An Exploratory Analysis of a Treatment Based Classification Algorithm to Treat Patellar Tendinopathy


  • Monica Matocha Texas Lutheran University
  • Patti Syvertson Crystal Springs Uplands School
  • Janet McMurray McMurry University
  • Emily R Dietz Orthopedic Associates of Lancaster
  • Russell T Baker University of Idaho
  • Alan Nasypany University of Idaho
  • Don Reordan Jacksonville Physical Therapy
  • Darcy Downey Texas State University



Patellar Tendinopathy, Manual Techniques, Treatment Based Classification, Patient-Reported Outcomes


The general and athletic populations commonly experience patellar tendon pain, which is frequently treated with a gold standard 12-week eccentric exercise protocol. The present research study was designed to determine the effects of a treatment based classification (TBC) algorithm utilizing indirect treatment techniques in patellar tendinopathy participants. Ten participants (seven females, three males, mean age = 19.6 ± 1.07, mean symptom duration = 2.14 years with a range of one week to six years) with patellar tendinopathy were evaluated and included in this study. Each participant underwent a thorough evaluation process to aid in determining inclusion: participant medical history, range of motion measurements, orthopedic tests, a scan for soft tissue tender points, neurodynamic tests, and a local Mulligan Concept technique to determine diagnosis, study inclusion, and treatment classification. The following outcome measures were collected to establish baseline scores and assess participant improvement: the Disablement in the Physically Active Scale (DPA Scale), Numerical Rating Scale (NRS), Victorian Institute of Sports Assessment for the Patellar Tendon (VISA-P), Global Rating of Change (GRC), Nirschl Phase Rating Scale, and Blazina Knee Scale. Paired t-tests with 95% confidence intervals, were analyzed on NRS, DPA Scale, and VISA-P to determine the effectiveness of all treatment from initial exam to discharge. Cohen’s d was also computed to determine the effect size of each of the aforementioned outcome measures. Descriptive statistics were computed for the GRC at discharge. The mean change for the NRS (M = 4.7, 95% CI[3.57 to 5.82], p < .001), DPA Scale (M = 21.8, 95% CI[12.43 to 31.16], p = .001), and VISA-P (M = 22.70, 95% CI[33.71 to 11.68], p < .001) were statistically significant. The mean for the GRC (M = 5.3) was clinically meaningful. All of the participants (100%) met discharge criteria. The results of this case series demonstrated an increase in function and decrease in pain for participants with patellar tendinopathy within three office visits when utilizing a TBC algorithm.

Author Biographies

Patti Syvertson, Crystal Springs Uplands School

Patti Syvertson DAT, ATC serves as the Director of Sports Medicine and Chair of the Mind Body Program at Crystal Springs Uplands School in Hillsborough, CA. 

Janet McMurray, McMurry University

Janet McMurray DAT, LAT, ATC is an assistant professor in the Department of Kinesiology at McMurry University

Emily R Dietz, Orthopedic Associates of Lancaster

Emily R. Dietz DAT, ATC, LAT, CEIS Dr. Dietz graduated with her Bachelor's degree from Mercyhurst University, Masters degree West Virginia University, and her Doctorate from the University of Idaho. She is currently employed by Orthopedic Associates of Lancaster practicing at Elizabethtown College in Elizabethtown, PA as the Head Athletic Trainer. Dr. Dietz also serves as an adjunct professor for the University of Charleston, WV and Elizabethtown College, PA. 

Russell T Baker, University of Idaho

Russell T. Baker is a clinical assistant professor and the director of the MSAT program at the University of Idaho. His research interests include rehabilitation of acute and chronic musculoskeletal pathologies using manual therapy and patient reported outcome instrument psychometrics.

Alan Nasypany, University of Idaho

Alan Nasypany Ed.D, LAT, ATC is a clinical associate professor and the director of the doctor of athletic training at the University of Idaho.

Don Reordan, Jacksonville Physical Therapy

Don Reordan, PT, Jacksonville Physical Therapy Don graduated from the University of Southern California in 1981 and has over 35 years of experience in sports and orthopedic manual physical therapy in the USA, and briefly in New Zealand. He is an ABPTS board-certified orthopedic clinical specialist. The Mulligan Concept of manual therapy has been an integral part of Don’s practice since 1984. He is an accredited member of the Mulligan Concept Teachers Association and teaches courses to health care practitioners throughout the USA.

Darcy Downey, Texas State University

Darcy Downey, EdD, ATC, LAT is a clinical assistant professor and director of professional program in athletic training at Texas State University.






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