This week's article is "Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial" by Breda et al. published in 2021 in the British Journal of Sports Medicine. It compares a progressive tendon loading program using a 3/10 pain threshold to an eccentric exercise program with >5/10 pain threshold for management of patellar tendinopathy. After 24 weeks, they found 43% of those in the progressive loading group returned to their prior level of sport, while 27% of those in the eccentric exercise group returned to their prior level. They found similar levels of satisfaction with the program (~80%) and adherence (~45%), and length of symptoms prior to participation did not impact timeline to return to sport. One of our key critiques of this study is clinically it is rare to perform an exercise program at greater than 5/10 pain levels, with typical pain thresholds being 3-4/10 pain. Would there have been a difference if they utilized a similar pain threshold? In addition, the eccentric program could have been progressive, like their other tendon loading program. Those in the eccentric group essentially did the same exercise for the same amount of time that the other group progressed through 3 phases of exercise (isometric, isotonic, plyometric). We would also would have liked to have seen an analysis that grouped participants based on high adherence vs low adherence to see if exercise adherence moderated the effect on return to prior level. It would not be surprising if those who were more adherent to the exercise program, whether it was progressive loading vs eccentric exercise, saw faster return to prior level of function than those who were not adherent. Physical therapists could use this result to justify their services since this was an unsupervised program, so this result would show a benefit to supervised PT. What are your thoughts on patellar tendinopathy? What does your programming typically look like for those with patellar tendinopathy?

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Reference: (Breda et al., 2021) Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/33219115/

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