Excerpt 2 of 8 · Clinical exam

A Simple Modification to Better Assess Patellar Tendinopathy in Runners

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.