Continued Activity During Rehabilitation in Patients With Patellar Tendinopathy

Patellar tendinopathy is a chronic, degenerative condition of the patellar tendon that
results in pain, altered tendon structure, functional impairments, decreased sports
performance, and lost playing time. It commonly affects jumping athletes in sports such as
volleyball and basketball. The prevalence of patellar tendinopathy is high, with 11.8-14.4%
of recreational and 32-45% of elite volleyball and basketball players reporting symptoms.
Although many athletes will seek treatment, 27-49% will experience re-injury and over half of
those injured will retire from their sport of choice due to recurrent symptoms. Additionally,
the absence of symptoms does not ensure full recovery of tendon health and function, which
may contribute to the high rates of recurrence.

Exercise therapy for the treatment of patellar tendinopathy is supported by the highest level
of evidence. However, exercise therapy has been found to be ineffective if the patients
continue with full sports participation. On the other hand, it is unclear if it is necessary
for athletes to completely halt physical activities while undergoing treatment. Absence from
sport due to injury has been associated with increased anxiety, depression, and decreased
self-esteem. Therefore, it is of interest to maintain sports participation, as long as it
does not interfere with injury recovery.

In a randomized controlled trial (RCT) the investigators evaluated if continued running and
jumping during treatment with an Achilles tendon-loading strengthening program had an effect
on the outcome in patients with Achilles tendinopathy. In this study the investigators found
that there were no detrimental effects of being physically active when the level of activity
was guided by a pain-monitoring model. However, the impact of pain-guided activity
modification has not been investigated in patellar tendinopathy. The proposed pilot study
will determine if continued activity, using a pain-monitoring model, is feasible during
treatment for patients with patellar tendinopathy. Furthermore, the investigators will
evaluate if there is a negative effect on recovery of symptoms, tendon structure and
mechanical properties, and functional recovery when adding continued physical activity
compared to rest during exercise therapy treatment. To achieve this objective, the
investigators will conduct a RCT comparing patients with patellar tendinopathy that are
allowed to continue sports participation during treatment, using a pain-monitoring model, to
those that are not allowed to participate in activities that cause pain.

Aim 1 is to evaluate feasibility by examining compliance and satisfaction with continued
sports participation, guided by a pain-monitoring model, compared to refraining from sports
participation during treatment. This will provide critical information to determine if a
larger randomized clinical trial is feasible and if the study protocol needs to be modified.
Aim 2 is to evaluate if there is a difference in change over time in symptoms, tendon
structure and mechanical properties, and function between the two interventions.

This study will be the first to evaluate continued sports participation, guided by a
pain-monitoring model, during rehabilitation in patients with patellar tendinopathy. The
results from this study will play a critical role in achieving the long-term research goal of
understanding of how to develop tailored treatments for patients with tendon injury.
Ultimately this work will inform clinician recommendations regarding activity modification
and potentially, limit the negative psychosocial impacts of the injury.

Inclusion Criteria:

- Diagnosis of patellar tendinopathy

Exclusion Criteria:

- Injury that limits ability to participate in testing

- History of knee surgery within the last 6 months.

- Injection, shockwave, tenotomy or Ten-X to the patellar tendon within the last 6
months.