Abstract
Purpose
To compare tendon strain and stiffness between athletes with patellar tendinopathy and healthy controls, and explore whether the intensity of pain and dysfunction were related to the mechanical properties of the tendon.
Methods
Thirty-four male athletes with patellar tendinopathy and 13 healthy controls matched by age and activity levels were recruited. The in vivo mechanical properties of the patellar tendon were examined by ultrasonography and dynamometry. In subjects with patellar tendinopathy, the intensities of self-perceived pain (maximal pain in the past 7 days and pain during a single-legged declined-squat test) using the visual analogue scale and the assessment of functional disability using the Victorian Institute of Sport Assessment—patellar questionnaire, were collected.
Results
In subjects with patellar tendinopathy, tendon strain was significantly reduced by 22% (8.9 ± 3.7 vs. 14.3 ± 4.7%, P = 0.005) when compared with healthy controls. There was no significant group difference in tendon stiffness (P = 0.27). Significant negative correlations between tendon strain and the maximal self-perceived pain over 7 days (r = −0.37, P = 0.03), and pain during a single-legged declined-squat test (r = −0.37, P = 0.03) were detected. A trend of significant positive correlation was found between tendon stiffness and pain during a single-legged declined-squat test (r = 0.30, P = 0.09).
Conclusion
Our findings show that tendon strain is reduced in athletes with patellar tendinopathy, and a lower tendon strain is associated with a greater magnitude of pain perceived.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- BF:
-
Biceps femoris
- BMI:
-
Body mass index
- d :
-
Deformation
- F :
-
Force
- L:
-
Length
- MDD:
-
Minimal detectable differences
- PMA:
-
Patellar tendon moment arm
- RMS:
-
Root mean square
- SD:
-
Standard deviation
- US:
-
Ultrasound
- VAS:
-
Visual analogue scale
- VISA-p:
-
Victorian Institute of Sport Assessment
References
Aström M, Rausing A (1995) Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Relat Res 316:151–164
Bah I, Kwak ST, Chimenti RL et al (2016) Mechanical changes in the Achilles tendon due to insertional Achilles tendinopathy. J Mech Behav Biomed Mater 53:320–328
Baltzopoulos V (1995) A videofluoroscopy method for optical distortion correction and measurement of knee-joint kinematics. Clin Biomech (Bristol Avon) 10:85–92
Couppé C, Kongsgaard M, Aagaard P et al (2013) Differences in tendon properties in elite badminton players with or without patellar tendinopathy. Scand J Med Sci Sports 23(2):e89–e95
Frohm A, Saartok T, Halvorsen K, Renstrom P (2007) Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols. Br J Sports Med 41:e7
Goncalves-Neto J, Witzel SS, Teodoro WR et al (2002) Changes in collagen matrix composition in human posterior tibial tendon dysfunction. Joint Bone Spine 69(2):189–194
Heales LJ, Lim EC, Hodges PW, Vicenzino B (2014) Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability—implications for central nervous system involvement: a systematic review with meta-analysis. Br J Sports Med 48(19):1400–1406
Helland C, Bojsen-Moller J, Raastad T et al (2013) Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy. Br J Sports Med 47(13):862–868
Hermens HJ (1999) Commission of the European Communities, SENIAM project. European recommendations for surface electromyography: results of the SENIAM project, 2nd edn. Roessingh Research and Development, Enschede, pp 15–54
Hooley CJ, Cohen RE (1979) A model for the creep behaviour of tendon. Int J Biol Macromol 1(3):123–132
Ireland D, Harrall R, Curry V et al (2001) Multiple changes in gene expression in chronic human Achilles tendinopathy. Matrix Biol 20(3):159–169
Kalebo P, Sward L, Karlsson J, Peterson L (1991) Ultrasonography in the detection of partial patellar ligament ruptures (jumper’s knee). Skeletal Radiol 20:285–289
Khan KM, Bonar F, Desmond PM et al (1996) Patellar tendinosis (jumper’s knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology 200:821–827
Kongsgaard M, Kovanen V, Aagaard P et al (2009) Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports 19(6):790–802
Kongsgaard M, Qvortrup K, Larsen J et al (2010) Fibril morphology and tendon mechanical properties in patellar tendinopathy: effects of heavy slow resistance training. Am J Sports Med 38:749–756
Krevolin JL, Pandy MG, Pearce JC (2004) Moment arm of the patellar tendon in the human knee. J Biomech 37:785–788
Kubo K, Yata H, Kanehisa H, Fukunaga T (2006) Effects of isometric squat training on the tendon stiffness and jump performance. Eur J Appl Physiol 96:305–314
Kulig K, Landel R, Chang YJ et al (2013) Patellar tendon morphology in volleyball athletes with and without patellar tendinopathy. Scand J Med Sci Sports 23(2):e81–e88
Lichtwark GA, Wilson AM (2005) In vivo mechanical properties of the human Achilles tendon during one legged hopping. J Exp Biol 208(Pt 24):4715–4725
Lippold OC (1952) The relationship between integrated action potentials in a human muscle and its isometric tension. J Physiol 177:492–499
Maffulli N, Reaper J, Ewen SW, Waterston SW, Barrass V (2006) Chondral metaplasia in calcific insertional tendinopathy of the achilles tendon. Clin J Sport Med 16(4):329–334
Magnusson SP, Hansen P, Kjaer M (2003) Tendon properties in relation to muscular activity and physical training. Scand J Med Sci Sports 13(4):211–223
Magnusson SP, Langberg H, Kjaer M (2010) The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol 6:262–268
Malliaras P, Kamal B, Nowell A et al (2013) Patellar tendon adaptation in relation to load-intensity and contraction type. J Biomech 46(11):1893–1899
Purdam CR, Cook JL, Hopper DH, Khan KM, VIS Tendon Study Group (2003) Discriminative ability of functional loading tests for adolescent jumper’s knee. Phys Ther Sport 4(1):3–9
Reeves ND, Maganaris CN, Narici MV (2003) Effect of strength training on human patella tendon mechanical properties of older individuals. J Physiol 548:971–981
Seynnes OR, Erskine RM, Maganaris CN et al (2009) Training-induced changes in structural and mechanical properties of the patellar tendon are related to muscle hypertrophy but not to strength gains. J Appl Physiol 107(2):523–530
Seynnes OR, Bojsen-Møller J, Albracht K et al (2015) Ultrasound-based testing of tendon mechanical properties: a critical evaluation. J Appl Physiol 118(2):133–141
Visentini PJ, Khan KM, Cook JL et al (1998) The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport 1(1):22–28
Zwerver J, Bredeweg SW, van den Akker-Scheek I (2011) Prevalence of jumper’s knee among nonelite athletes from different sports: a cross-sectional survey. Am J Sports Med 39(9):1984–1988
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Communicated by Olivier Seynnes.
Rights and permissions
About this article
Cite this article
Lee, W.C., Zhang, Z.J., Masci, L. et al. Alterations in mechanical properties of the patellar tendon is associated with pain in athletes with patellar tendinopathy. Eur J Appl Physiol 117, 1039–1045 (2017). https://doi.org/10.1007/s00421-017-3593-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00421-017-3593-1