Evaluation of Eccentric Exercise in Treatment of Patellar Tendinitis

Evaluation of eccentric exercise in treatment of patellar tendinitis. Jensen K, Di Fabio RP. Physical Therapy. 1989 Mar;69(3):211-6.

Abstract

The purpose of this study was to analyze the effects of a quadriceps femoris muscle eccentric training program on strength gain in patients with patellar tendinitis. The effect of an eight-week eccentric exercise program on quadriceps femoris muscle work was evaluated in four groups of subjects–two groups of “normal” (healthy) subjects and two groups of patients with patellar tendinitis. All four groups participated in a home muscle stretching exercise program, but only two groups–one group of normal subjects (N-A) and one group of subjects with tendinitis (T-A)–received additional eccentric training on an eccentric isokinetic dynamometer. The eccentric quadriceps femoris muscle work ratio (involved limb/uninvolved limb x 100) was used to quantify strength in the N-A and T-A Groups. Pain ratings were recorded for subjects with tendinitis before and after the eight-week experiment and were correlated with the dependent variable using a Spearman rank-order correlation coefficient. The N-A Group performed significantly better than all subjects with tendinitis (p less than .05). Subjects in the T-A Group, however, showed a trend toward increasing eccentric quadriceps femoris muscle work capacity over the eight-week training period. As pain ratings in the T-A Group increased, work ratios decreased. We concluded that eccentric exercise may be an effective treatment for patellar tendinitis, but that knee pain may limit optimal gains in strength.

Diagnosis:  Patellar tendinopathy

Outcome:  Strength tested with eccentric contractions on KIN/COM dynamometer and VAS scores both resting and during activity. Normal subjects gained more strength (23%) than tendinitis group also increased strength but it was not statistically significant, noting that while strength did increase, the pain may limit work loads, which thereby hinders strength increases. Though they tested pain levels they did not report how pain changed over the course of the treatment in any group.

When Assessed:  8 weeks

Subjects:  31 subjects, 15 female, 16 male aged 21-45 years. 15 had patellar tendinopathy and 16 were normal controls.

Protocol:  Subjects were divided into 4 groups, normal and tendinitis groups with home stretches only and normal and tendinitis groups with the addition of isokinetic eccentric exercises done 3 times per week on KIN/COM dynamometer for 8 weeks progressing from 30 degrees per second to 70 degrees per second. Six sets of 5 reps were done in week one, 8 sets of 5 week 2 and 12 sets of 5 week 3-8.

Other Activity:  No mention.

Chad’s Comments:  Noted the Curwin and Stanish theory, suggesting that eccentric exercise would better prepare the patient to withstand the higher forces of eccentric contractions during sports or ADLs with the theory it was these contractions that cause the damage to the tendon, they cited the 1973 Komi study on force velocity curves which is not on Medline. Difficult to determine much from this study as the results were not given in very clear format, the protocol was only 8 weeks long and the exercises were done 3 times per week with sets of only 5 repetitions.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

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.

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