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Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial
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  • Published on:
    What matters? Program or pain?
    • Georg Supp, Physical Therapist PULZ im Rieselfeld
    • Other Contributors:
      • Stephanie Moers, Physical Therapist

    We would like to congratulate the authors on this interesting publication. The supplementary material is of especially high value and we appreciate how it can assist clinicians to evaluate the described program in their daily clinical practice. The studied progressive tendon-loading program reflects, in many aspects, what we find effective with our athletic and non-athletic patient population in our clinic.

    However, from our perspective there are some issues with the study that question the authors’ conclusion of a superiority of Progressive Tendon-Loading Exercise Therapy (PTLE) over Eccentric Exercise Therapy (EET).

    1. Does the study truly compare PTLE with EET?
    In stage 1, patients in the EET group were instructed to perform the exercises with pain VAS ≥ 5/10, whereas the PTLE group performed the exercises ‘within the limits of acceptable pain’. This requirement adds a non-controlled variable. Does the study solely compare the effect of two different progressing loading regimes, or does it compare painful exercises with exercises performed in an acceptable range of pain?
    What matters most here? The program or the pain?

    2. How do the authors justify the ≥ 5 VAS in the EET group?
    Instructing patients to perform exercises that produce at least a pain of VAS 5 is uncommon. To justify this, Breda et al. refer to the study of Visnes (2005).1 This RCT with 29 volleyball players with patellar tendinopathy had shown no effect on knee funct...

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    Conflict of Interest:
    None declared.