Excerpt from
Clinical Running Essentials

When working with runners presenting with patellar tendinopathy, selecting assessments isolating the involved structures is critical. While the lateral step-down is a standard go-to physical performance test, it often fails to tell the whole story, particularly in runners with limited ankle dorsiflexion or who’ve been trained to adopt a hip flexion strategy.

In this video, I share a simple yet effective modification I use in the clinic to evaluate the knee extensor mechanism and tendon irritability.

Why Modify the Standard Lateral Step-Down?

Factors like ankle mobility can influence the traditional lateral step-down. When dorsiflexion is limited, runners tend to shift into greater hip flexion during the task, offloading the very tissue we’re trying to assess.

This alternative approach removes the ankle from the equation and encourages a more upright posture while safeguarding against “sitting” into the hip. The result? A greater mechanical demand on the knee extensor mechanism, giving you a clearer picture of both:

• • Tissue irritability
  • Willingness to load the tendon

How I Use It in Clinical Practice

I often use this modified step-down as a “daily load test.” It helps guide my decision-making when it comes to:

• • Prescribing loading strategies
  • Modifying strength work
  • Progressing running volume and intensity

It’s a quick, reliable way to gather meaningful data in the clinic, especially for runners on the return-to-sport path.

This modification has greatly impacted how I assess and manage patellar tendinopathy in runners and has been instrumental in helping me overcome my own patellar tendinopathy. Give it a try, and let me know if you have any questions.

Watch more samples from Clinical Running Essentials:

Want to go deeper?

Clinical Running Essentials is my brand-new, 20-hour, CEU-approved online course designed for clinicians who work with runners — and it’s officially live.

Inside, you’ll gain the tools, structure, and confidence to guide runners from injury back to peak performance, with content covering:

📏 Run-Centric Orthopedic & Clinical Examination
Apply evidence-based assessments tailored to running. As a direct access provider, assess joint integrity, soft tissue health, and functional movement while knowing when to refer or collaborate with other medical and allied health professionals.

🦴 Bone Stress Injuries
Spot red flags early, develop a refined understanding of imaging, and apply risk models to support clinical decision-making, especially for high-risk injury sites.

🔹 Lower Limb Tendinopathies
Confidently assess and treat Achilles, patellar, glute med, and proximal hamstring tendinopathies using education, progressive loading, and sound return-to-run strategies.

💪 Strength & Control Drills
Rebuild capacity with progressive loading and plyometrics emphasizing smooth, fluid movement for running performance.

📈 Return-to-Run Programming
Learn and apply clear, criteria-based progressions and objective benchmarks to return runners to consistent, confident training.

Clinical Running Essentials is the culmination of everything I've studied, practiced, and refined over the years — a course built to equip you with the skills, insight, and clinical reasoning to help any runner who walks through your door.

This is more than CEUs. It's a roadmap to guide runners out of the medical system and back to the sport they love — stronger, smarter, and with a renewed sense of possibility.

I created this for you and the runners counting on you.

LET'S GO!!!