Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial

Pietrosimone, Brian; Blackburn, J. Troy; Wikstrom, Erik A.; Berkoff, David J.; Docking, Sean; Cook, Jill; Padua, Darin A.

doi:10.1016/j.ptsp.2020.09.003

Cited by 6 publications

(2 citation statements)

References 36 publications

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“…Online supplemental table 1 shows the characteristics of the included studies 12–48. A total of 37 randomised controlled trials (RCTs) were found to be eligible, including 1332 patients (1407 tendons) with patellar tendinopathy (mean age 29.2 years).…”

Section: Resultsmentioning

confidence: 99%

Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

Challoumas

Pedret²,

Biddle

et al. 2021

BMJ Open Sport Exerc Med

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ObjectivesWe performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT).MethodsSeveral databases were searched in May 2021 for RCTs assessing the effectiveness of any intervention compared with any other intervention, placebo or no treatment for pain and/or function in PT. The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE (Grading of Recommendations, Assessment, Development and Evaluations)/GRADE-NMA tools.ResultsA total of 37 RCTs were eligible that assessed 33 different interventions and their combinations, most represented by single studies. Based on pairwise meta-analyses of two RCTs, extracorporeal shockwave therapy (ESWT) does not appear to be superior to sham ESWT (eccentric exercise in both groups) for short-term pain (mean differences (MD) +0.1, 95% CI (−0.8 to 1), p=0.84) or function (MD −1.8, 95% CI (–8 to 4.4), p=0.57). Based on a pairwise meta-analysis of three RCTs, isometric exercise appears as effective as isotonic exercise for immediate postintervention pain relief (MD −1.03, 95% CI (−2.6 to 0.5), p=0.19). Our NMA showed that topical glyceryl trinitrate (GTN) and hyaluronic acid injection, both combined with eccentric exercise and moderate, slow resistance exercise had the highest probability of being the most effective interventions (low/very low strength of evidence).ConclusionsPromising interventions with inadequate evidence, such as topical GTN, hyaluronic acid injections and isometric and slow resistance exercise, should be further investigated through high-quality RCTs. Meanwhile, eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy.

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Section: Resultsmentioning

confidence: 99%

Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

Challoumas

Pedret²,

Biddle

et al. 2021

BMJ Open Sport Exerc Med

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“…In these patella tendon studies, the isometric tendon loading is thought to have different positive effects. It has a positive mechano-transductive effect on the surrounding aligned fibrillar tissue where the cells convert mechanical stimulus into electrochemical activity, [ 50 ] an acute pain reducing effect, [ 24 ] and it decreases cortical inhibition [ 26 ]. This may allow for the biomechanical tendon profile to normalize [ 17 , 25 , 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study

Krogh

Jensen

Madsen

et al. 2022

Translational Sports Medicine

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Background. Achilles tendinopathy (AT) is a common musculoskeletal disorder, and its management remains challenging. Hypothesis/Purpose. By conducting a pilot study, we aimed to assess the feasibility, safety, and clinical improvement of a new home-based 4-stage rehabilitation program with progressive loading including isometric exercises on a small scale prior to setting up a randomized controlled trial. Methods. Ten recreational athletes with chronic midportion AT were included. The primary outcome was change in VISA-A score after 1, 2, 3, 6, and 12 months. Secondary outcomes included tenderness on palpation of the tendon and ultrasonographic changes after 6 months. Results. Average VISA-A improvements of 26.9 points ( P = 0.004 ) and 35.4 points ( P = 0.006 ) were observed at 6- and 12-month follow-up, respectively. Tenderness on palpation of the tendon (0–10) was reduced from 5.5 to 2.5 ( P < 0.001 ). Color Doppler ultrasound activity (0–4) was reduced by 50%, from an average of grade 2 to grade 1 ( P = 0.023 ). The hypoechoic cross-sectional area of the Achilles tendon was reduced from an average of 29.1% to 8.5% ( P = 0.001 ). Tendon thickness showed no statistically significant change ( P = 0.415 ). Conclusion. Following the 4-stage rehabilitation program for AT based on isometric training and progressive loading, we observed improvement in both VISA-A score and ultrasonography in a group of athletes who had previously failed to benefit from standard AT rehabilitation. The study was feasible in terms of high adherence to the program and with no observed safety issues. The results of this pilot study support a further assessment of this specific approach for rehabilitation in a future randomized controlled trial.

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Interventions for prevention and in-season management of patellar tendinopathy in athletes: A scoping review

Burton

2022

Physical Therapy in Sport

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Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial

Cited by 6 publications

References 36 publications

Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study

Interventions for prevention and in-season management of patellar tendinopathy in athletes: A scoping review

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