Effect of Dynamic Taping on Landing Biomechanical Characteristics in Volleyball and Basketball Players With Symptoms of Patellar Tendinopathy - Motor Control and Biomechanical Characteristics During the Landing Task
Conditions: Biomechanical Phenomena
Sponsor: National Yang Ming Chiao Tung University

 
Study Protocol with Statistical Analysis Plan 
 
 
Effect of Dynamic Taping on Landing Biomechanical 
Characteristics in Volleyball and Basketball Players with 
Symptoms of Patellar Tendinopathy - Motor Control and 
Biomechanical Characteristics during the Landing Task  
 
 
 
 
 
 
 
NCT number: NCT05454449 
 
Authors: Chia-Yu Chen, Yi-Fen Shih 
Department of Physical Therapy and Assistive Technology, National Yang 
Ming Chiao Tung University 
 
 
April. 14th ,2024

Study background and purposes: 
Patellar tendinopathy (PT) is an overuse condition characterized by repetitive 
stress on the patellar tendon, leading to structural changes in the tendon due to 
accumulated microtrauma. It is prevalent among athletes involved in sports requiring 
extensive jumping, such as volleyball and basketball, with a higher incidence in males 
than females. More than one-third of athletes may not return to their previous level of 
activity within six months of treatment, and severe cases may even necessitate the 
cessation of their athletic careers. Previous research has found that patients with PT 
symptoms for more than three months tend to reduce the use of the knee joint for 
energy absorption during landing. While this mechanism may prevent further 
deterioration of the injured patellar tendon, it redistributes energy loading to other 
joints during landing, increasing the energy absorption required at the hip joint and 
potentially leading to other lower limb injuries in the long term. This highlights the 
importance of the hip joint in addition to the knee joint for such athletes. However, 
previous studies have mainly focused on changes in landing patterns in the sagittal 
plane in athletes with patellar tendinopathy, lacking research on the other two planes 
and muscle activation during landing. Changes in landing patterns can be observed 
not only biomechanically but also through movement control. Alterations in 
movement patterns are also associated with muscle activation and movement control. 

Similar investigations have been conducted for other knee conditions such as anterior 
cruciate ligament injuries and patellofemoral pain syndrome, but there is currently no 
research specifically addressing symptomatic athletes with patellar tendinopathy. 
Understanding the muscle activation and biomechanical changes during landing in 
athletes with patellar tendinopathy can help identify potential issues in clinical 
practice and implement exercise adjustments to prevent secondary problems and 
exacerbation of symptoms, while normalizing movement patterns in athletes. 
Additionally, the hip joint plays a crucial role in closed kinetic chain movements. If 
the relationship between joint movement control issues and patellar tendinopathy can 
be identified, it could serve as a simple assessment tool in clinical practice to 
determine the risk of developing patellar tendinopathy. 
In summary, patellar tendinopathy may be associated with changes in landing 
patterns. However, the biomechanical alterations of the hip and knee joints in the 
frontal and transverse planes are still unclear. Furthermore, factors affecting 
movement patterns, such as movement control and muscle activation status, remain to 
be elucidated. Therefore, the purpose of this study is to investigate movement control 
in athletes with patellar tendinopathy and the biomechanical characteristics of the hip 
and knee joints during landing tasks. We hypothesize that athletes with PT symptoms 
will demonstrate poorer movement control abilities compared to those without 

symptoms, and during the landing phase of loaded movements, they will exhibit 
increased hip adduction, greater hip extension torque, higher quadriceps activation, 
delayed gluteal activation timing, and earlier rectus femoris activation timing. 
 
Study design and participants: 
This is a cross-sectional observational study. Participants aged 18 to 40 were 
recruited for the experiment. The symptomatic group was selected based on the 
following criteria, and then matched to find an asymptomatic group. 
Inclusion criteria for the symptomatic group were:  
ü 
Experiencing anterior knee pain during loading activities for more than 
three months 
ü 
Pain localized only to the inferior pole of the patella 
ü 
Having participated in collegiate-level or higher volleyball/basketball-
related sports training for at least two years 
ü 
Currently engaging in activities inducing knee pain for at least 90 minutes 
per week 
ü 
Scoring below 80 on the Chinese version of the Victorian Institute of Sport 
Assessment-patellar tendinopathy questionnaire (VISA-PCh). 
Inclusion criteria for the asymptomatic group were: 

ü 
Having participated in collegiate-level or higher volleyball/basketball-
related sports training for at least two years 
ü 
Currently engaging in related activities for more than 90 minutes per week 
ü 
Reporting no lower limb pain scores greater than 3 (on a scale of 10) in the 
past three months 
ü 
Scoring greater than or equal to 80 on the VISA-PCh questionnaire. 
Any of the following conditions in either the symptomatic or asymptomatic 
group led to exclusion from recruitment:  
ü 
Undergoing relevant rehabilitation exercises for knee pain in the past three 
months 
ü 
Having other chronic lower limb pain issues 
ü 
Self-reporting pregnancy 
ü 
History of lower limb surgery or patellar tendon steroid injections 
ü 
Medical history of rheumatic, immune, or neurological systemic diseases. 
 
Study methods: 
Data on participants' gender, age, height, weight, exercise frequency and 
duration, years of sports experience, specific sports discipline, participation in 
highest-level competitions, history of lower limb injuries, and completion of the 

Chinese version of the Victorian Institute of Sport Assessment-patellar tendinopathy 
questionnaire were collected via cloud-based forms. Using this information, eligible 
participants were screened, with the symptomatic group recruited first. Then, 
individuals in the asymptomatic group were matched to the symptomatic group based 
on gender, age (±10%), height (±10%), weight (±10%), and sports discipline. 
Before testing, researchers conducted a second screening to confirm eligibility. If 
eligible, researchers provided detailed explanations of the study procedures and 
purposes to participants, who then signed informed consent forms. Prior to testing, 
participants warmed up for 5 minutes. Testing was conducted in the following order: 
Jump height testing: Participants wore athletic shoes and performed a vertical 
jump test, followed by stationary and spike jump tests. Each test was performed three 
times for practice and three times for formal testing. The average of the formal test 
results, minus the average fingertip reach height, yielded the jump height results. 
Ankle dorsiflexion angle measurement: Participants stood facing a wall with 
hands on the wall for support. While maintaining a lunge position with the front heel 
on the ground, participants dorsiflexed the ankle to its maximum angle. The angle 
formed between a line segment from the tip of the fibula to 10 cm below the lateral 
malleolus and the horizontal line was measured. The angle measurement was 
performed three times for each foot, and the average was taken. 

Motor control testing: four tests were performed to assess hip and knee joint 
control, including hip flexion control, internal rotation control, external 
rotation/abduction control, and hip adduction control. Each test was practiced three 
times and performed formally five times. 
Loading testing: Participants performed countermovement jump, drop vertical 
jump, and step-down test to assess lower limb function. Each test was performed 
according to specific protocols. 
Muscle electromyography (EMG) data collection: EMG electrodes were placed 
on both gluteus maximus, biceps femoris, rectus femoris, vastus lateralis ,and 
participants performed maximal voluntary isometric contractions. Additionally, 
handheld dynamometry was used to measure hip extensor strength. 
Finally, data processing and statistical analysis were performed to complete the 
experiment. 
 
Data analysis: 
The total scores of motor control tests of the symptomatic group's pain foot were 
summed and converted into percentages, which were then compared with the average 
total scores of the control group's bilateral foot tests to assess lower limb control 
ability between the two groups. 

Reflective ball trajectories were captured using a motion capture system 
equipped with eight high-speed cameras, sample rate at a frequency of 100 Hz. Force 
data were collected using two force plates measuring 60 cm in length and 40 cm in 
width, sample rate at a frequency of 1000 Hz. The data were integrated via 
analog/digital conversion boards and analyzed using Nexus 1.8.1 motion analysis 
software. The plug-in gait model was employed to calculate raw data, yielding three-
dimensional angles and moments of the hip and knee joints, as well as maximum 
ground reaction forces. 
Surface electromyography (EMG) data were obtained at a sampling frequency of 
1500 Hz. MATLAB programming was utilized to filter and rectify signals within the 
20-450 Hz range, with root mean square calculated at 20-millisecond intervals and 
signal windows set at 1 millisecond to reduce signal data alterations. Muscle 
activation during movements was standardized using maximum voluntary 
contractions, computing the average and maximum activation of muscles during 
movements. Muscle activation onset was defined as the baseline value plus three 
standard deviations above the mean of the pre-movement period, with the time point 
indicating the onset of muscle activation identified accordingly. 
For all variables except muscle activation onset time, data points within ±0.01 
seconds of the required data were averaged to obtain the final results, thereby 

minimizing the impact of extreme values. 
 
Statistical analysis: 
Analysis was conducted using Statistical Product and Service Solution (SPSS) 
25.0 (IBM Corp., USA), with a significance level set at 0.05. Descriptive statistics 
were used for demographic data analysis of participants, chi-square tests were 
employed for categorical variables, and independent samples t-tests were utilized for 
comparing differences between the two groups for continuous variables. 
For motion analysis, kinetics, muscle activities, and motor control score 
percentages, independent samples t-tests were employed to compare the differences 
between the two groups.