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14 Exercise Programs To Decrease Pain In Athletes With Patellar Tendinopathy In-season: A Rct
  1. Mathijs van Ark1,2,
  2. Jill Cook2,
  3. Sean Docking2,
  4. Johannes Zwerver1,
  5. James Gaida1,
  6. Inge van den Akker-Scheek1,
  7. Ebonie Rio2
  1. 1University of Groningen, University Medical Center Groningen, Center for Sports Medicine, Groningen, The Netherlands
  2. 2Chool of Physiotherapy, Monash University, Frankston, Victoria, Australia


Introduction Many athletes with patellar tendinopathy are still participating in sports but have symptoms during or after activities. It is hard to decrease pain in-season with current treatments; eccentric exercises in-season have resulted in worsening of symptoms [Fredberg, 2008; Visnes, 2007]. Other exercise programs (isometric and isotonic exercises) have the potential to decrease pain while continuing sport activities [Kongsgaard, 2010; Naugle 2012]. The aim of this study was to compare an isometric against an isotonic exercise protocol designed to decrease patellar tendon pain in-season.

Methods Jumping athletes with patellar tendinopathy playing at least 3 times per week participated in this study. They were randomised into an isometric exercise or isotonic exercise group. The exercise programs consisted of 4 exercise sessions per week for 4 weeks. The exercise sessions consisted of 5 sets of 45 second isometric holds for the isometric group and 4 sets of 8 repetitions heavy slow resistance for the isotonic group; both exercises were performed on a leg extension machine. Pain during a Single Leg Decline Squat (SLDS) on a Numeric Rating Scale (0–10) was used as the main outcome measure. Participants kept a diary in which they scored the pre and post exercise pain scores when they performed an exercise session. A Generalised Estimating Equations (GEE) model was run with participants (id) as subject variable; main and interaction effects were determined for the factors time and type of intervention.

Results Preliminary results (n = 15) showed a significant improvement of both groups over time (Wald chi-square = 657.4, df =13, p ≤ 0.001). Both groups improved but showed a significantly different effect over time (interaction effect time by intervention, Wald chi-square = 3897.7, df =13, p ≤ 0. 001). This difference seems to take place in week 2 and 3 (Figure 1). There was no difference between groups (Wald chi-square = 0.438, df =1, p = 0.508).

Abstract 14 Figure 1

Mean of average NRS-pain on SLDS per participant per week for intervention groups

Discussion Preliminary results showed that both isometric and isotonic exercises result in a decrease in pain in athletes with patellar tendinopathy symptoms over a 4 week period in-season. This is one of the first in-season studies that makes a direct comparison between exercise protocols for patellar tendinopathy and to our knowledge the first study to investigate isometric exercises in a clinical setting. A decrease in pain score in week 2 and increase in week 3 of the isometric group might possibly be explained by a fast decrease in pain which might have resulted in an increase in activities and a related increase in pain. Isometric and isotonic exercise programs are promising easy-to-use exercises to reduce pain from patellar tendinopathy for athletes in-season.

References Fredberg et al. Am J Sports Med. 2008;36:451–460

Kongsgaard et al. Am J Sports Med. 2010;38:749–756

Naugle et al. J Pain. 2012;13(12):1139–1150

Visnes H et al. Br J Sports Med. 2007;41(4):217–223

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