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Effect of eccentric exercises at the knee with hip muscle strengthening to treat patellar tendinopathy in active duty military personnel: a randomized pilot
MacDonald K, Day J, Dionne C
Orthopaedic Physical Therapy Practice 2019;31(1):8-16
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND AND PURPOSE: Tendinopathy is an over-use condition that results in painfully reduced exercise tolerance, mechanical loading capacity, and function negatively impacting soldiers and mission readiness. Investigation of conservative treatment options is critical to facilitate mission readiness. The purpose was to evaluate and compare clinical outcomes (pain and function) following eccentric training (decline squats) with and without the addition of proximal hip strengthening exercises. METHODS: Forty-one activity duty soldiers (mean age 29.3 years, range 19 to 38) with patella tendinopathy were randomized to a standard of care (SOC) group (n = 17) or treatment group (n = 14). Intervention: The SOC group performed unilateral 25 degree eccentric squats (3 sets of 15 repetitions, 2 times per day) for 12 weeks. The treatment group performed the same exercises plus concentric hip strengthening (3 sets of 10 repetitions, 3 times per week) for 12 weeks. FINDINGS: We found no significant differences between groups for any of the outcome measures. We observed significant within group differences for all outcome measures. The LEFS SOC increased from 57.7 to 66.8 (p = 0.008) and the treatment LEFS increased from 54.8 to 64.8 (p = 0.007) at 24 weeks. The VISA-P SOC increased from 51.7 to 70.4 (p = 0.001) and the treatment group increased from 51.8 to 72 (p = 0.002) at 24 weeks. Both groups reached minimal clinical important difference (MCID) for LEFS and VISA-P at 24 weeks. Clinical Relevance: Soldiers may want to consider the addition of hip strengthening as a feasible intervention for the treatment of patellar tendinopathy. CONCLUSION: Favorable effects were demonstrated with patellar tendinopathy using either a combined treatment of eccentric squat and hip muscle strengthening or SOC eccentric squat only group over a 24 week follow-up. The results suggest either treatment strategy is likely to result in improvements when treating an active duty military population.

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