Skip to main content
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2001 Feb;35(1):60–64. doi: 10.1136/bjsm.35.1.60

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

L Cannell 1, J Taunton 1, D Clement 1, C Smith 1, K Khan 1
PMCID: PMC1724276  PMID: 11157465

Abstract

Objectives—To compare the therapeutic effect of two different exercise protocols in athletes with jumper's knee.

Methods—Randomised clinical trial comparing a 12 week programme of either drop squat exercises or leg extension/leg curl exercises. Measurement was performed at baseline and after six and 12 weeks. Primary outcome measures were pain (visual analogue scale 1–10) and return to sport. Secondary outcome measures included quadriceps and hamstring moment of force using a Cybex II isokinetic dynamometer at 30°/second. Differences in pain response between the drop squat and leg extension/curl treatment groups were assessed by 2 (group) x 3 (time) analysis of variance. Two by two contingency tables were used to test differences in rates of return to sport. Analysis of variance (2 (injured versus non-injured leg) x 2 (group) x 3 (time)) was also used to determine differences for secondary outcome measures.

Results—Over the 12 week intervention, pain diminished by 2.3 points (36%) in the leg extension/curl group and 3.2 points (57%) in the squat group. There was a significant main effect of both exercise protocols on pain (p<0.01) with no interaction effect. Nine of 10 subjects in the drop squat group returned to sporting activity by 12 weeks, but five of those subjects still had low level pain. Six of nine of the leg extension/curl group returned to sporting activity by 12 weeks and four patients had low level pain. There was no significant difference between groups in numbers returning to sporting activity. There were no differences in the change in quadriceps or hamstring muscle moment of force between groups.

Conclusions—Progressive drop squats and leg extension/curl exercises can reduce the pain of jumper's knee in a 12 week period and permit a high proportion of patients to return to sport. Not all patients, however, return to sport by that time.

Key Words: knee; patellar tendon; tendinopathy; tendinosis; eccentric strengthening; strength training

Full Text

The Full Text of this article is available as a PDF (121.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alfredson H., Pietilä T., Jonsson P., Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998 May-Jun;26(3):360–366. doi: 10.1177/03635465980260030301. [DOI] [PubMed] [Google Scholar]
  2. Alfredson H., Thorsen K., Lorentzon R. In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain. Knee Surg Sports Traumatol Arthrosc. 1999;7(6):378–381. doi: 10.1007/s001670050184. [DOI] [PubMed] [Google Scholar]
  3. Blair B., Rokito A. S., Cuomo F., Jarolem K., Zuckerman J. D. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am. 1996 Nov;78(11):1685–1689. doi: 10.2106/00004623-199611000-00007. [DOI] [PubMed] [Google Scholar]
  4. Blazina M. E., Kerlan R. K., Jobe F. W., Carter V. S., Carlson G. J. Jumper's knee. Orthop Clin North Am. 1973 Jul;4(3):665–678. [PubMed] [Google Scholar]
  5. Coleman B. D., Khan K. M., Kiss Z. S., Bartlett J., Young D. A., Wark J. D. Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Victorian Institute of Sport Tendon Study Group. Am J Sports Med. 2000 Mar-Apr;28(2):183–190. doi: 10.1177/03635465000280020801. [DOI] [PubMed] [Google Scholar]
  6. Coleman B. D., Khan K. M., Maffulli N., Cook J. L., Wark J. D. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports. 2000 Feb;10(1):2–11. doi: 10.1034/j.1600-0838.2000.010001002.x. [DOI] [PubMed] [Google Scholar]
  7. Cook J. L., Khan K. M., Harcourt P. R., Grant M., Young D. A., Bonar S. F. A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group. Br J Sports Med. 1997 Dec;31(4):332–336. doi: 10.1136/bjsm.31.4.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cook J. L., Khan K. M., Harcourt P. R., Kiss Z. S., Fehrmann M. W., Griffiths L., Wark J. D. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med. 1998 Apr;8(2):73–77. doi: 10.1097/00042752-199804000-00001. [DOI] [PubMed] [Google Scholar]
  9. Cook J. L., Khan K. M., Kiss Z. S., Griffiths L. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years. Scand J Med Sci Sports. 2000 Aug;10(4):216–220. doi: 10.1034/j.1600-0838.2000.010004216.x. [DOI] [PubMed] [Google Scholar]
  10. Cook J. L., Khan K. M., Kiss Z. S., Purdam C. R., Griffiths L. Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players. J Ultrasound Med. 2000 Jul;19(7):473–479. doi: 10.7863/jum.2000.19.7.473. [DOI] [PubMed] [Google Scholar]
  11. Cook J. L., Kiss Z. S., Khan K. M. Patellar tendinitis: the significance of magnetic resonance imaging findings. Am J Sports Med. 1999 Nov-Dec;27(6):831–831. doi: 10.1177/03635465990270062601. [DOI] [PubMed] [Google Scholar]
  12. Fritschy D., de Gautard R. Jumper's knee and ultrasonography. Am J Sports Med. 1988 Nov-Dec;16(6):637–640. doi: 10.1177/036354658801600614. [DOI] [PubMed] [Google Scholar]
  13. Hay E. M., Paterson S. M., Lewis M., Hosie G., Croft P. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ. 1999 Oct 9;319(7215):964–968. doi: 10.1136/bmj.319.7215.964. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hölmich P., Uhrskou P., Ulnits L., Kanstrup I. L., Nielsen M. B., Bjerg A. M., Krogsgaard K. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet. 1999 Feb 6;353(9151):439–443. doi: 10.1016/S0140-6736(98)03340-6. [DOI] [PubMed] [Google Scholar]
  15. Jensen K., Di Fabio R. P. Evaluation of eccentric exercise in treatment of patellar tendinitis. Phys Ther. 1989 Mar;69(3):211–216. doi: 10.1093/ptj/69.3.211. [DOI] [PubMed] [Google Scholar]
  16. Karlsson J., Kälebo P., Goksör L. A., Thomée R., Swärd L. Partial rupture of the patellar ligament. Am J Sports Med. 1992 Jul-Aug;20(4):390–395. doi: 10.1177/036354659202000404. [DOI] [PubMed] [Google Scholar]
  17. Khan K. M., Cook J. L., Bonar F., Harcourt P., Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999 Jun;27(6):393–408. doi: 10.2165/00007256-199927060-00004. [DOI] [PubMed] [Google Scholar]
  18. Khan K. M., Cook J. L., Maffulli N., Kannus P. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med. 2000 Apr;34(2):81–83. doi: 10.1136/bjsm.34.2.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Khan K. M., Maffulli N. Tendinopathy: an Achilles' heel for athletes and clinicians. Clin J Sport Med. 1998 Jul;8(3):151–154. [PubMed] [Google Scholar]
  20. Khan K. M., Visentini P. J., Kiss Z. S., Desmond P. M., Coleman B. D., Cook J. L., Tress B. M., Wark J. D., Forster B. B. Correlation of ultrasound and magnetic resonance imaging with clinical outcome after patellar tenotomy: prospective and retrospective studies. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med. 1999 Jul;9(3):129–137. doi: 10.1097/00042752-199907000-00003. [DOI] [PubMed] [Google Scholar]
  21. Kiss Z. S., Kellaway D. P., Cook J. L., Khan K. M. Postoperative patellar tendon healing: an ultrasound study. VIS Tendon Study Group. Australas Radiol. 1998 Feb;42(1):28–32. doi: 10.1111/j.1440-1673.1998.tb00559.x. [DOI] [PubMed] [Google Scholar]
  22. Lian O., Holen K. J., Engebretsen L., Bahr R. Relationship between symptoms of jumper's knee and the ultrasound characteristics of the patellar tendon among high level male volleyball players. Scand J Med Sci Sports. 1996 Oct;6(5):291–296. doi: 10.1111/j.1600-0838.1996.tb00473.x. [DOI] [PubMed] [Google Scholar]
  23. Maffulli N., Khan K. M., Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998 Nov-Dec;14(8):840–843. doi: 10.1016/s0749-8063(98)70021-0. [DOI] [PubMed] [Google Scholar]
  24. Movin T., Gad A., Reinholt F. P., Rolf C. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand. 1997 Apr;68(2):170–175. doi: 10.3109/17453679709004002. [DOI] [PubMed] [Google Scholar]
  25. Myllymäki T., Bondestam S., Suramo I., Cederberg A., Peltokallio P. Ultrasonography of jumper's knee. Acta Radiol. 1990 Mar;31(2):147–149. [PubMed] [Google Scholar]
  26. Shalaby M., Almekinders L. C. Patellar tendinitis: the significance of magnetic resonance imaging findings. Am J Sports Med. 1999 May-Jun;27(3):345–349. doi: 10.1177/03635465990270031301. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES