Continued Activity During Rehabilitation in Patients With Patellar Tendinopathy
Condition: Patellar Tendinopathy; Patellar Tendinitis; Patellar Tendon Pain; Patellar Tendinosis; Jumper's Knee
MeSH terms: Tendinopathy
Study type: Interventional

Summary: 
      This pilot study will evaluate the feasibility of pain-guided activity modification during
      rehabilitation for patellar tendinopathy. The information provided will be utilized to
      conduct a larger randomized clinical trial to determine if there is a difference in recovery
      from patellar tendinopathy during rehabilitation between individuals that use pain-guided
      activity modification and those that halt all painful activities. Recovery from patellar
      tendinopathy will be assessed using pain ratings, tendon-specific outcome measures, tendon
      structure, tendon mechanical properties, and muscle function.
    

Detailed description: 
      Patellar tendinopathy is a chronic, degenerative condition of the patellar tendon that
      results in pain, altered tendon structure, functional impairments, decreased sports
      performance, and lost playing time. It commonly affects jumping athletes in sports such as
      volleyball and basketball. The prevalence of patellar tendinopathy is high, with 11.8-14.4%
      of recreational and 32-45% of elite volleyball and basketball players reporting symptoms.
      Although many athletes will seek treatment, 27-49% will experience re-injury and over half of
      those injured will retire from their sport of choice due to recurrent symptoms. Additionally,
      the absence of symptoms does not ensure full recovery of tendon health and function, which
      may contribute to the high rates of recurrence.

      Exercise therapy for the treatment of patellar tendinopathy is supported by the highest level
      of evidence. However, exercise therapy has been found to be ineffective if the patients
      continue with full sports participation. On the other hand, it is unclear if it is necessary
      for athletes to completely halt physical activities while undergoing treatment. Absence from
      sport due to injury has been associated with increased anxiety, depression, and decreased
      self-esteem. Therefore, it is of interest to maintain sports participation, as long as it
      does not interfere with injury recovery.

      In a randomized controlled trial (RCT) the investigators evaluated if continued running and
      jumping during treatment with an Achilles tendon-loading strengthening program had an effect
      on the outcome in patients with Achilles tendinopathy. In this study the investigators found
      that there were no detrimental effects of being physically active when the level of activity
      was guided by a pain-monitoring model. However, the impact of pain-guided activity
      modification has not been investigated in patellar tendinopathy. The proposed pilot study
      will determine if continued activity, using a pain-monitoring model, is feasible during
      treatment for patients with patellar tendinopathy. Furthermore, the investigators will
      evaluate if there is a negative effect on recovery of symptoms, tendon structure and
      mechanical properties, and functional recovery when adding continued physical activity
      compared to rest during exercise therapy treatment. To achieve this objective, the
      investigators will conduct a RCT comparing patients with patellar tendinopathy that are
      allowed to continue sports participation during treatment, using a pain-monitoring model, to
      those that are not allowed to participate in activities that cause pain.

      Aim 1 is to evaluate feasibility by examining compliance and satisfaction with continued
      sports participation, guided by a pain-monitoring model, compared to refraining from sports
      participation during treatment. This will provide critical information to determine if a
      larger randomized clinical trial is feasible and if the study protocol needs to be modified.
      Aim 2 is to evaluate if there is a difference in change over time in symptoms, tendon
      structure and mechanical properties, and function between the two interventions.

      This study will be the first to evaluate continued sports participation, guided by a
      pain-monitoring model, during rehabilitation in patients with patellar tendinopathy. The
      results from this study will play a critical role in achieving the long-term research goal of
      understanding of how to develop tailored treatments for patients with tendon injury.
      Ultimately this work will inform clinician recommendations regarding activity modification
      and potentially, limit the negative psychosocial impacts of the injury.
    

Intervention name(s): Exercise Treatment; Pain- Guided Activity Modification
Intervention type(s): Other; Other
Intervention description(s): Exercise treatment will consist of squatting and knee extension exercises, designed to progressively load the patellar tendon (Heavy-Slow Resistance protocol). A pain-monitoring model is used to guide exercise loads. As the protocol progresses, exercise load is increased while repetitions are decreased.; Participants sports participation and physical activity will be guided by the Pain-Monitoring Model. Using the Pain-Monitoring Model, patients may participate in activities that cause patellar tendon pain, as long as pain does not exceed 5/10 on the numeric pain rating scale (NPRS) (0 = No pain, 10 = Worst pain imaginable) during or immediately after activity. Additionally, pain should return to pre-activity levels by the following morning and pain should not increase from week-to-week.
Other intervention name(s): Rehabilitation exercise; Physical Therapy treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two treatment groups receiving different activity modification instructions.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Tendinopathy; Tendinitis; Tendinosis; Rehabilitation; Exercise Treatment; Activity Modification