Eccentric training for 'jumper's knee'- is there one right protocol existing?

The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes.
Visnes, H. and Bahr, R. British Journal of Sports Medicine, 2007; 41: 217 – 223.
http://www.ncbi.nlm.nih.gov/pubmed/17261559

Patellar tendinopathy occurs frequently in jumping (volleyball, basketball) and endurance (running, triathlon) athletes. Various treatment options are available. Eccentric exercises have been advocated to be very effective tool, with research finding proving that notion. Nevertheless, no consensus exists in regards to what specific prescription should be implemented for this kind of intervention. Therefore, authors conducted this review to help clinicians make appropriate choices regarding exact form of eccentric exercise to be used for patients.

Seven articles on the clinical effects of eccentric training on patellar tendinopathy and including a total of 162 patients were included in the paper. Although the quality of the studies was variable, the treatment could be estimated to give the patients a 50–70% chance of improvement of knee function and pain. Review found that there are number of different forms of eccentric training including drop squats or slow eccentric movement, squatting on a decline board or level ground, exercising into tendon pain or short of pain, loading the eccentric phase only or both phases, and progressing with speed, then loading or simply loading. Based on the results no final protocol could be designed, however studies indicate that that the treatment programme should include a decline board, should be performed with some level of discomfort, and that athletes should be removed from sports activity.
As usually, more research is needed to provide clear statements. Based on my experience from clinical setting, I would definitely opt for eccentric training in athletes suffering from ‘jumper’s knee”. This is because its effectiveness has been proven in research as well as because the mechanism underlaying its efficacy is based on anatomy, biomechanics and pathogenesis of the condition. I usually advise the patients to cease the sports activity for the first 6 weeks of treatment while performing eccentric exercise on decline board daily, 3 sets per 15 reps, allowing little pain/discomfort while performing (though I don’t know the rationale for pain, anybody??). Also, I advise to perform slow eccentric squats with the leg unloaded in the concentric phase as the non-injured leg is used to get back to the starting position. For those having less time, I would opt for shockwave therapy, though research is inconclusive. Nevertheless, it is the mechanism of its efficacy again, to support its use.
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