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Patellar tendinopathy (jumper's knee) occurs in several sports, with jumping athletes being the most susceptible. 1 For example, the prevalence of jumper's knee is 40-50% among elite volleyball players. 2, 3 This often recurrent condition can severely limit or even end an athletic career, and recovery from each episode can be prolonged. 4 Importantly, the condition is not self limiting, and, although rest may offer symptomatic relief, pain often recurs on resumption of activity. Surgical options have provided limited success, with a retrospective study finding that only half of all athletes who had either open or arthroscopic patellar tenotomy were competing at their former sporting level at a four year follow up. 5
Tendinopathy research to date has concentrated on the morphology and aetiology of this condition, with little focus on conservative treatment options. Although testing the efficacy of clinical intervention protocols does not identify the underlying pathomechanics, it does provide invaluable clinical information on the usefulness of these protocols.
Conservative treatment of patellar tendinopathy is empirically and clinically based, with progressive eccentric strengthening forming the cornerstone of most rehabilitation programmes. Despite this, there is little clinically relevant research on which to base an eccentric training programme, as there are few randomised controlled trials that have compared exercise based protocols for this condition. 6, 7 Although speed based eccentric exercise programmes proposed by Curwin and Stanish 8 are in widespread use, the efficacy of these programmes for patellar tendinopathy has not been fully investigated.
The success of a pain based eccentric exercise programme has been demonstrated in the treatment of Achilles tendinopathy, 9 but the effect of painful eccentric training during the rehabilitation of patellar tendinopathy is unknown. Furthermore, recent investigations have shown that squats performed on a 25° decline board target the knee extensor mechanism more specifically than the standard squat, and it has been suggested that this may be relevant in the management of patellar tendinopathy. 10, 11 Given these findings, a combination of squatting on a decline board and into tendon pain would theoretically provide an effective conservative treatment protocol for patellar tendinopathy.
The purpose of this study was to investigate the short and long term efficacy of two exercise programmes, one based on a traditional eccentric protocol (step group) and one...