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

Abstract

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.