Preprint / Version 1

Interventions for Prevention and In-season Management of Patellar Tendinopathy in Athletes

A scoping review

##article.authors##

  • Ian Burton NHS
  • Aisling McCormack

DOI:

https://doi.org/10.51224/SRXIV.119

Keywords:

Patellar, Tendinopathy, Resistance training, Rehabilitation, Athlete, Musculoskeletal, Sport

Abstract

Introduction: Patellar tendinopathy has a significant prevalence in athletes and presents a tremendous burden on athletes and clinicians due to its long-lasting duration, persistent symptoms, and lack of available effective treatments. This scoping review aimed to summarise current evidence on prevention and in-season management interventions for patellar tendinopathy in athletes, evaluating intervention parameters and outcomes.

Methods and analysis: The recommended methodological framework described by the Joanna Briggs Institute was used to structure this review, with reporting in accordance with the PRISMA-ScR. Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, and the Cochrane library (Controlled trials, Systematic reviews). All primary study designs investigating prevention or in-season management interventions for patellar tendinopathy, while maintaining athletes in sport were considered for inclusion.

Findings: 5987 articles were identified with 29 included in the review. Despite a dearth of studies to date on preventative interventions for athletes with patellar tendinopathy, evidence suggests that resistance training is an effective prophylactic method. There is a significant body of evidence suggesting that resistance training is effective for managing patellar tendinopathy in-season, with evidence greater for eccentric training, followed by heavy slow resistance training and isometric training. Inertial flywheel and blood-flow restricted resistance training may also be effective in-season management strategies. There is currently no evidence to suggest that ESWT offers any additional benefit over resistance training in competing athletes. Patellar strapping and taping may offer short-term pain relief during training and competition. High risk athletes, particularly those participating in jumping sports, should be required to undergo progressive resistance training as a preventative method for patellar tendinopathy. Similarly, athletes diagnosed with patellar tendinopathy should undergo a progressive resistance training intervention while maintaining sports participation, prior to considering sport withdrawal.

Metrics

Metrics Loading ...

References

AGERGAARD, A.S., SVENSSON, R.B., MALMGAARD-CLAUSEN, N.M., COUPPE, C., HJORTSHOEJ, M.H., DOESSING, S., KJAER, M. and MAGNUSSON, S.P., 2021. Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial. The American Journal of Sports Medicine, 49(4), pp. 982-993.

ALGHAMDI, N.H., POHLIG, R.T., LUNDBERG, M. and SILBERNAGEL, K.G., 2021. The Impact of the Degree of Kinesiophobia on Recovery in Patients With Achilles Tendinopathy. Physical Therapy, 101(11), pp. 10.1093/ptj/pzab178.

ARVINEN-BARROW, M. and CLEMENT, D., 2017. Preliminary investigation into sport and exercise psychology consultants' views and experiences of an interprofessional care team approach to sport injury rehabilitation. Journal of interprofessional care, 31(1), pp. 66-74.

BASAS, A., COOK, J., GOMEZ, M.A., RAFAEL, M.A., RAMIREZ, C., MEDEIROS, B. and LORENZO, A., 2018. Effects of a strength protocol combined with electrical stimulation on patellar tendinopathy: 42 months retrospective follow-up on 6 high-level jumping athletes. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 34, pp. 105-112.

BIERNAT, R., TRZASKOMA, Z., TRZASKOMA, L. and CZAPROWSKI, D., 2014. Rehabilitation protocol for patellar tendinopathy applied among 16- to 19-year old volleyball players. Journal of strength and conditioning research, 28(1), pp. 43-52.

BITTENCOURT, N.F.N., OLIVEIRA, R.R., VAZ, R.P.M., SILVA, R.S. and MENDONCA, L.M., 2022. Preventive effect of tailored exercises on patellar tendinopathy in elite youth athletes: A cohort study. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 53, pp. 60-66.

BREDA, S.J., OEI, E.H.G., ZWERVER, J., VISSER, E., WAARSING, E., KRESTIN, G.P. and DE VOS, R.J., 2021. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. British journal of sports medicine, 55(9), pp. 501-509.

CANNELL, L.J., TAUNTON, J.E., CLEMENT, D.B., SMITH, C. and KHAN, K.M., 2001. A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper's knee in athletes: pilot study. British journal of sports medicine, 35(1), pp. 60-64.

CHALLOUMAS, D., PEDRET, C., BIDDLE, M., NG, N.Y.B., KIRWAN, P., COOPER, B., NICHOLAS, P., WILSON, S., CLIFFORD, C. and MILLAR, N.L., 2021. Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ open sport & exercise medicine, 7(4), pp. e001110.

COOK, J.L. and PURDAM, C.R., 2014. The challenge of managing tendinopathy in competing athletes. British journal of sports medicine, 48(7), pp. 506-509.

CUDDEFORD, T. and BRUMITT, J., 2020. In-Season Rehabilitation Program using Blood Flow Restriction Therapy for Two Decathletes with Patellar Tendinopathy: a Case Report. International journal of sports physical therapy, 15(6), pp. 1184-1195.

DE VRIES, A., ZWERVER, J., DIERCKS, R., TAK, I., VAN BERKEL, S., VAN CINGEL, R., VAN DER WORP, H. and VAN DEN AKKER-SCHEEK, I., 2016. Effect of patellar strap and sports tape on pain in patellar tendinopathy: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 26(10), pp. 1217-1224.

FENDRI, T., REBAI, H., HARRABI, M.A., CHAARI, F., BOYAS, S., BEAUNE, B. and SAHLI, S., 2021. Athletes with unilateral patellar tendinopathy have increased subsequent lower extremity musculoskeletal injury risk. European journal of sport science, , pp. 1-8.

FORD, J.L., ILDEFONSO, K., JONES, M.L. and ARVINEN-BARROW, M., 2017. Sport-related anxiety: current insights. Open access journal of sports medicine, 8, pp. 205-212.

FREDBERG, U., BOLVIG, L. and ANDERSEN, N.T., 2008. Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. The American Journal of Sports Medicine, 36(3), pp. 451-460.

GAIDA, J.E. and COOK, J., 2011. Treatment options for patellar tendinopathy: critical review. Current sports medicine reports, 10(5), pp. 255-270.

GIRGIS, B. and DUARTE, J.A., 2020. Physical therapy for tendinopathy: An umbrella review of systematic reviews and meta-analyses. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 46, pp. 30-46.

GUAL, G., FORT-VANMEERHAEGHE, A., ROMERO-RODRIGUEZ, D. and TESCH, P.A., 2016. Effects of In-Season Inertial Resistance Training With Eccentric Overload in a Sports Population at Risk for Patellar Tendinopathy. Journal of strength and conditioning research, 30(7), pp. 1834-1842.

HARRIS, M., SCHULTZ, A., DREW, M.K., RIO, E., ADAMS, S. and EDWARDS, S., 2020. Thirty-seven jump-landing biomechanical variables are associated with asymptomatic patellar tendon abnormality and patellar tendinopathy: A systematic review. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 45, pp. 38-55.

HERNANDEZ-SANCHEZ, S., HIDALGO, M.D. and GOMEZ, A., 2014. Responsiveness of the VISA-P scale for patellar tendinopathy in athletes. British journal of sports medicine, 48(6), pp. 453-457.

HOLDEN, S., LYNG, K., GRAVEN-NIELSEN, T., RIEL, H., OLESEN, J.L., LARSEN, L.H. and RATHLEFF, M.S., 2020. Isometric exercise and pain in patellar tendinopathy: A randomized crossover trial. Journal of science and medicine in sport, 23(3), pp. 208-214.

IRBY, A., GUTIERREZ, J., CHAMBERLIN, C., THOMAS, S.J. and ROSEN, A.B., 2020. Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scandinavian Journal of Medicine & Science in Sports, 30(10), pp. 1810-1826.

JANSSEN, I., VAN DER WORP, H., HENSING, S. and ZWERVER, J., 2018. Investigating Achilles and patellar tendinopathy prevalence in elite athletics. Research in sports medicine (Print), 26(1), pp. 1-12.

KONGSGAARD, M., KOVANEN, V., AAGAARD, P., DOESSING, S., HANSEN, P., LAURSEN, A.H., KALDAU, N.C., KJAER, M. and MAGNUSSON, S.P., 2009. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scandinavian Journal of Medicine & Science in Sports, 19(6), pp. 790-802.

KRAEMER, R. and KNOBLOCH, K., 2009. A soccer-specific balance training program for hamstring muscle and patellar and achilles tendon injuries: an intervention study in premier league female soccer. The American Journal of Sports Medicine, 37(7), pp. 1384-1393.

KULIG, K., NOCETI-DEWIT, L.M., REISCHL, S.F. and LANDEL, R.F., 2015. Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes. Brazilian journal of physical therapy, 19(5), pp. 410-420.

LARSSON, M.E., KALL, I. and NILSSON-HELANDER, K., 2012. Treatment of patellar tendinopathy--a systematic review of randomized controlled trials. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 20(8), pp. 1632-1646.

LEE, W.C., NG, G.Y., ZHANG, Z.J., MALLIARAS, P., MASCI, L. and FU, S.N., 2020. Changes on Tendon Stiffness and Clinical Outcomes in Athletes Are Associated With Patellar Tendinopathy After Eccentric Exercise. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 30(1), pp. 25-32.

LIAN, O.B., ENGEBRETSEN, L. and BAHR, R., 2005. Prevalence of jumper's knee among elite athletes from different sports: a cross-sectional study. The American Journal of Sports Medicine, 33(4), pp. 561-567.

LIM, H.Y. and WONG, S.H., 2018. Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiotherapy Research International : The Journal for Researchers and Clinicians in Physical Therapy, 23(4), pp. e1721.

MALLIARAS, P., COOK, J., PURDAM, C. and RIO, E., 2015. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp. 887-898.

MELLOR, R., BENNELL, K., GRIMALDI, A., NICOLSON, P., KASZA, J., HODGES, P., WAJSWELNER, H. and VICENZINO, B., 2018. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. British journal of sports medicine, 52(22), pp. 1464-1472.

MENDONCA, L.D., OCARINO, J.M., BITTENCOURT, N.F.N., MACEDO, L.G. and FONSECA, S.T., 2018. Association of Hip and Foot Factors With Patellar Tendinopathy (Jumper's Knee) in Athletes. The Journal of orthopaedic and sports physical therapy, 48(9), pp. 676-684.

MENDONCA, L.D., VERHAGEN, E., BITTENCOURT, N.F., GONCALVES, G.G., OCARINO, J.M. and FONSECA, S.T., 2016. Factors associated with the presence of patellar tendon abnormalities in male athletes. Journal of science and medicine in sport, 19(5), pp. 389-394.

MENDONCA, L.M., BITTENCOURT, N.F.N., ALVES, L.E.M., RESENDE, R.A. and SERRAO, F.V., 2020. Interventions used for Rehabilitation and Prevention of Patellar Tendinopathy in athletes: a survey of Brazilian Sports Physical Therapists. Brazilian journal of physical therapy, 24(1), pp. 46-53.

MENDONCA, L.M., LEITE, H.R., ZWERVER, J., HENSCHKE, N., BRANCO, G. and OLIVEIRA, V.C., 2020. How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations. British journal of sports medicine, 54(2), pp. 87-93.

MERSMANN, F., LAUBE, G., MARZILGER, R., BOHM, S., SCHROLL, A. and ARAMPATZIS, A., 2021. A Functional High-Load Exercise Intervention for the Patellar Tendon Reduces Tendon Pain Prevalence During a Competitive Season in Adolescent Handball Players. Frontiers in physiology, 12, pp. 626225.

MILLAR, N.L., SILBERNAGEL, K.G., THORBORG, K., KIRWAN, P.D., GALATZ, L.M., ABRAMS, G.D., MURRELL, G.A.C., MCINNES, I.B. and RODEO, S.A., 2021. Tendinopathy. Nature reviews.Disease primers, 7(1), pp. 1-020-00234-1.

NUNEZ-MARTINEZ, P. and HERNANDEZ-GUILLEN, D., 2021. Management of Patellar Tendinopathy Through Monitoring, Load Control, and Therapeutic Exercise: A Systematic Review. Journal of Sport Rehabilitation, , pp. 1-14.

PETERS, J.A., ZWERVER, J., DIERCKS, R.L., ELFERINK-GEMSER, M.T. and VAN DEN AKKER-SCHEEK, I., 2016. Preventive interventions for tendinopathy: A systematic review. Journal of science and medicine in sport, 19(3), pp. 205-211.

PIETROSIMONE, L.S., BLACKBURN, J.T., WIKSTROM, E.A., BERKOFF, D.J., DOCKING, S.I., COOK, J. and PADUA, D.A., 2020. Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 46, pp. 177-185.

RIO, E., KIDGELL, D., PURDAM, C., GAIDA, J., MOSELEY, G.L., PEARCE, A.J. and COOK, J., 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British journal of sports medicine, 49(19), pp. 1277-1283.

RIO, E., PURDAM, C., GIRDWOOD, M. and COOK, J., 2017. Isometric Exercise to Reduce Pain in Patellar Tendinopathy In-Season; Is It Effective "on the Road?". Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, .

ROMERO-RODRIGUEZ, D., GUAL, G. and TESCH, P.A., 2011. Efficacy of an inertial resistance training paradigm in the treatment of patellar tendinopathy in athletes: a case-series study. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 12(1), pp. 43-48.

ROSEN, A.B., WELLSANDT, E., NICOLA, M. and TAO, M.A., 2021. Current Clinical Concepts: Clinical Management of Patellar Tendinopathy. Journal of athletic training, .

RUDAVSKY, A. and COOK, J., 2014. Physiotherapy management of patellar tendinopathy (jumper's knee). Journal of physiotherapy, 60(3), pp. 122-129.

RUFFINO, D., MALLIARAS, P., MARCHEGIANI, S. and CAMPANA, V., 2021. Inertial flywheel vs heavy slow resistance training among athletes with patellar tendinopathy: A randomised trial. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 52, pp. 30-37.

SAITHNA, A., GOGNA, R., BARAZA, N., MODI, C. and SPENCER, S., 2012. Eccentric Exercise Protocols for Patella Tendinopathy: Should we Really be Withdrawing Athletes from Sport? A Systematic Review. The open orthopaedics journal, 6, pp. 553-557.

SANCHEZ-GOMEZ, A., JURADO-CASTRO, J.M., MATA, F., SANCHEZ-OLIVER, A.J. and DOMINGUEZ, R., 2022. Effects of beta-Hydroxy beta-Methylbutyric Supplementation in Combination with Conservative Non-Invasive Treatments in Athletes with Patellar Tendinopathy: A Pilot Study. International journal of environmental research and public health, 19(1), pp. 10.3390/ijerph19010471.

SANCHO, I., MORRISSEY, D., WILLY, R.W., BARTON, C. and MALLIARAS, P., 2019. Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: A single cohort feasibility study. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 40, pp. 107-116.

SCATTONE SILVA, R., FERREIRA, A.L., NAKAGAWA, T.H., SANTOS, J.E. and SERRAO, F.V., 2015. Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification: Case Report With 6-Month Follow-up. The Journal of orthopaedic and sports physical therapy, 45(11), pp. 899-909.

SCATTONE SILVA, R., NAKAGAWA, T.H., FERREIRA, A.L., GARCIA, L.C., SANTOS, J.E. and SERRAO, F.V., 2016. Lower limb strength and flexibility in athletes with and without patellar tendinopathy. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 20, pp. 19-25.

SCOTT, A., LAPRADE, R.F., HARMON, K.G., FILARDO, G., KON, E., DELLA VILLA, S., BAHR, R., MOKSNES, H., TORGALSEN, T., LEE, J., DRAGOO, J.L. and ENGEBRETSEN, L., 2019. Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. The American Journal of Sports Medicine, 47(7), pp. 1654-1661.

SCULLY, D., KREMER, J., MEADE, M.M., GRAHAM, R. and DUDGEON, K., 1998. Physical exercise and psychological well being: a critical review. British journal of sports medicine, 32(2), pp. 111-120.

SECRIST, E.S., BHAT, S.B. and DODSON, C.C., 2016. The Financial and Professional Impact of Anterior Cruciate Ligament Injuries in National Football League Athletes. Orthopaedic journal of sports medicine, 4(8), pp. 2325967116663921.

SPRAGUE, A.L., COUPPE, C., POHLIG, R.T., SNYDER-MACKLER, L. and SILBERNAGEL, K.G., 2021. Pain-guided activity modification during treatment for patellar tendinopathy: a feasibility and pilot randomized clinical trial. Pilot and feasibility studies, 7(1), pp. 58-021-00792-5.

SPRAGUE, A.L., SMITH, A.H., KNOX, P., POHLIG, R.T. and GRAVARE SILBERNAGEL, K., 2018. Modifiable risk factors for patellar tendinopathy in athletes: a systematic review and meta-analysis. British journal of sports medicine, 52(24), pp. 1575-1585.

THIJS, K.M., ZWERVER, J., BACKX, F.J., STEENEKEN, V., RAYER, S., GROENENBOOM, P. and MOEN, M.H., 2017. Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 27(2), pp. 89-96.

TRICCO, A.C., LILLIE, E., ZARIN, W., O'BRIEN, K.K., COLQUHOUN, H., LEVAC, D., MOHER, D., PETERS, M.D.J., HORSLEY, T., WEEKS, L., HEMPEL, S., AKL, E.A., CHANG, C., MCGOWAN, J., STEWART, L., HARTLING, L., ALDCROFT, A., WILSON, M.G., GARRITTY, C., LEWIN, S., GODFREY, C.M., MACDONALD, M.T., LANGLOIS, E.V., SOARES-WEISER, K., MORIARTY, J., CLIFFORD, T., TUNCALP, O. and STRAUS, S.E., 2018. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), pp. 467-473.

VAN ARK, M., COOK, J.L., DOCKING, S.I., ZWERVER, J., GAIDA, J.E., VAN DEN AKKER-SCHEEK, I. and RIO, E., 2016. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. Journal of science and medicine in sport, 19(9), pp. 702-706.

VAN DER WORP, H., VAN ARK, M., ROERINK, S., PEPPING, G.J., VAN DEN AKKER-SCHEEK, I. and ZWERVER, J., 2011. Risk factors for patellar tendinopathy: a systematic review of the literature. British journal of sports medicine, 45(5), pp. 446-452.

VAN DER WORP, H., VAN ARK, M., ZWERVER, J. and VAN DEN AKKER-SCHEEK, I., 2012. Risk factors for patellar tendinopathy in basketball and volleyball players: a cross-sectional study. Scandinavian Journal of Medicine & Science in Sports, 22(6), pp. 783-790.

VAN RIJN, D., VAN DEN AKKER-SCHEEK, I., STEUNEBRINK, M., DIERCKS, R.L., ZWERVER, J. and VAN DER WORP, H., 2019. Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 29(3), pp. 181-187.

VANDER DOELEN, T. and JELLEY, W., 2020. Non-surgical treatment of patellar tendinopathy: A systematic review of randomized controlled trials. Journal of science and medicine in sport, 23(2), pp. 118-124.

VANDER DOELEN, T. and SCOTT, A., 2020. Multimodal management of patellar tendinopathy in basketball players: A retrospective chart review pilot study. Journal of Bodywork and Movement Therapies, 24(3), pp. 267-272.

VICENZINO, B., 2015. Tendinopathy: Evidence-Informed Physical Therapy Clinical Reasoning. The Journal of orthopaedic and sports physical therapy, 45(11), pp. 816-818.

VISNES, H., HOKSRUD, A., COOK, J. and BAHR, R., 2005. No effect of eccentric training on jumper's knee in volleyball players during the competitive season: a randomized clinical trial. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 15(4), pp. 227-234.

WIESE-BJORNSTAL, D.M., 2010. Psychology and socioculture affect injury risk, response, and recovery in high-intensity athletes: a consensus statement. Scandinavian Journal of Medicine & Science in Sports, 20 Suppl 2, pp. 103-111.

WITVROUW, E., BELLEMANS, J., LYSENS, R., DANNEELS, L. and CAMBIER, D., 2001. Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study. The American Journal of Sports Medicine, 29(2), pp. 190-195.

YOUNG, M.A., COOK, J.L., PURDAM, C.R., KISS, Z.S. and ALFREDSON, H., 2005. Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. British journal of sports medicine, 39(2), pp. 102-105.

ZWERVER, J., BREDEWEG, S.W. and VAN DEN AKKER-SCHEEK, I., 2011. Prevalence of Jumper's knee among nonelite athletes from different sports: a cross-sectional survey. The American Journal of Sports Medicine, 39(9), pp. 1984-1988.

ZWERVER, J., HARTGENS, F., VERHAGEN, E., VAN DER WORP, H., VAN DEN AKKER-SCHEEK, I. and DIERCKS, R.L., 2011. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial. The American Journal of Sports Medicine, 39(6), pp. 1191-1199.

Downloads

Posted

2022-02-10