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Case study Ef ficacy of an inertial resistance training paradigm in the treatment of patellar tendinopathy in athletes: A case-series study D. Romero-Rodriguez a, * , G. Gual a,b , P.A. Tesch c a Blanquerna Faculty of Health Sciences, Universitat Ramon Llull, Barcelona, Spain b Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Spain c Department of Health Sciences, Mid Sweden University, Östersund, Sweden a r t i c l e i n f o Article history: Received 25 May 2010 Received in revised form 11 October 2010 Accepted 19 October 2010 Keywords: Patellar tendinopathy Eccentric Resistance training Inertial resistance a b s t r a c t Study design: Case-series study with pre- vs. post-test measurements design. Background: Strength training programs empha sizing ecce ntric muscle actions have receiv ed much attention in the treatment of tendinopathies. The current study reports on the ef ficacy of a novel strength training paradigm using inertial eccentric-concentric resistance to treat chronic patellar tendinopathy. Case description: Ten athletes with chronic patellar tendinopathy (15 tendons) volunteered for the study. Subjects completed a 6-week training program employing a leg press flywheel ergometer. Pre and post measuremen ts asse ssed lowe r limb maximal stre ngth and vert ical count er -mov ement -jump (CMJ) heigh t. Surfa ce elec tromyogr aphy (SEMG) analy sis of paras pinal , rectus femori s, bice ps femor is and medial gastrocnemius muscles were collected. All measurements were performed one week before and after the training period. Clinical measures of pain and tendon function were assessed by means of a visual analogue scale (VAS) and a patellar tendinopathy questionnaire (VISA) at baseline, post-training and follow-up (12 wk). The Wilcoxon signed-rank test was employed for data comparisons. Results: Eccentric stren gth incre ased after train ing (90% , p < 0.05) . Simi larl y, VAS and VISA scores improved after training as well (60% and 86%, respectively, p < 0.01). There were no changes in CMJ height. Conclusion: Short-term training using inertial eccentric overload, resulted in improved muscle function and reduced subjective pain in long-lasting patellar tendinopathy. Ó 2010 Elsevier Ltd. All rights reserved. 1. Background Patellar tendinopathy is a frequent adverse issue in elite and recreational athletes participating in sports relying on high inten- sit y or high vol ume runni ng or hopping actions (Cook, Khan, Harcourt, Grant, Young, & Bonar, 1997; Khan et al., 1996 ). Its aeti- ology is associa ted with ove rus e lea ding to complaints of pain loca liz ed to the lower inse rti on of the pat ell ar ten don, whi ch typically appears during and after physical activity (Fredb erg & Bolvig, 199 9). While conservative treatment of patellar tendinopathy typically comprises combin ations of passive techniques, e.g., rest, ultra- sound, electrotherapy (Brukner & Khan, 1993; Cook & Khan, 2001; Ferretti, Ippolito, Mariani, & Puddu, 1983; Fredberg & Bolvig, 1999 ), few, if any, of these methods rest on evidence-based data. Indeed, the se mea sur es ha ve not produc ed any posi tive eff ects in the treatment of chronic tendinopathy (Cook & Khan, 2001). Strength training programs, and particularly those emphasizing eccen tric muscleactions ( Brock ett,Morgan, & Prosk e, 2001;Frenet te & Côté,2000; Hort obagy i, Houmard, Fra ser , Dude k, Lambe rt, & Tra cy, 1998; LaStayo, Woolf, Lewek, Snyder-Mackler, Reich, & Lindstedt, 2003; Trappe , Carrit hers, White, Lambert , Evans, & Denn is, 2002), have received much attention as potential aid in the treatment of te ndin opa thy.Overa ll, theresul ts of pas t stud iessugge st that almost any tra ini ng pro gram employing supine or decline squatsordevices offering eccentric overload (Bahr , Fossan, Løken , & Engeb rets en, 2006; Cannell, Taunt on, Clement, Smith, & Khan , 2001; Frohm, Halv orsen , & Thorst ensson , 2005; Frohm, Saartok, Halvorse n, & Renström, 2007; Jonsson & Alfre dson, 2005; Kongs gaar d et al., 2009; Purdam, Jonsson, Alfredson, Lorentzon, Cook, & Khan, 2004; Rabin , 2006; Stasinop oulos & Stas inopoul os, 2004; Visnes & Bahr , 2007; Youn g, Cook, Purdam, Kiss, & Alfredson, 2005), could * Corresponding author. EUSES (University School of Sport and Health), Universitat de Girona, Francesc Macia 65, 17190 Salt, Girona, Spain. Tel.: þ34 972405130; fax: þ34 972400781. E-mail address: [email protected] (D. Romero- Rodriguez) . Contents lists available at ScienceDirect Physical Therapy in Sport journal homepage: www.elsevier.com/ptsp 1466-853X/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.ptsp.2010.10.003 Physical Therapy in Sport 12 (2011) 43e48

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