Pain-guided activity modification during treatment for patellar tendinopathy: a feasibility and pilot randomized clinical trial

Abstract

Background Activity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was to assess (1) the feasibility of using pain-guided activity modification during treatment for patellar tendinopathy and (2) if our outcome measures are responsive to changes in tendon health over the course of treatment. Methods This was an unblinded, randomized two-arm pilot and feasibility study randomized clinical trial with parallel assignment, conducted in Newark, DE. Individuals between the ages of 16 and 40 years old with patellar tendinopathy were included. Participants were randomly assigned to a pain-guided activity (PGA) or pain-free activity (PFA) group using a spreadsheet-based randomization scheme. All participants received standardized treatment using a modified version of the heavy-slow resistance protocol 3×/week for 12 weeks. For the first 6 weeks, the PGA group used the Pain-Monitoring Model to guide activity outside of treatment and the PFA group was restricted from running, jumping, or activities that provoked their patellar tendon pain. Feasibility outcomes included recruitment, enrollment, randomization, compliance, and retention percentages. Clinical evaluations were conducted at baseline, 6, and 12 weeks to assess symptom severity, psychological factors, tendon morphology and mechanical properties, lower extremity function, and quadriceps muscle performance. Results In a ~ 13-month period, 108 individuals were screened, 47/108 (43.5%) were eligible for participation, and 15/47 (32.0%) of those were enrolled (9 PGA, 6 PFA). The recruitment rate was 1.15 participants/month. The mean ± SD compliance with treatment was PGA: 86.1 ± 13.0% and PFA: 67.1 ± 30.7%. There was one missed evaluation session and two adverse events, which were not due to study interventions. Changes exceeding the smallest detectable change were observed for at least one outcome in each domain of tendon health. Conclusions Use of pain-guided activity modification during exercise therapy for patellar tendinopathy was found to be feasible, and the proposed outcome measures appropriate. Computer-based allocation concealment, blinding of evaluators, and greater recruitment of high-level athletes should be implemented in future trials. Trial registration ClinicalTrials.gov identifier: NCT03694730. Registered 3rd of October, 2018.

Association Between Physical Tests and Patients-Reported Outcomes in Athletes Performing Exercise Therapy for Patellar Tendinopathy: A Secondary Analysis of the JUMPER Study

“…Performance Test. As for vertical jump height, despite the fact that Sprague et al 35 reported a jump height improvement after 12 weeks, our data showed no change in vertical jump height, similar to other previous studies. 1,32 It is interesting to note that jump performance in our study population did not improve given that muscle strength and flexibility were both increased after exercise therapy; that may be because other factors, such as arm swing or trunk angle, can also affect vertical jump height.…”

Therapie und Training bei Tendinopathien

“…Da es sich bei der Tendinopathie unabhängig von der betroffenen Körperregion um ein im Wesentlichen überlastungsinduziertes Beschwerdebild handelt, sollte das Management der Belastung adressiert werden. Hierfür hat sich das Pain Monitoring Model 15 bewährt. Solange die Patient*innen dessen Kriterien erfüllen, ist ihnen die weitere Ausübung ihrer Sportart erlaubt.…”

“…Am nächsten Morgen nach der Aktivität sollte auf der NRS ein Wert von 5 nicht überschritten werden und die Beschwerden sollten sich nicht von Woche zu Woche weiter verschlechtern 15 , 16 .…”

Reliability of Continuous Shear Wave Elastography in the Pathological Patellar Tendon

“…3 Tendon structure is associated with function and outcomes after injury, and may be readily assessed in a clinical setting. [4][5][6][7][8] Evaluating the structural changes in the injured patellar tendon may assist in identifying the underlying pathophysiology as well as guide clinical care after injury.Patellar tendinopathy (PT) is an overuse injury of the patellar tendon typically associated with activities involving plyometrics. 9,10…”

“…One of the themes observed across pathological tendons, regardless of the source of injury, are morphological alterations (eg, tendon thickening, larger cross‐sectional areas, or hypoechoic regions identified on sonographic evaluations) to the tendon 3 . Tendon structure is associated with function and outcomes after injury, and may be readily assessed in a clinical setting 4–8 . Evaluating the structural changes in the injured patellar tendon may assist in identifying the underlying pathophysiology as well as guide clinical care after injury.…”