12 Week Heavy Slow Resistance (HSR) Training Progression For Patellar

Tendinopathy

Disclaimer: This plan was drafted for an athlete that was thoroughly examined to determine current tolerance and capacity for load.
She was monitored and coached throughout the process. This plan is not a substitute for a consult and examination by a licensed
medical or rehabilitation professional. It is simply an insight into how we progressed her rehab for a patellar tendinopathy. If you
currently have a diagnosis of patellar tendinopathy, seek advice from a medical or rehabilitation professional to get an individualized
plan written for you. By proceeding, you understand that the author is not engaged in rendering medical or professional services.
Expert assistance should be sought for individualized diagnosis and treatment.

Key principles

- Tendons must be loaded to drive adaptation. While there is little evidence showing that degeneration in a
tendon can be reversed, what we can do is increase the capacity to withstand stress within the healthy tendon.
For this plan, training occurred mostly at or above 70% of a pain free 1 rep max.

- It takes about 8 to 12 weeks to see any adaptation in the tendon. This is why we made the plan as long as it is.

- Pain does not necessarily mean damage. We accepted that some pain may occur when loading the tendon, but
made sure that it stayed below a 3/10. All top sets were performed with no pain. If any pain occurred, it
happened because of fatigue in the later volume sets. Ideally, no pain occurred at all.

- More is not necessarily better. We need to use the minimum volume necessary to drive adaptation. In a state of
tendinopathy, there will be a lower tissue capacity and tolerance to stress. For this reason, we didnt push the
volumes past the pre-programmed ranges.

- It is best to space training sessions out 2 to 3 days as it can take up to 3 days after a training session before a net
positive collagen synthesis has occurred. In this training plan, sessions were planned for Monday, Wednesday,
and Friday so that a bout of training occurred every other day.

- Before beginning HSR training, we made sure that the desired end range position could be achieved pain free
with just bodyweight. The rationale is that if bodyweight was painful, adding external load would simply
exacerbate it. For this reason, we progressed through both isometric and eccentric exercises before beginning
HSR.

- Exercise selection was based on what was most tolerable. In this case, the athletes competition movement was
a high bar squat. So we started at a box squat, progressed to a low bar squat, and then to the high bar squat as
tolerance improved. There was no set time frame to progress from one to the other. It was simply determined
by comfort.

- We used tempo to minimize pain and stress during the movement. Both top sets and volume sets were done
with a 3 second eccentric, a pause in the bottom position, and then a normal controlled concentric.

Jacob R Harden, DC Instagram: @dr.jacob.harden

Monica L Wharton, DC Instagram: @quaddoc
 12 Week Heavy Slow Resistance (HSR) Training Progression For
Patellar Tendinopathy

Month 1 - All training is written as weight x sets x reps. Percentages were based off of the daily rep max.

Week 1:

- Day 1
o Find best pain free 3 rep max followed by 65% x 3 x 12
- Day 2
o Find best pain free 3 rep max followed by 70% x 3 x 10
- Day 3
o Find best pain free 3 rep max followed by 75% x 3 x 8

Week 2:

- Day 1
o Find best pain free 3 rep max followed by 70% x 4 x 12
- Day 2
o Find best pain free 3 rep max followed by 75% x 3 x 10
- Day 3
o Find best pain free 3 rep max followed by 80% x 4 x 8

Week 3:

- Day 1
o Find best pain free 3 rep max followed by 67.5% x 4 x 12
- Day 2
o Find best pain free 3 rep max followed by 72.5% x 3 x 10
- Day 3
o Find best pain free 3 rep max followed by 77.5% x 4 x 8

Week 4:

- Day 1
o Find best pain free 3 rep max followed by 72.5% x 4 x 12
- Day 2
o Find best pain free 3 rep max followed by 77.5% x 3 x 10
- Day 3
o Find best pain free 3 rep max followed by 82.5% x 4 x 8

Jacob R Harden, DC Instagram: @dr.jacob.harden

Monica L Wharton, DC Instagram: @quaddoc
 12 Week Heavy Slow Resistance (HSR) Training Progression For
Patellar Tendinopathy

Month 2 - All training is written as weight x sets x reps. Percentages were based off of the daily rep max.

Week 5:

- Day 1
o Find best pain free 2 rep max followed by 70% x 3 x 10
- Day 2
o Find best pain free 2 rep max followed by 75% x 3 x 8
- Day 3
o Find best pain free 2 rep max followed by 80% x 3 x 6

Week 6:

- Day 1
o Find best pain free 2 rep max followed by 75% x 4 x 10
- Day 2
o Find best pain free 2 rep max followed by 80% x 3 x 8
- Day 3
o Find best pain free 2 rep max followed by 85% x 4 x 6

Week 7:

- Day 1
o Find best pain free 2 rep max followed by 80% x 4 x 8
- Day 2
o Find best pain free 2 rep max followed by 82.5% x 3 x 6
- Day 3
o Find best pain free 2 rep max followed by 85% x 4 x 4

Week 8:

- Day 1
o Find best pain free 2 rep max followed by 82.5% x 4 x 8
- Day 2
o Find best pain free 2 rep max followed by 85% x 3 x 6
- Day 3
o Find best pain free 2 rep max followed by 87.5% x 4 x 4

Jacob R Harden, DC Instagram: @dr.jacob.harden

Monica L Wharton, DC Instagram: @quaddoc
 12 Week Heavy Slow Resistance (HSR) Training Progression For
Patellar Tendinopathy

Month 3 - All training is written as weight x sets x reps. Percentages were based off of the daily rep max. No rep max
performed in Week 12 as we wanted to mitigate fatigue for an absolute pain free 1 rep max attempt.

Week 9:

- Day 1
o Conservative 1 rep max followed by 80% x 3 x 5
- Day 2
o Conservative 1 rep max followed by 85% x 3 x 3
- Day 3
o Conservative 1 rep max followed by 90% x 3 x 1

Week 10:

- Day 1
o Conservative 1 rep max followed by 82.5% x 4 x 5
- Day 2
o Conservative 1 rep max followed by 87.5% x 3 x 3
- Day 3
o Conservative 1 rep max followed by 92.5% x 5 x 1

Week 11:

- Day 1
o Conservative 1 rep max followed by 80% x 4 x 5
- Day 2
o Conservative 1 rep max followed by 90% x 4 x 2
- Day 3
o Conservative 1 rep max followed by 95% x 4 x 1

Week 12:

- Day 1
o 85% x 4 x 3 based off of Week 11, Day 3 rep max. No rep max performed in training.
- Day 2
o 75% x 3 x 3 based off of Week 11, Day 3 rep max. No rep max performed in training.
- Day 3
o Work up to pain free 1 rep max

Jacob R Harden, DC Instagram: @dr.jacob.harden

Monica L Wharton, DC Instagram: @quaddoc