A randomised controlled study; treatment of patellatendinopathy with excentric exercise and shockwavetherapy

Tendinopathy of the patellatendon, jumper's knee, is a chronic overuse injury
of the patella tendon. It can result in ending the sportcareer.
There is pain in the inferior part of the patella tendon, which increases with
more stress. When there is a chronic tendinopathy there is a disrupted
regenerationproces. Because of that shockabsorbtion is less than normal.
Tendinopathy of the patella tendon cab be treated with excentric exercise. This
treatment was first described by Curwin and Stanish in 1884.The best results
are described when squats are done in an angle of 25 degrees. The painful leg
makes a flection of the knee, after that with bot legs up. Each day two
sessions of three sets of fifthteen repetitions. With this treatment 50-70% of
the patients improves in kneefunction and pain.
Except excentric exercise there is another treatment started in the '90,
extracorporal shockwave therapy (ESWT). Wang finded in 2007 a significant
improvement of pain, VISA-P and kneefunction. Van Leeuwen et al concluded in
2009 that ESWT is an effective and save way for treatment in patella
tendinopathy.
There are still no publications of the combination of excentric exercise and
ESWT. There are some results from other studies but it never was published. One
study was from Peers et al. But they had only a follow up period of twelf
weeks. This study showed an significant improvement of VISA-P score. Recently
this combination was already tried in treatment of midportion tendinopathy of
the achillestendon. Rompe et al (2009) compared excentric exercise with
excentric exercise and ESWT. After four months the recovery is significantly
better in the combination group than in the only excentric exercise group.

The purpose of the study is compare the effect excentric exercise in
combination with electric shockwave therapy with excentric exercise and sham
shockwave therapy. This is measured with the VISA-P score in short term, middle
term and long term period.

The study is a randomised study looking at the effect of treatment of
patellatendinopathy with excentric exercise and shockwavetherapy comparing
excentric exercise with sham shockwavetherapy.
The diagnosis is been given bij a sports doctor with a lot of experience in
patellatendinopathy.
After inclusion there is determination of the pain pressure threshold, the VAS
score and VISA-P. After the explination of the excentric exercise they can to
the exercises at home. This will start after the first session with shockwave.

Intervention:
Excentric exercise: squats on a declineboard of 25 degrees. First you must bent
your knee, than put the other leg next to the first leg to come up again.
During three months two sessions a day of three sets fifthteen repetitions with
one minute rest between the sets. They can do the exercises upto a VAS score=4,
above that stop the exercise. When there is no pain during the exercise you can
use some weights. If the exercise is to painful than you can help yourself to
lean on the back of a chair.

shockwave: three treatments with 1000 impulses, 4 Hz and energylevel of 0,20
mJ/mm2 (Peers 2003) with a Sonocure focussed shockwave where the most painful
point must be treated. Before the treatment there is no use of anaesthetics or
analgesics. The shockwavetherapy is in week 1,2 and 3 after inclusion. An
experienced physical therapist do the shockwavetherapy.

sham shockwave: three treatments with 1000 impulses of 0,03 mJ/mm2 with a
absorbing pad. Before the treatment there is no use of anaesthetics or
analgesics. The shockwavetherapy is in week 1,2 and 3 after inclusion . An
experienced physical therapist do the sham shockwavetherapy.

Sportsactivity during treatment is possible but not above the VAS-score=4. If
it's above 4 than it is necessary to adjust the load.

not applicable

The excentric exercise and shockwavetherapy or sham shockwavetherapy can be a
little painfull.