Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial
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  • Published on:
    Isotonic Exercises

    Peru, Lima, December 05, 2021

    Editor of the magazine "British Journal Sports Medicine"

    I address this to you, in relation to the article "Efficacy of progressive tendon load
    exercise therapy in patients with patellar tendinopathy: a randomized clinical trial."
    Their study shows the comparison between the effectiveness of progressive load
    exercises (PLE) with eccentric exercise therapy (EE) in patients with patellar
    tendinopathy (PT). However, it is also known that slow and heavy isotonic exercises lead
    to both short and long-term improvement of pain and other symptoms, because it
    improves the pathology, increases the remodeling of the fibers and normalizes the
    morphology of the fibers. tendon fibrils (1).

    So, you could have added in your research, as this technique has proven to be effective
    and if included it would make a more interesting comparison. Therefore, adding more
    reasons why you should consider incorporating isotonic exercises is that in the study by
    Dr. Qassim et al. validated that a four week heavy slow isotonic training program during
    the season resulted in a gradual improvement in pain in athletes with PT (1), since among
    its multiple benefits of this training is that it can restore muscle mass and the strength of
    the lower limb, and can perform with minimal pain; Unlike the analysis of Purdam Cr. and
    Visnes H. that indicated that the...

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    Conflict of Interest:
    None declared.
  • Published on:
    Suggestion to improve the methodology of this study

    Dear Dr Breda and colleagues,

    Thanks for your insightful publication. I would like to add to Georg Supp and Stephanie Moers comments on this article.

    I agree with the previous comments that the current experimental design is more a comparison between the effectiveness of low pain loading exercise and painful loading exercise in patients with patellar tendinopathy according to the current methodology.

    As a fairer comparison, it should be rather progressive tendon-loading exercise versus statics/ regressive loading exercise. Otherwise, it can also be progressive isometric & isotonic tendon-loading exercise versus progressive eccentric loading exercise as well. No clear standardization on the loading of the exercise makes it less convincing to achieve the authors’ conclusion.

    Conflict of Interest:
    None declared.
  • 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.