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CompletedNCT03262181Updated Feb 19, 2019

The Acute Effects of an Isometric Loading Intervention on Lower Extremity Landing Biomechanics in Individuals With Patellar Tendinopathy

An interventional study of Isometric Exercise and Sham Transcutaneous Electrical Nerve Stimulation in Tendinopathy, sponsored by University of North Carolina, Chapel Hill. Completed at 1 site in United States. Open to male participants aged 15 Years to 28 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2019-02-19.

Sponsored by University of North Carolina, Chapel Hill · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
43
Allocation
Randomized
Ages
15 Years to 28 Years
Sex
Male
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Study summary

The purpose of this study is to determine differences in lower extremity landing biomechanics and real-world physical activity between individuals with patellar tendinopathy compared to individuals without patellar tendinopathy,and to determine the acute effects of an isometric loading intervention on lower extremity landing biomechanics in individuals with patellar tendinopathy.

02

Conditions studied

  • Tendinopathy

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Keywords

  • Exercise
  • Physical Activity
  • Biomechanics
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Who can participate

Ages eligible
15 Years to 28 Years
Sexes eligible
Male
Accepts healthy volunteers
Yes

Inclusion criteria

The investigators will recruit a convenience sample of participants who meet the following overall criteria:

  1. Age 15 and post-pubertal (confirmed by Pubertal Development Scale Questionnaire) - 28 years
  2. Actively participating within an organized sport setting (high school, collegiate, club, competitive intramural sports) in their respective team's weekly training and competitions, quantified by a Tegner Activity Level Scale of at least 5.

Exclusion criteria

Exclusion Criteria:

The following exclusion criteria will be applied to all participants:

  1. Any anterior knee pain with no patellar tendon abnormality on ultrasound assessment.
  2. History of any knee joint surgery ever.
  3. History of other (non-knee) lower extremity surgery in the last 1 year.
  4. History of lower extremity injury in last 6 months (other than patellar tendinopathy).
  5. An injection (corticosteroids, plasma-rich-protein, etc.) to the patellar tendon in the last 3 months.
  6. Known history of osteoarthritis or current symptoms related to osteoarthritis (i.e. stiffness, swelling).
  7. Participation in formal rehabilitation for patellar tendinopathy in prior 3 months
  8. Known neurological disorders, including: stroke, multiple sclerosis, ALS, diabetic neuropathy, epilepsy, traumatic brain injury resulting in loss of consciousness, concussion within the last 6 months, cranial neural surgery, balance disorders.
  9. Use of pacemaker or another implantable electronic device.
  10. History of cardiac arrhythmia or any cardiac condition.
  11. History of psychiatric disorder. *
  12. History of cancer in the brain or thigh musculature.
  13. Pubertal Development Scale Score \< 12 (Stages 1-4)

    • Note: Rationale for exclusion of individuals with a history of psychiatric disorders is that these individuals may have taken or be taking pharmacological agents that could affect pain or neuromuscular control.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Crossover assignment
Masking
Double (Participant, Investigator)
Enrollment
43 participants (actual)

Study arms

  • Experimental
    Isometric Exercise Condition

    The participant will perform 5 sets of a 45-second isometric contractions at 70% of their maximum voluntary isometric contraction (MVIC). During the 45-second contraction, the participant will be provided with visual biofeedback on a computer screen (70% MVIC target line and +/- 5% error lines). The participant will be instructed to produce a level of isometric quadriceps contraction that maintains the isometric torque output line as close the target line as possible and always between the two error lines.

    Other: Isometric Exercise

  • Sham comparator
    Sham TENS Condition

    Two electrodes of the Select System TENS unit (Empi, Inc., St. Paul, MN) will be placed on either side of the patellar tendon on the test limb. The same instruction script will be used for each participant, stating, "A surface electrode has been placed on either side of your patellar tendon. I will turn on the stimulation unit to emit a stimulus to your patellar tendon. This is a special sub-sensory stimulation treatment, so you will not feel anything during this period as the stimulus is set at a very low, non-detectable threshold. Please remain still during this 45-second period, letting your leg rest passively in the machine without contracting your leg muscles. After the 45-second period, the stimulation unit will be turned off and you will have a 2-minute rest period. We will repeat this same treatment/rest sequence 5 total times."

    Other: Sham Transcutaneous Electrical Nerve Stimulation

Interventions

  • OtherIsometric Exercise

    5 sets of 45-seconds quadriceps contraction, each followed by 2-minutes of rest.

    Also known as: Therapeutic Exercise

  • OtherSham Transcutaneous Electrical Nerve Stimulation

    5 sets of 45-seconds intervals without quadriceps contraction, each followed by 2-minutes of rest.

    Also known as: Sham TENS

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What researchers measure

Primary outcomes

  1. Difference in the change in mean internal knee extension moment during landing between groups

    Angular force or moment will be measured in Nm/kg\*m where "Nm" represents angular force and "kg\*m" represents normalization to body weight and height.

    Time frame: Pre- and post-intervention condition (~30 minutes)

  2. Difference in the change in mean internal hip flexion moment during landing between groups

    Angular force or moment will be measured in Nm/kg\*m where "Nm" represents angular force and "kg\*m" represents normalization to body weight and height.

    Time frame: Pre- and post-intervention condition (~30 minutes)

  3. Difference in the change in mean peak vertical ground reaction force during landing between groups

    Vertical ground reaction force will be measured in N(BW) where "N" is a measure of force and "BW" represents normalization to body weight.

    Time frame: Pre- and post-intervention condition (~30 minutes)

  4. Difference in the change in mean peak vertical ground reaction force loading rate during landing between groups

    Vertical ground reaction force loading rate will be measured in N(BW)/s where "N" is a measure of force and "BW" represents normalization to body weight and "s" is the time unit seconds.

    Time frame: Pre- and post-intervention condition (~30 minutes)

  5. Difference in the change in mean peak patellar tendon force during landing between groups

    Patellar tendon force will be measured in N(BW) where "N" is a measure of force and "BW" represents normalization to body weight.

    Time frame: Pre- and post-intervention condition (~30 minutes)

Secondary outcomes

  1. Difference in average steps-per-day between groups

    Steps-per-day calculated by an ActiGraph GT9X Link Accelerometer (ActiGraph Corporation, Pensacola, FL) wearable physical activity device worn at the hip using a belt clip.

    Time frame: Day 1 - Day 7

  2. Difference in average minutes of moderate-to-vigorous physical activity (MVPA) between groups

    MVPA calculated by an ActiGraph GT9X Link Accelerometer (ActiGraph Corporation, Pensacola, FL) wearable physical activity device worn at the hip using a belt clip.

    Time frame: Day 1 - Day 7

  3. Difference in change in anterior knee pain (self-reported via visual analog scale (0-10)) between groups

    A standard visual analog scale (0-10) will be utilized to assess pain, where 0=complete absence of pain and 10=worst pain imaginable (higher scores indicate worse pain). This scale will be delivered verbally and the participants will respond verbally.

    Time frame: Pre- and post-intervention condition (~10 minutes)

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Study locations

1 site
  • Sports Medicine Research Laboratory
    Chapel Hill, North Carolina 27599, United States
07

References and documents

Individual participant data

Plan to share: Undecided

No publications or documents are linked to this record.

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Registry details

Key details

Study ID
NCT03262181
Lead sponsor
University of North Carolina, Chapel Hill
Collaborators
Foundation for Physical Therapy, Inc.
Responsible party
Sponsor
First posted
Aug 25, 2017
Start date
Sep 15, 2017
Primary completion
Apr 20, 2018
Completion
Apr 20, 2018
Last update
Feb 19, 2019

Study contacts

Darin A Padua, PhD, ATC
study chair · Professor and Department Chair
Laura E Stanley, DPT
principal investigator · Graduate Research Assistant

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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