Information for the Practitioner

The Decline Board is angled at 25 degrees. Since the development of the use of a Decline in eccentric rehabilitation by Tendon expert Jill Cook, much research has shown its benefits to:
2: Improve calf flexibility without impinging the ankle anteriorly. This is crucial to restore ankle dorsiflexion Range of Movement (ROM).
A loss of ankle dorsiflexion ROM leads to an increase in ground reaction forces and thus Achilles and Patella tendon loading. This increases the risk of developing Achilles or Patellar Tendinopathies.
Furthermore, a loss of ankle dorsiflexion ROM is compensated for during gait by subtalar pronation (rearfoot eversion), hip adduction and internal rotation and knee abduction (valgus). This biomechanical fault is implicated in hip, knee and ankle injuries, and is well described as a major cause of Anterior Cruciate ligament tears in the athlete as well as patellofemoral pain syndrome (PFPS) in individuals.

Soleus Stretch

Gastrocnemius stretch

Medial head

1: Target strengthening of the knee extensors not achievable in a standard squat.
The Decline Board is a valuable tool in rehabilitation and strengthening of the knee extensor mechanism, especially in those suffering from PFPS.
Single or double leg squats with the decline board position the hip in flexion, which offloads the hip extensors and targets eccentric loading on the knee extensors, significantly increasing patellar tendon load.
A study of rehabilitation programs for elite volleyball players with jumper’s knee found that using the Decline Board produced superior strength gains and improvements in tendon pain compared to a standard squat program.

Decline squat with weights

1‐legged decline squat

Calf and Achilles Tendon strengthening

Dimensions and weight

  • Size: 50cm x 40 cm. Height: 18cm
  • Weight: 4.10kg
  • Durable Mild Steel

Suggested Protocols

Research shows that specific and structured and exercise‐based rehabilitation programmes for patellar and Achilles tendinopathies are successful.
Warning: Exercise prescription is dependent on many factors, including base strength, flexibility and severity of injury. It is important to consider pre‐injury functional / sporting level as well as the ultimate goal of the rehabilitation programme.

Typical Rehabilitation protocols:

Patellar Tendon

  • Double leg, progressing to Single leg
  • 1‐2 sec down, and 1‐2 sec return
  • 2‐3 sets of 15‐20 reps
  • 30 second rest b/w sets
  • 1 session / day.
  • Systematically increase loading by adding weights to overload the tendon
  • Systematically increase speed of exercise
  • Exercise programmes vary from 3 months, with maintenance for 6‐12 months

Quadriceps hypertrophy

  • Single leg
  • 4‐5 sets of 6‐12 reps
  • 3 sec up/down
  • 30 sec rest b/w sets
  • 3/ week sessions
  • Systematically increase loading to build muscle.

Calf flexibility

  • 30‐60 sec holds in 3 directions (see diagram). Repeat 3 times
  • 2‐3 times daily
  • 6 days a week to improve flexibility
  • 3‐4 days a week to maintain flexibility.


Jill Cook: The Tendon Rehab Course: Course Notes 2010.
Powers CM. The influence of abnormal hip mechanics on knee injury A biomechanical perspective. JOSPT 2010; 40(2): 42‐51.
Sports Physical Therapy Section Abstracts: Platform presentations SPL1‐SPL28. JOSPT 2010; 40(1): A39‐A51.
Levinger P, Gilleard W. The heel strike transient during walking in subjects with patellofemoral pain syndrome. Phys Ther Sport 2005; 6:83‐88.
Patellofemoral pain syndrome: proximal, distal and local factors. An international research retreat. JOSPT 2009; 40(3):A1‐A48.
Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes.
Kountouris A, Cook J. Rehabilitation of achilles and patellar tendinopathies. Best Practice & Research Clin Rheum 2007; 21(2):295‐316.
Cook JL, Khan KM, Kiss ZS et al. Posterior leg tightness and vertical jump are associated with US patellar abnormality in 14‐18 year old basketball players: a cross‐sectional anthropometric and physical performance study. British Journal of Sports medicine 2004; 38:206‐209.
Young M, Cook J, Purdam C et al. Eccentric decline squat protocol offers superior results at 12 months compared to traditional eccentric protocol for patellar tendinopathy in volleyball players. British Journal of Sports Medicine 2005; 39(2): 102‐105.
Malliaris P, Cook J. Reduced ankle dorsiflexion may increase the risk of patellar tendon injury among volleyball players. Journal of Science and Medicine in Sport 2006 Aug; 9(4):304‐309.

September 26, 2017 Another Category
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