THE STRENGTHENING OF THE TRUNK MUSCLES ENHANCES THE IMPROVEMENT OF PATIENTS WITH PATELLAR TENDINOPATHY, IN AN ECCENTRIC TRAINING PROGRAM?

A. Marcolino^1,2,3, V. Engelke², L. Neves⁴, F. Serrão¹

Background: Patellar tendinopathy (PT) is a musculoskeletal injury characterized by the presence of pain in the patellar tendon in the presence of load usually in activities that store and release energy in the patellar tendon, such as jumping. Pathological features include altered cellularity break down in the extracellular matrix. The consensus that the treatment of PT should involve exercises that produce load on the tendon. The most investigated intervention for the treatment of PT is the eccentric exercise for the quadriceps muscle. More recently, a study showed that the position of the trunk in the sagittal plane during a jump landing, it changes the loads applied to the patellar tendon. Thus, an intervention program that improves trunk control may decrease pain and improve the function of people with PT.

Purpose: Evaluation the rehabilitation program consisting of strength exercises for the trunk muscles and eccentric exercises for the quadriceps are superior to a program composed only of eccentric exercises for the quadriceps in the treatment of people with PT.

Methods: This is a randomized clinical study, with an intentional sample of twenty participants of both sexes, with a mean age of 21.9(±2.48) and with a diagnosis of PT. The participants were randomly divided into two groups: 1-Eccentric Group(EG): this group performed the single leg squat on a decline and 2–Eccentric + Trunk Group(ETG): this group performed the single leg squat on a decline and a strengthening program focusing on trunk muscles. The participants performed eccentric training standing on a 25˚ decline board. Both groups performed the exercises twice a week, with three sets of 15 repetitions, for six weeks. The assessments were performed before and after the intervention. The intensity of pain was evaluated using a numeric visual scale(NVS). To assess the severity of symptoms was used Victorian Institute of Sport Assessment–Patella(VISA-P) questionnaire. The functional performance was evaluated using the vertical jump, single hop for distance(SH), triple hop for distance(TH), crossover hop for distance(CH) tests. The trunk and lower limb strength were evaluated through the plank exercise and isometric contractions, respectively.

Results: After 6 weeks of intervention, there was an improvement in the variables analyzed in the pre and post-intervention comparison in the intragroup analysis, but not diferences in the intergroups analysis. Regarding pain, both groups were effective. In VISA–P questionnaire score in the intragroup analysis both groups showed improvement in the pre and post-intervention with p<0.05. Functional analysis through jump tests showed improvement in the intragroup analysis mainly of the patients of the ETG. When analyzing the strength of the trunk and lower limb muscles in the analysis of the knee, there was an intragroup difference in the flexion strength of both groups and extension only in the ETG and in the trunk muscles through the plank test, both groups improved.

Conclusion(s): With the evaluated sample  both groups improved with the proposed exercises. However, the ETG group was more effective, enhancing the results obtained.

Implications: The exercises for the trunk muscles improvement the performence of the lower limb in patients with PT.

Funding, acknowledgements: Federal University of São Carlos - UFSCar, São Paulo, Brazil
Federal University of Santa Catarina - UFSC, SC, Brazil

Keywords: Rehabilitation, Excentric exercise, Pain

Topic: Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Federal University of Santa Catarina

Committee: Ethics Committee of the Federal University of Santa Catarina

Ethics number: 68378317.2.0000.0121