Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial
Introduction Patellar tendinopathy (PT) rehabilitation programmes frequently incorporate eccentric exercise (EE), where participants have limited control over the range of motion, speed, force production and load. Newly developed training protocols that employ visual feedback with specialised device...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e092104.full |
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| author | David Evans Francesco Negro Michail Arvanitidis Eduardo Martinez-Valdes Ragul Selvamoorthy Patricio Pincheira |
| author_facet | David Evans Francesco Negro Michail Arvanitidis Eduardo Martinez-Valdes Ragul Selvamoorthy Patricio Pincheira |
| author_sort | David Evans |
| collection | DOAJ |
| description | Introduction Patellar tendinopathy (PT) rehabilitation programmes frequently incorporate eccentric exercise (EE), where participants have limited control over the range of motion, speed, force production and load. Newly developed training protocols that employ visual feedback with specialised devices offer controlled management of loads, speeds and forces across the full range of motion, potentially providing greater benefits.Objective This protocol outlines a randomised controlled trial designed to compare the effects of a visuomotor torque feedback (TF) protocol with a traditional EE protocol on the rehabilitation of PT over a 6-week period. Our primary objective is to evaluate whether the TF protocol reduces pain and disability more effectively than the EE protocol in individuals with PT. Secondary objectives include analysing structural and architectural changes in the patellar tendon and quadriceps femoris muscles, as well as examining motor unit discharge dynamics in response to EE and TF training. Lastly, we aim to compare these dynamics and structural changes between healthy controls and individuals with PT.Methods Thirty two individuals with PT and twenty six healthy controls will be recruited. The PT group will be subdivided into an EE group, and a TF group, with both groups undergoing a 6-week training programme. The EE group will perform their exercises two times per day, while the TF group will do so 2–3 times a week. In individuals with PT, the primary outcomes will be the Victorian Institute of Sport-Patella (VISA-P) questionnaire to measure disability/physical function, and pain with a Numerical Rating Scale (NRS). To gain insights on mechanisms of action for potential improvements, motor unit discharge characteristics of the quadriceps femoris muscles will be assessed with high-density surface electromyography. Additionally, we will measure structural/architectural changes to the patellar tendon and quadriceps femoris muscles using B-mode ultrasonography and shear-wave elastography.Ethics and dissemination This study was approved by the Science, Technology, Engineering and Mathematics Ethical Review Committee from the University of Birmingham (ERN_2257-Jun2024). The results of this study will be disseminated in peer-reviewed journals and at international conferences.Trial registration number ISRCTN15821610. |
| format | Article |
| id | doaj-art-46b43d48ba81450aa54027f468938815 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-46b43d48ba81450aa54027f4689388152025-02-11T08:10:18ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-092104Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trialDavid Evans0Francesco Negro1Michail Arvanitidis2Eduardo Martinez-Valdes3Ragul Selvamoorthy4Patricio Pincheira5School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UKDepartment of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, ItalySchool of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UKUniversity of Birmingham, Birmingham, UKSchool of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UKUniversity of Southern Queensland, Toowoomba, Queensland, AustraliaIntroduction Patellar tendinopathy (PT) rehabilitation programmes frequently incorporate eccentric exercise (EE), where participants have limited control over the range of motion, speed, force production and load. Newly developed training protocols that employ visual feedback with specialised devices offer controlled management of loads, speeds and forces across the full range of motion, potentially providing greater benefits.Objective This protocol outlines a randomised controlled trial designed to compare the effects of a visuomotor torque feedback (TF) protocol with a traditional EE protocol on the rehabilitation of PT over a 6-week period. Our primary objective is to evaluate whether the TF protocol reduces pain and disability more effectively than the EE protocol in individuals with PT. Secondary objectives include analysing structural and architectural changes in the patellar tendon and quadriceps femoris muscles, as well as examining motor unit discharge dynamics in response to EE and TF training. Lastly, we aim to compare these dynamics and structural changes between healthy controls and individuals with PT.Methods Thirty two individuals with PT and twenty six healthy controls will be recruited. The PT group will be subdivided into an EE group, and a TF group, with both groups undergoing a 6-week training programme. The EE group will perform their exercises two times per day, while the TF group will do so 2–3 times a week. In individuals with PT, the primary outcomes will be the Victorian Institute of Sport-Patella (VISA-P) questionnaire to measure disability/physical function, and pain with a Numerical Rating Scale (NRS). To gain insights on mechanisms of action for potential improvements, motor unit discharge characteristics of the quadriceps femoris muscles will be assessed with high-density surface electromyography. Additionally, we will measure structural/architectural changes to the patellar tendon and quadriceps femoris muscles using B-mode ultrasonography and shear-wave elastography.Ethics and dissemination This study was approved by the Science, Technology, Engineering and Mathematics Ethical Review Committee from the University of Birmingham (ERN_2257-Jun2024). The results of this study will be disseminated in peer-reviewed journals and at international conferences.Trial registration number ISRCTN15821610.https://bmjopen.bmj.com/content/15/2/e092104.full |
| spellingShingle | David Evans Francesco Negro Michail Arvanitidis Eduardo Martinez-Valdes Ragul Selvamoorthy Patricio Pincheira Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial BMJ Open |
| title | Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial |
| title_full | Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial |
| title_fullStr | Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial |
| title_full_unstemmed | Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial |
| title_short | Torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy: protocol for a randomised controlled trial |
| title_sort | torque visuomotor feedback training versus standard eccentric exercise for the management of patellar tendinopathy protocol for a randomised controlled trial |
| url | https://bmjopen.bmj.com/content/15/2/e092104.full |
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