Is There a Mechanistic Reason for the Response or Non-response to Isometric Exercise in Tendinopathy?
- Conditions
- Tendinopathy
- Interventions
- Diagnostic Test: Evaluation of local tendon deformation
- Registration Number
- NCT03848598
- Lead Sponsor
- Universitaire Ziekenhuizen KU Leuven
- Brief Summary
In early phase tendinopathy, isometric exercises are seen as ideal to provide pain relief to patients. This approach is mainly based on a paper by Rio et al (2016), where they found that isometric exercises of a certain load magnitude and time (5 repetitions of 45 second hold at 70% of maximum) gave 100% pain relief for 45 minutes in patients with patellar tendinopathy. This then helps patients to perform their more heavy load exercises during rehabilitation, which would otherwise be too painful.
Unfortunately, the study of Rio et al only consisted of 6 participants, and recent papers have contradicted the findings. In Achilles tendinopathy, plantar fasciopathy and lateral elbow tendinopathy, the pain relief was not consistently present, with "responders" and "non-responders" being found in these studies. Also, a study yet to be published (poster at conference), replicating Rio et al, also found a heterogeneous response, debunking the "one size fits all" approach that seemed to work.
However, in our understanding, isometric exercises do have a crucial role in early tendinopathy management, but the way the exercise is performed, in which position, what magnitude of load, time under tension, ... has an important influence. The same protocol (5 repetitions of 45 second hold at 70% of maximum) might lead to big inter-individual differences. Therefore, there might be a mechanistic reason why some patients respond, and others do not.
Fortunately, the P.I. of this current trial application has recently optimized an ultrasound-based method to quantify local tendon deformation during exercises. The main purpose of this trial is therefore to evaluate the local tendon deformation pattern of patients with tendinopathy during isometric exercises and evaluate whether there is an interindividual difference in pattern between "responders" and "non-responders".
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 20
- Clinical diagnosis of patellar tendinopathy, consisting of
- pain located at the proximal part of the patellar tendon
- painful at palpation the proximal part of the patellar tendon
- Numeric Rating Scale > 1/10 with squat on decline (20°) board
- previous treatment for patellar tendinopathy
- rupture of patellar tendon on ultrasound
- unclear differential diagnosis with patellofemoral pain
- concomitant neuromuscular disorders
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Responders Evaluation of local tendon deformation Patients suffering from patellar tendinopathy who have complete pain resolution after performing isometric exercises. Non-responders Evaluation of local tendon deformation Patients suffering from patellar tendinopathy who do not have complete pain resolution after performing isometric exercises.
- Primary Outcome Measures
Name Time Method Local tendon tissue displacement in three layers of the tendon (deep, middle and superficial layer); as measured by ultrasound-based speckle tracking Immediately during isometric exercise Millimeter
- Secondary Outcome Measures
Name Time Method Non-uniform displacement; as measured by ultrasound-based speckle tracking Immediately during isometric exercise % (measure for relative displacement of the superficial layer of the tendon versus the deep layer, and then divided by the mean total displacement of the three layers combined)
Trial Locations
- Locations (1)
University Hospitals
🇧🇪Leuven, Vlaams-Brabant, Belgium