Eccentric Exercise Protocols for Patella Tendinopathy: Should we Really be Withdrawing Athletes from Sport? A Systematic Review

Abstract

The 2007 review by Visnes and Bahr concluded that athletes with patella tendinopathy should be withdrawn from sport whilst engaging in eccentric exercise (EE) rehabilitation programs. However, deprivation of sport is associated with a number of negative psychological and physiological effects. Withdrawal from sport is therefore a decision that warrants due consideration of the risk/benefit ratio. The aim of this study was to determine whether sufficient evidence exists to warrant withdrawal of athletes from sport during an eccentric exercise rehabilitation program. A systematic review of the literature was performed to identify relevant randomised trials. Data was extracted to determine whether athletes were withdrawn from sport, what evidence was presented to support the chosen strategy and whether this affected the clinical outcome. Seven studies were included. None of these reported high quality evidence to support withdrawal. In addition, three studies were identified in which athletes were not withdrawn from sport and still benefited from EE. This review has demonstrated that there is no high quality evidence to support a strategy of withdrawal from sport in the management of patella tendinopathy.

Proposing a Patellar Tendinopathy Screening tool following a systematic review

“…Once the pain is under control, progression to eccentric exercise can be started using the load tolerance principle (Malliaras et al 2015 ). Eccentric exercise has been a cornerstone in PT rehabilitation since the 1980s (Steunebrink et al 2013 ) and it is a popular (Saithna et al 2012 ), extensively investigated therapeutic treatment for PT (Murtaugh & Ihm 2013 ) that improves functionality (Sosa et al 2014 ).…”

Evidence to Practice Review: Best Practices in Patellar Tendinopathy Management

“…12 Evidence also suggests that promoting tissue healing and managing symptoms are not mutually exclusive, as complete removal from sport may be contraindicated as loading is necessary to maintain healthy tendons. 13 The key for clinicians is to manage and reduce training loads, which can be done by utilizing a painmonitoring model with visual analogue scales. 14 In addition, poor patient compliance with eccentric protocols are often implicated in the lack of overall success due to their painful nature.…”

Mise au point sur le traitement des tendinopathies patellaires par le travail musculaire excentrique

“…La majorité des études démontrent l'efficacité du traitement des tendinopathies par l'entraînement excentrique [14][15][16][20][21][22][23], mais il apparaît qu'au fil des années plusieurs questions récurrentes sont soulevées concernant les paramètres des exercices.…”

“…Visnes a montré que la poursuite du sport associée au travail excentrique conduisait à l'échec [14]. Saithna se fonde sur une revue de la littérature pour montrer qu'il n'y a pas d'évidence scientifique suffisante pour imposer l'arrêt du sport durant la réalisation du traitement excentrique [23]. L'auteur argue que, du fait que trois des sept études analysées ne comportaient pas d'arrêt de sport tout en tirant bénéfice du protocole, les autres études n'ont pas suffisamment d'évidence scientifique en faveur d'un arrêt du sport.…”