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This study aims to investigate the effects of two different resistance training interventions on the structural, morphological, mechanical, and functional properties of the thigh muscles (in particular the quadriceps femoris) and the patellar tendon, in participants with current patellar tendinopathy.
Patellar tendinopathy is a common musculoskeletal injury among physically active people and athletes, particularly those who play sports that involve high jumps, such as volleyball and basketball. This condition is associated with alterations in the intrinsic properties of the muscle (e.g., cross-sectional area, muscle length) and the patellar tendon (e.g., stiffness, thickness), along with impairments in sports performance (e.g., altered jump height) and tendon pain.
The current gold-standard treatment for tendinopathies is composed mainly of eccentric training, which overall shows a good percentage of remission of the symptoms, but on the other hand, a high percentage of recurrence of said symptoms.
The objectives are to find out if a specific and controlled eccentric training and heavy-slow resistance training, which literature has shown to be a friendly and closer to daily-life movement alternative for management of patellar tendinopathy. Through the assessment of several muscle, tendon, and performance parameters, our study aims to investigate if individually targeted training variables on both training interventions show a better improvement in the intrinsic properties of the anatomical structures, as well as functional and performance parameters like pain level, strength, jump height, etc.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Eccentric Training | Experimental | Participants between 18 and 50 years of age with patellar tendinopathy who will receive the eccentric intervention only. |
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| Heavy-Slow Resistance Training | Experimental | Participants between 18 and 50 years of age with patellar tendinopathy who will receive the heavy-slow resistance training intervention only. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Eccentric Training | Other | The intervention consists of 12 weeks of resistance training, with a frequency of three times per week. Participants in this group will perform two exercises on a leg press and knee extension machine at their own training facility. This intervention has a repetition time of four seconds, with only the eccentric phase of the movement being performed. They will rest between two and three minutes between sets and will perform the exercises as long as their pain level is less than or equal to four on a pain scale from 0-10. The training parameters are the following, applying to both leg press and knee extension exercises: Week 1: 3 sets of 15 repetitions at 60% of their 1-repetition maximum (1RM) Week 2 and 3: 3 sets of 12 repetitions at 70% of their 1RM Week 4 and 5: 3 sets of 10 repetitions at 75% of their 1RM Week 6 to 12: 4 sets of 8 repetitions at 80% of their 1RM. |
| Measure | Description | Time Frame |
|---|---|---|
| Tendon Thickness | Anteroposterior thickness of the patellar tendon (in milimiters) measures by B-Mode Ultrasound (Aixplorer V12.3 Supersonic Imaging, France) with a SuperLinear 15-4 MHz probe. Three images at the same position will be taken for further analysis with the software ImageJ. | From enrollment to the end of training at 12 weeks |
| Tendon sitffness | Stiffness of the patellar tendon (in kilopascal) will be measured with Shear-Wave Elastrography (Aixplorer V12.3, Supersonic Imaging, France). The measurement site is 0.5cm from the patellar apex, and five videos of 15 seconds will be recorded for further analysis with Matlab. | From enrollment to the end of training at 12 weeks |
| Tendon CSA | Cross-sectional area of the patellar tendon (in centimiters) on its proximal, middle and distal part, will be measured with B-Mode Ultrasound (Aixplorer V12.3, Supersonic Imaging, France). Three images per site, accounting for a total of 9 images, will be taken for further analysis with the software ImageJ. | From enrollment to the end of training at 12 weeks |
| Fascicle length | Length of the fascicles of the vastus lateralis muscle (in centimiters) will be measures with Extended Field of View (Panoramic) B-Mode Ultrasound (Aixplorer V12.3, Supersonic Imaging, France). Five images will be taken for further analysis with the software ImageJ. | From enrollment to the end of training at 12 weeks |
| Muscle Strength | Maximum voluntary isometric torque of the knee extensors (in newton per meters) will be measured with the Isomed2000, Germany device. Three trials will be performed, with three minutes of rest in between, and the trial with the maximum peak torque will be taken for analysis. |
| Measure | Description | Time Frame |
|---|---|---|
| Tendon Neovascularization | Presence of blood vessels in the patellar tendon will be analysed with Color Doppler Ultrasound (MyLab60, Esaote S.p.A., Italy). The measurement site is 0.5cm from the patellar apex. Five videos of 15 seconds each will be taken for further analysis with Matlab. | From enrollment to the end of training at 12 weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Josefina Manieu Seguel, M.Sc. | University of Graz | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Graz | Graz | Styria | 8010 | Austria |
Metrics obtained from the outcome variables. No personal information will be shared (e.g., name, gender, anthropometrics)
The IPD and supporting information will be available starting June 2026, archived and available to the specific members mentioned above for a period of 10 years (June 2036).
The supervisor and the senior postdoctoral researcher will have access to the information. They will have access to the metrics of the outcome variables of each participant. This includes: tendon stiffness, tendon thickness, tendon cross-sectional area, tendon neovascularization, tendon Young's modulus, muscle thickness, muscle stiffness, fascicle length, strength test results, jump height, pain scores, and questionnaire scores. They will have access through a secure University server that stores the data under the principal investigator's name, which allows selective access to specified people.
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The study is designed as a randomized controlled trial (RCT). This means the participants will be randomly assigned to one of two intervention groups:
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| Heavy-Slow Resistance Training | Other | The intervention consists of 12 weeks of resistance training, with a frequency of three times per week. Participants in this group will perform two exercises on a leg press and knee extension machine at their own training facility. This intervention has a repetition time of four seconds, of which two seconds will be spent on the concentric phase and two seconds on the eccentric phase of the movement being performed. They will rest between two and three minutes between sets and will perform the exercises as long as their pain level is less than or equal to four on a pain scale from 0-10. The training parameters are the following, applying to both leg press and knee extension exercises: Week 1: 3 sets of 15 repetitions at 60% of their 1-repetition maximum (1RM) Week 2 and 3: 3 sets of 12 repetitions at 70% of their 1RM Week 4 and 5: 3 sets of 10 repetitions at 75% of their 1RM Week 6 to 12: 4 sets of 8 repetitions at 80% of their 1RM. |
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| From enrollment to the end of training at 12 weeks |
| 1 repetition maximum | Maximum strength of the leg press and knee extension exercises (in kilograms) will be measured with the leg press and knee extension devices (compass540, Physiomed, Germany). Participants will perform repetitions with increasing weights, until they can perform a maximum of eight repetitions with a specific weight. This weight will be then used to estimate their maximum 1RM, to further calculate the training loads. | From enrollment to the end of training at 12 weeks |
| Overall Pain | Pain assessed at rest and during a single-leg-decline squat (SLDS) will be assessed with the numerical rating scale of 11 points called Visual Analogue Scale (VAS). Higher values mean higher pain levels. | From enrollment to the end of training at 12 weeks |
| Functionality | Functionality assessed with the VISA-P Questionnaire. This questionnaire includes 10 questions with a score from 0 to 10, for a maximum questionnaire score of 100 points. Higher scores mean better functionality. | From enrollment to the end of training at 12 weeks |
| Young's Modulus |
Tendon Young's Modulus (in kilopascal) will be assessed with Shear-Wave Elastography (Aixplorer V12.3, Supersonic Imaging, France). |
| From enrollment to the end of training at 12 weeks |
| Muscle Thickness | Thickness of the vastus lateralis muscle (in centimiters) will be obtained with Extended Fielv of View Panoramic Ultrasound (Aixplorer V12.3, Supersonic Imaging, France). Five images will be taken, and muscle thickness will be measures on three places on the thickest part of the muscle, and averaged for further analysis with ImageJ. | From enrollment to the end of training at 12 weeks |
| Muscle Stiffness | Stiffness of the vastus lateralis tendon (in kilopascal) will be measured with Shear-Wave Elastrography (Aixplorer V12.3, Supersonic Imaging, France). The measurement site is 60% of the length of the muscle, from the greater trochanter to the lateral femur condyle. Five videos of 15 seconds will be recorded for further analysis with Matlab. | From enrollment to the end of training at 12 weeks |
| Jump Height | Height of the Countermovement Jump measured with Kinvent Force Plates will be assessed. The participants will perform three jumps with two minutes rest in between them. | From enrollment to the end of training at 12 weeks |