Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Kongsgaard M, Kovanen V, Aagaard P, Doessing S, Hansen P, Laursen AH, Kaldau NC, Kjaer M, Magnusson SP. Scand J Med Sci Sports. 2009 Dec;19(6):790-802. Epub 2009 May 28.
A randomized-controlled single-blind trial was conducted to investigate the clinical, structural and functional effects of peritendinous corticosteroid injections (CORT), eccentric decline squat training (ECC) and heavy slow resistance training (HSR) in patellar tendinopathy. Thirty-nine male patients were randomized to CORT, ECC or HSR for 12 weeks. We assessed function and symptoms (VISA-p questionnaire), tendon pain during activity (VAS), treatment satisfaction, tendon swelling, tendon vascularization, tendon mechanical properties and collagen crosslink properties. Assessments were made at 0 weeks, 12 weeks and at follow-up (half-year). All groups improved in VISA-p and VAS from 0 to 12 weeks (P<0.05). VISA-p and VAS improvements were maintained at follow-up in ECC and HSR but deteriorated in CORT (P<0.05). In CORT and HSR, tendon swelling decreased (-13+/-9% and -12+/-13%, P<0.05) and so did vascularization (-52+/-49% and -45+/-23%, P<0.01) at 12 weeks. Tendon mechanical properties were similar in healthy and injured tendons and were unaffected by treatment. HSR yielded an elevated collagen network turnover. At the half-year follow-up, treatment satisfaction differed between groups, with HSR being most satisfied. Conclusively, CORT has good short-term but poor long-term clinical effects, in patellar tendinopathy. HSR has good short- and long-term clinical effects accompanied by pathology improvement and increased collagen turnover.
Diagnosis: Patellar Tendinitis
Outcome: VAS during sports and VISA-P Cortisone group VISA-P increased from 64 to 82 at 12 weeks but returned to 64 at 6 months, VAS during preferred sporting activity decreased from 58 to 18 at 12 weeks, but back up to 31 at 6 months. The eccentric group VISA-P increased from 53 to 75 at 12 weeks and 76 at 6 months, VAS during preferred sporting activity decreased from 59 to 31 at 12 weeks, and 22 at 6 months. The concentric group VISA-P increased from 56 to 78 at 12 weeks and 86 at 6 months, VAS during preferred sporting activity decreased from 61 to 19 at 12 weeks, and 13 at 6 months.
When Assessed: 12 weeks and 6 months
Subjects: 52 male recreational athletes, age 18-50, average 31-34 years, 12 in CORT group, 12 in ECC group, 13 in HSR group.
Protocol: Cortisone group had 2 shots in patellar tendon, one at week zero and one at 4 weeks. The Eccentric group did eccentric decline squats 3×15 twice per day 7 days per week for 12 weeks. The concentric group did 15 RM worked down to 6 RM by week 12, 4 sets per exercise on squats, leg press and hack squats 3 times per week. 3 second concentric and 3 second eccentric phases on each. Pain was OK during both eccentric and concentric exercises so long as pain was not increased following the exercise.
Other Activity: Sporting activities were allowed in all groups so long as pain did not rise above 30 on VAS. They noted other studies had gone as high as 50 on VAS in recreational activities and still been successful.
Chad’s Comments: Most interesting new study to me, found combined concentric/eccentric training better than eccentric training, with benefits being greater as time went on. “HSR proved to be more effective than ECC with regard to tendon tissue normalization and collagen turnover/production, and tended to improve clinical outcomes more than ECC.” The cortisone group started off best in the short term (12 weeks) but finished up worst in the long term (26 weeks) as usual.
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Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.