PATELLAR Tendinopathy – Evidence Based Exercise [Literature Review]

By dpope2020

August 30, 2024

dan pope, fitness pain free, how to treat patellar tendinopathy, jumper's knee, jumpers knee exercises, knee pain, patella tendonitis, patellar tendinitis, patellar tendinopathy clinical examination, patellar tendinopathy exercises, patellar tendinopathy test, patellar tendinopathy treatment, patellar tendonitis, patellar tendonitis exercises, patellar tendonitis rehab, patellar tendonitis treatment, physical therapy, physiotherapy

PATELLAR Tendinopathy - Evidence Based Exercise [Literature Review]

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In today's video we go over PATELLAR Tendinopathy - Evidence Based Exercise [Literature Review]: FPF Show Episode 144

  • 0:00 Introduction
  • 1:57 The critical importance of patient education
  • 3:12 How much pain is acceptable for patients during exercise and sport activity?
  • 4:39 Is one form of exercise (isometrics, isotonics, heavy slow loads, eccentric, progressive tendon loading) better then another?
  • 8:30 Are heavy loads more effective then moderate loads?
  • 10:35 Why are isometrics so popular for tendinopathy?
  • 22:38 Is blood flow restriction (BFR) training helpful for patellar tendinopathy?
  • 27:33 If we combine different types of exercise does this lead to superior outcomes? [Progressive tendon loading]
  • 37:39 Evidence based progressions and regressions for exercises for patellar tendinopathy
  • 41:54 Should we alter jumping mechanics in patients with patellar tendinopathy?
  • 47:00 Load management strategies for patients with patellar tendinopathy
  • 48:29 What additional treatments are available when exercise therapy fails? [PRP, Stem cells, laser, shockwave, strapping, surgery]

Is it good when it feels like a blow torch is on my knee cap?

- Dan Pope DPT,OCS,CSCS

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Dan Pope DPT, OCS, CSCS

References: 

  1. King D, Yakubek G, Chughtai M, Khlopas A, Saluan P, Mont MA, Genin J. Quadriceps tendinopathy: a review-part 1: epidemiology and diagnosis. Ann Transl Med. 2019 Feb;7(4):71. doi: 10.21037/atm.2019.01.58. PMID: 30963066; PMCID: PMC6409230.

  2. Docking SI, Cook J. How do tendons adapt? Going beyond tissue responses to understand positive adaptation and pathology development: A narrative review. J Musculoskelet Neuronal Interact. 2019 Sep 1;19(3):300-310. PMID: 31475937; PMCID: PMC6737558.

  3. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015 Mar;43(3):752-61. doi: 10.1177/0363546514531911. Epub 2014 May 9. PMID: 24817008.

  4. Breda SJ, Oei EHG, Zwerver J, et alEffectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trialBritish Journal of Sports Medicine 2021;55:501-509.

  5. Agergaard AS, Svensson RB, Malmgaard-Clausen NM, Couppé C, Hjortshoej MH, Doessing S, Kjaer M, Magnusson SP. Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial. Am J Sports Med. 2021 Mar;49(4):982-993. doi: 10.1177/0363546520988741. Epub 2021 Feb 22. PMID: 33616456.

  6. van Ark M, Cook JL, Docking SI, Zwerver J, Gaida JE, van den Akker-Scheek I, Rio E. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. J Sci Med Sport. 2016 Sep;19(9):702-6. doi: 10.1016/j.jsams.2015.11.006. Epub 2015 Dec 7. PMID: 26707957

  7. Rio E, van Ark M, Docking S, Moseley GL, Kidgell D, Gaida JE, van den Akker-Scheek I, Zwerver J, Cook J. Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial. Clin J Sport Med. 2017 May;27(3):253-259. doi: 10.1097/JSM.0000000000000364. PMID: 27513733.

  8. Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. J Orthop Sports Phys Ther. 2015 Nov;45(11):887-98. doi: 10.2519/jospt.2015.5987. Epub 2015 Sep 21. PMID: 26390269.

  9. Lim HY, Wong SH. Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiother Res Int. 2018 Oct;23(4):e1721. doi: 10.1002/pri.1721. Epub 2018 Jul 4. PMID: 29972281.

  10. Rio E, Kidgell D, Purdam C, et alIsometric exercise induces analgesia and reduces inhibition in patellar tendinopathyBritish Journal of Sports Medicine 2015;49:1277-1283.

  11. Cuddeford T, Brumitt J. IN-SEASON REHABILITATION PROGRAM USING BLOOD FLOW RESTRICTION THERAPY FOR TWO DECATHLETES WITH PATELLAR TENDINOPATHY: A CASE REPORT. Int J Sports Phys Ther. 2020 Dec;15(6):1184-1195. doi: 10.26603/ijspt20201184. PMID: 33344034; PMCID: PMC7727412.

  12. Burton I, McCormack A. Blood Flow Restriction Resistance Training in Tendon Rehabilitation: A Scoping Review on Intervention Parameters, Physiological Effects, and Outcomes. Front Sports Act Living. 2022 Apr 25;4:879860. doi: 10.3389/fspor.2022.879860. PMID: 35548459; PMCID: PMC9083008.

  13. Scattone Silva R, Song KE, Hullfish TJ, Sprague A, Silbernagel KG, Baxter JR. Patellar Tendon Load Progression during Rehabilitation Exercises: Implications for the Treatment of Patellar Tendon Injuries. Med Sci Sports Exerc. 2024 Mar 1;56(3):545-552. doi: 10.1249/MSS.0000000000003323. Epub 2023 Oct 16. PMID: 37847102; PMCID: PMC10925836.

  14. Tayfur A, Haque A, Salles JI, Malliaras P, Screen H, Morrissey D. Are Landing Patterns in Jumping Athletes Associated with Patellar Tendinopathy? A Systematic Review with Evidence Gap Map and Meta-analysis. Sports Med. 2022 Jan;52(1):123-137. doi: 10.1007/s40279-021-01550-6. Epub 2021 Sep 23. PMID: 34554424; PMCID: PMC8761156.

  15. Challoumas D, Pedret C, Biddle M, Ng NYB, Kirwan P, Cooper B, Nicholas P, Wilson S, Clifford C, Millar NL. Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ Open Sport Exerc Med. 2021 Nov 29;7(4):e001110. doi: 10.1136/bmjsem-2021-001110. PMID: 34900334; PMCID: PMC8634001.

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  19. Challoumas D, Kirwan PD, Borysov D, et alTopical glyceryl trinitrate for the treatment of tendinopathies: a systematic reviewBritish Journal of Sports Medicine 2019;53:251-262.

  20. Marigi EM, Buckley P, Razi F, Abbas MJ, Jildeh TR, Camp CL, Krych AJ, Okoroha KR. Patellar Tendinopathy: Critical Analysis Review of Current Nonoperative Treatments. JBJS Rev. 2022 Mar 8;10(3). doi: 10.2106/JBJS.RVW.21.00168. PMID: 35358114.