The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee) - a critical review of exercise programs

Håvard Visnes ¹ and Roald Bahr ^1*

¹ Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Science, Norway

^* To whom correspondence should be addressed. E-mail: roald{at}nih.no.

Accepted 20 November 2006

Abstract

Eccentric training has become a popular treatment for patellar tendinopathy. Our purpose was to review the evolution of eccentric strength training programs for patellar tendinopathy with a focus on the exercise prescriptions used, to help clinicians make appropriate choices and identify areas needing further research.

Methods: A computerized search of the entire Medline database was performed on September 1, 2006 to identify prospective and randomized clinical trials with a focus on clinical outcome of eccentric training for patellar tendinopathy.

Results: We included seven articles with a total of 162 patients where eccentric training was one of the interventions, all published after 2000. The results were positive but study quality was variable, with small numbers or short follow up periods. The content of the different training programs varied, but most of them were home-based programs with twice-a-day training for 12 weeks. A number of potentially significant differences in the eccentric programs used were identified: drop squats or slow eccentric movement, squatting on a decline board or level ground, exercising into tendon pain or short of pain, loading the eccentric phase only or both phases, and progressing with speed then load or simply load.

Conclusion: Most studies suggest that eccentric training may have a positive effect, but our ability to recommend a specific protocol is limited. The studies available indicate that the treatment program should include a decline board, be performed with some level of discomfort and that athletes should be removed from sports activity. However, these aspects need further study.

Key Words: Eccentric training, Exercise, Jumper's knee, Rehabilitation, Tendinopathy

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