Patellar Tendinopathy
Conditions
Brief summary
This study aims to investigate the effects of two different resistance training interventions on the structural, morphological, mechanical, and functional properties of the thigh muscles (in particular the quadriceps femoris) and the patellar tendon, in participants with current patellar tendinopathy.
Detailed description
Patellar tendinopathy is a common musculoskeletal injury among physically active people and athletes, particularly those who play sports that involve high jumps, such as volleyball and basketball. This condition is associated with alterations in the intrinsic properties of the muscle (e.g., cross-sectional area, muscle length) and the patellar tendon (e.g., stiffness, thickness), along with impairments in sports performance (e.g., altered jump height) and tendon pain. The current gold-standard treatment for tendinopathies is composed mainly of eccentric training, which overall shows a good percentage of remission of the symptoms, but on the other hand, a high percentage of recurrence of said symptoms. The objectives are to find out if a specific and controlled eccentric training and heavy-slow resistance training, which literature has shown to be a friendly and closer to daily-life movement alternative for management of patellar tendinopathy. Through the assessment of several muscle, tendon, and performance parameters, our study aims to investigate if individually targeted training variables on both training interventions show a better improvement in the intrinsic properties of the anatomical structures, as well as functional and performance parameters like pain level, strength, jump height, etc.
Interventions
OTHEREccentric Training
The intervention consists of 12 weeks of resistance training, with a frequency of three times per week. Participants in this group will perform two exercises on a leg press and knee extension machine at their own training facility. This intervention has a repetition time of four seconds, with only the eccentric phase of the movement being performed. They will rest between two and three minutes between sets and will perform the exercises as long as their pain level is less than or equal to four on a pain scale from 0-10. The training parameters are the following, applying to both leg press and knee extension exercises: Week 1: 3 sets of 15 repetitions at 60% of their 1-repetition maximum (1RM) Week 2 and 3: 3 sets of 12 repetitions at 70% of their 1RM Week 4 and 5: 3 sets of 10 repetitions at 75% of their 1RM Week 6 to 12: 4 sets of 8 repetitions at 80% of their 1RM.
The intervention consists of 12 weeks of resistance training, with a frequency of three times per week. Participants in this group will perform two exercises on a leg press and knee extension machine at their own training facility. This intervention has a repetition time of four seconds, of which two seconds will be spent on the concentric phase and two seconds on the eccentric phase of the movement being performed. They will rest between two and three minutes between sets and will perform the exercises as long as their pain level is less than or equal to four on a pain scale from 0-10. The training parameters are the following, applying to both leg press and knee extension exercises: Week 1: 3 sets of 15 repetitions at 60% of their 1-repetition maximum (1RM) Week 2 and 3: 3 sets of 12 repetitions at 70% of their 1RM Week 4 and 5: 3 sets of 10 repetitions at 75% of their 1RM Week 6 to 12: 4 sets of 8 repetitions at 80% of their 1RM.
Sponsors
University of Graz
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The study is designed as a randomized controlled trial (RCT). This means the participants will be randomly assigned to one of two intervention groups: * Eccentric group: the intervention group will perform an eccentric resistance training protocol for 12 weeks. This means the focus is on the deceleration or "return" part of the movement. * Heavy-slow resistance training: this group will perform both the concentric and the eccentric parts of the exercises for 12 weeks. In simple words, a closer-to-normal strength training protocol.
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Between 18 and 50 years of age * Pain at the inferior pole of the patella, longer than 3 months * Active lifestyle (sport/exercise minimum 3 times per week) * No previous injuries or surgeries on the affected leg
Exclusion criteria
* Corticoid injections in the last 6 months * Current intake of pain or non-steroidal anti-inflammatory drugs * Additional tendinopathy treatments in the last 6 months (i.e., physical therapy, shock-wave therapy, drug interventions, etc.) * Neuromuscular or cardiovascular associated diseases or conditions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tendon Thickness | From enrollment to the end of training at 12 weeks | Anteroposterior thickness of the patellar tendon (in milimiters) measures by B-Mode Ultrasound (Aixplorer V12.3 Supersonic Imaging, France) with a SuperLinear 15-4 MHz probe. Three images at the same position will be taken for further analysis with the software ImageJ. |
| Tendon sitffness | From enrollment to the end of training at 12 weeks | Stiffness of the patellar tendon (in kilopascal) will be measured with Shear-Wave Elastrography (Aixplorer V12.3, Supersonic Imaging, France). The measurement site is 0.5cm from the patellar apex, and five videos of 15 seconds will be recorded for further analysis with Matlab. |
| Tendon CSA | From enrollment to the end of training at 12 weeks | Cross-sectional area of the patellar tendon (in centimiters) on its proximal, middle and distal part, will be measured with B-Mode Ultrasound (Aixplorer V12.3, Supersonic Imaging, France). Three images per site, accounting for a total of 9 images, will be taken for further analysis with the software ImageJ. |
| Fascicle length | From enrollment to the end of training at 12 weeks | Length of the fascicles of the vastus lateralis muscle (in centimiters) will be measures with Extended Field of View (Panoramic) B-Mode Ultrasound (Aixplorer V12.3, Supersonic Imaging, France). Five images will be taken for further analysis with the software ImageJ. |
| Muscle Strength | From enrollment to the end of training at 12 weeks | Maximum voluntary isometric torque of the knee extensors (in newton per meters) will be measured with the Isomed2000, Germany device. Three trials will be performed, with three minutes of rest in between, and the trial with the maximum peak torque will be taken for analysis. |
| 1 repetition maximum | From enrollment to the end of training at 12 weeks | Maximum strength of the leg press and knee extension exercises (in kilograms) will be measured with the leg press and knee extension devices (compass540, Physiomed, Germany). Participants will perform repetitions with increasing weights, until they can perform a maximum of eight repetitions with a specific weight. This weight will be then used to estimate their maximum 1RM, to further calculate the training loads. |
| Overall Pain | From enrollment to the end of training at 12 weeks | Pain assessed at rest and during a single-leg-decline squat (SLDS) will be assessed with the numerical rating scale of 11 points called Visual Analogue Scale (VAS). Higher values mean higher pain levels. |
| Functionality | From enrollment to the end of training at 12 weeks | Functionality assessed with the VISA-P Questionnaire. This questionnaire includes 10 questions with a score from 0 to 10, for a maximum questionnaire score of 100 points. Higher scores mean better functionality. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Tendon Neovascularization | From enrollment to the end of training at 12 weeks | Presence of blood vessels in the patellar tendon will be analysed with Color Doppler Ultrasound (MyLab60, Esaote S.p.A., Italy). The measurement site is 0.5cm from the patellar apex. Five videos of 15 seconds each will be taken for further analysis with Matlab. |
| Young's Modulus | From enrollment to the end of training at 12 weeks | Tendon Young's Modulus (in kilopascal) will be assessed with Shear-Wave Elastography (Aixplorer V12.3, Supersonic Imaging, France). |
| Muscle Thickness | From enrollment to the end of training at 12 weeks | Thickness of the vastus lateralis muscle (in centimiters) will be obtained with Extended Fielv of View Panoramic Ultrasound (Aixplorer V12.3, Supersonic Imaging, France). Five images will be taken, and muscle thickness will be measures on three places on the thickest part of the muscle, and averaged for further analysis with ImageJ. |
| Muscle Stiffness | From enrollment to the end of training at 12 weeks | Stiffness of the vastus lateralis tendon (in kilopascal) will be measured with Shear-Wave Elastrography (Aixplorer V12.3, Supersonic Imaging, France). The measurement site is 60% of the length of the muscle, from the greater trochanter to the lateral femur condyle. Five videos of 15 seconds will be recorded for further analysis with Matlab. |
| Jump Height | From enrollment to the end of training at 12 weeks | Height of the Countermovement Jump measured with Kinvent Force Plates will be assessed. The participants will perform three jumps with two minutes rest in between them. |
Countries
Austria
Contacts
PRINCIPAL_INVESTIGATORJosefina Manieu Seguel, M.Sc.
University of Graz
Outcome results
None listed