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A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy
Department of Physical Therapies, Australian Institute of Sport, Belconnen, Australia.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
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2004 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 38, no 4, 395-397 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: This non-randomised pilot study investigated the effect of eccentric quadriceps training on 17 patients (22 tendons) with painful chronic patellar tendinopathy.

Methods: Two different eccentric exercise regimens were used by subjects with a long duration of pain with activity (more than six months). (a) Nine consecutive patients (10 tendons; eight men, one woman; mean age 22 years) performed eccentric exercise with the ankle joint in a standard (foot flat) position. (b) Eight patients (12 tendons; five men, three women; mean age 28 years) performed eccentric training standing on a 25° decline board, designed to increase load on the knee extensor mechanism. The eccentric training was performed twice daily, with three sets of 15 repetitions, for 12 weeks. Primary outcome measures were (a) 100 mm visual analogue scale (VAS), where the subject recorded the amount of pain during activity, and (b) return to previous activity. Follow up was at 12 weeks, with a further limited follow up at 15 months.

Results: Good clinical results were obtained in the group who trained on the decline board, with six patients (nine tendons) returning to sport and showing a significantly reduced amount of pain over the 12 week period. Mean VAS scores fell from 74.2 to 28.5 (p  =  0.004). At 15 months, four patients (five tendons) reported satisfactory results (mean VAS 26.2). In the standard squat group the results were poor, with only one athlete returning to previous activity. Mean VAS scores in this group were 79.0 at baseline and 72.3 at 12 weeks (p  =  0.144).

Conclusion: In a small group of patients with patellar tendinopathy, eccentric squats on a decline board produced encouraging results in terms of pain reduction and return to function in the short term. Eccentric exercise using standard single leg squats in a similar sized group appeared to be a less effective form of rehabilitation in reducing pain and returning subjects to previous levels of activity.


Place, publisher, year, edition, pages
Loughborough: British Assoc. of Sport and Medicine , 2004. Vol. 38, no 4, 395-397 p.
Keyword [en]
Adult, Athletic Injuries/*therapy, Chronic Disease, Exercise Therapy/*methods, Female, Follow-Up Studies, Humans, Knee Injuries/*therapy, Male, Muscular Diseases/*therapy, Pain/etiology/*therapy, Pain Measurement, Patella/*injuries, Pilot Projects, Tendons, Treatment Outcome
National Category
Medical and Health Sciences
URN: urn:nbn:se:umu:diva-16892DOI: 10.1136/bjsm.2003.000053PubMedID: 15273169OAI: diva2:156565
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2011-03-22Bibliographically approved
In thesis
1. Eccentric training in the treatment of tendinopathy
Open this publication in new window or tab >>Eccentric training in the treatment of tendinopathy
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic painful tendinopathies are common, not only in sports and recreationally active people, but also among people with a sedentary lifestyle. Both the lower and upper limbs are affected. There is lack of knowledge about the etiology and pathogenesis to tendinopathy, and many different treatments options have been presented. Unfortunately, most treatments have not been tested in scientific studies. Conservative (non-surgical) treatment has since long shown unsatisfactory results and surgical treatment is known to give unpredictable results.

The aim of this thesis was to evaluate new models of painful eccentric training for the conservative treatment of different chronic tendinopathies. After promising results in a pilot study, using painful eccentric calf muscle training in patients with chronic mid-portion Achilles tendinopathy, we investigated if these results could be reproduced in a larger group of patients with both mid-portion and insertional Achilles tendinopathy (study I). After 12 weeks, 89% of the patients with pain from the mid-portion were satisfied and back in previous activities. In the group with insertional Achilles tendinopathy the results were poor. A new model for eccentric training was designed for patients with insertional Achilles tendinopathy. The eccentric calf muscle training was done from tip-toe to floor level (study II). With this new regimen 67% of the patients were satisfied and back in previous activities. The next step was to investigate the effects of painful eccentric quadriceps training on patients with jumper´s knee/patellar tendinopathy (study III). Two different training protocols were used. Eccentric training performed on a 250 decline board showed promising results with reduced pain and a return to previous activities, while eccentric training without the decline board had poor results. In a following prospective study, patients with jumper´s knee/patellar tendinopathy were randomised to either concentric or eccentric painful quadriceps training on a 250 decline board (study IV). After 12 weeks of training, there were significantly better results in the group that did eccentric training. In a pilot study (study V), we investigated painful eccentric deltoideus and supraspinatus muscle training on a small group of patients on the waiting list for surgical treatment of subacromial impingement syndrome. After 12 weeks of training, 5 out of 9 patients were satisfied with the results of treatment and withdrew from the waiting list for surgery.

In conclusion, the present studies showed good clinical results with low risks of side effects and low costs. Thus, we suggest that painful eccentric training should be tried in patients with Achilles and patellar tendinopathy before intratendinous injections and surgery are considered. For patients with chronic painful impingement syndrome, the results of our small pilot study are interesting, and stimulates to randomised studies on larger materials.

Place, publisher, year, edition, pages
Umeå: Department of Surgical and Perioperative Sciences, Sports Medicine, 2009. 89 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1279
Eccentric training, Achilles tendon, patellar tendon, supraspinatus tendon, impingement, tendinopathy, tendinosis
urn:nbn:se:umu:diva-25856 (URN)978-91-7264-821-0 (ISBN)
Idrottsmedicin, 901 87, Umeå
Public defence
2009-10-09, KBC-huset, hörsal KB3B1, Umeå, 09:00 (Swedish)
Available from: 2009-09-17 Created: 2009-09-08 Last updated: 2010-01-18Bibliographically approved

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