored specifically to your ability, rehab status & sport by your coach.
You may be able to initiate plyometrics & return to run at week 3 post injection
Pain <3/10
Complete the follow in sequence
48hrs recovery between running sessions
2-3 sessions per week
Running Drills
Plyometric Exercise
Example Field Based Running - Pitch Perimeters
