School of Medicine and Health Sciences Poster Presentations

Title

Soft tissue mobilization in the management of individuals with patellar tendinopathy: A critically appraised topic.

Poster Number

253

Document Type

Poster

Status

Graduate Student - Doctoral

Abstract Category

Health Sciences

Keywords

knee, manual therapy, rehabilitation, tendon

Publication Date

Spring 2018

Abstract

Introduction

Patellar tendinopathy is a common overuse condition affecting athletes that can lead to significant functional disability, including cessation of sports. Tendinopathy is a chronic degenerative disease associated with abnormal tendon structure, often resulting in localized tenderness and load-dependent symptoms. Current evidence supports using staged progressions of exercise to reduce pain and improve function for this population. While soft tissue mobilization (STM) is commonly used for tendon dysfunction, its effects on patellar tendinopathy are not well described.

Methods

Five different electronic databases (PubMed, Scopus, CINAHL, SportDiscus, and the Cochrane Library) were searched using relevant keywords and appropriate MeSH terms to evaluate interventional trials of STM in management of patellar tendinopathy. Inclusion criteria was patients with patellar tendinopathy, randomized controlled trials (RCT) or cohort study designs, at least one STM technique, outcome measures of pain and/or function, full-text in English language, and human subjects. Studies were excluded if they did not meet the inclusion criteria, used instrument-assisted techniques, or were published greater than 20 years prior. After filtering results based on inclusion and exclusion criteria, three studies were included: two RCTs and one prospective cohort trial. Each trial was screened for quality using the PEDro or Critical Appraisal Skills Programme (CASP) scales.

Results

Of the three included trials, two utilized transverse friction massage (TFM) to the patellar tendon, while the third used fascial manipulation directed towards the thigh. Of the two trials using TFM, one demonstrated a statistically significant additive effect on pain and function when combined with exercise. The second trial using TFM did not demonstrate a statistical improvement in outcomes when used as a stand-alone intervention. The trial utilizing fascial manipulation demonstrated a statistically significant effect in decreasing pain. Each trial was scored to be of high quality.

Conclusion

This study examined the current utilization and benefit of STM in the management of patellar tendinopathy. Based on our review, we conclude that there is limited and conflicting evidence for using STM to improve symptomatic and functional outcomes in patellar tendinopathy. There may be a benefit to improving outcomes when STM is added to an exercise program, however its usage as an independent intervention does not appear to be beneficial. Fascial manipulation may be useful for reducing pain in individuals with patellar tendinopathy. Notable study limitations included small sample sizes and short follow-up periods. Further research is indicated related to the utilization of STM for patellar tendinopathy.

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Soft tissue mobilization in the management of individuals with patellar tendinopathy: A critically appraised topic.

Introduction

Patellar tendinopathy is a common overuse condition affecting athletes that can lead to significant functional disability, including cessation of sports. Tendinopathy is a chronic degenerative disease associated with abnormal tendon structure, often resulting in localized tenderness and load-dependent symptoms. Current evidence supports using staged progressions of exercise to reduce pain and improve function for this population. While soft tissue mobilization (STM) is commonly used for tendon dysfunction, its effects on patellar tendinopathy are not well described.

Methods

Five different electronic databases (PubMed, Scopus, CINAHL, SportDiscus, and the Cochrane Library) were searched using relevant keywords and appropriate MeSH terms to evaluate interventional trials of STM in management of patellar tendinopathy. Inclusion criteria was patients with patellar tendinopathy, randomized controlled trials (RCT) or cohort study designs, at least one STM technique, outcome measures of pain and/or function, full-text in English language, and human subjects. Studies were excluded if they did not meet the inclusion criteria, used instrument-assisted techniques, or were published greater than 20 years prior. After filtering results based on inclusion and exclusion criteria, three studies were included: two RCTs and one prospective cohort trial. Each trial was screened for quality using the PEDro or Critical Appraisal Skills Programme (CASP) scales.

Results

Of the three included trials, two utilized transverse friction massage (TFM) to the patellar tendon, while the third used fascial manipulation directed towards the thigh. Of the two trials using TFM, one demonstrated a statistically significant additive effect on pain and function when combined with exercise. The second trial using TFM did not demonstrate a statistical improvement in outcomes when used as a stand-alone intervention. The trial utilizing fascial manipulation demonstrated a statistically significant effect in decreasing pain. Each trial was scored to be of high quality.

Conclusion

This study examined the current utilization and benefit of STM in the management of patellar tendinopathy. Based on our review, we conclude that there is limited and conflicting evidence for using STM to improve symptomatic and functional outcomes in patellar tendinopathy. There may be a benefit to improving outcomes when STM is added to an exercise program, however its usage as an independent intervention does not appear to be beneficial. Fascial manipulation may be useful for reducing pain in individuals with patellar tendinopathy. Notable study limitations included small sample sizes and short follow-up periods. Further research is indicated related to the utilization of STM for patellar tendinopathy.