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This study investigates the effects of eccentric exercise therapy on postural control and strength in athletes with patellar tendinopathy.

March 30, 2026Open Access

Progressive tendon-loading eccentric exercise therapy in athletes with patellar tendinopathy improves postural control, quadriceps strength and pain: a randomized clinical trial

Key Points

This study investigates the effects of eccentric exercise therapy on postural control and strength in athletes with patellar tendinopathy.
Randomized controlled trial with 40 athletes suffering from patellar tendinopathy.
Participants divided into an eccentric exercise group and a control group for 12 weeks.
Static and dynamic postural control assessed using a stabilometric platform and Y-Balance Test.
Isometric quadriceps strength and pain were measured using a dynamometer and VISA-P questionnaire.
Eccentric exercise group showed a significant decrease in center of pressure velocity (CoPv) post-intervention compared to baseline.
Y-Balance Test scores significantly improved in the eccentric exercise group post-intervention.
Quadriceps strength increased significantly in the eccentric exercise group post-intervention.
Pain levels decreased significantly in the eccentric exercise group post-intervention.

Abstract

Introduction/ objectivesAthletes with patellar tendinopathy (PT) have impaired postural control and an increased subsequent sport injury risk.Improving their postural control is crucial to reduce future sports injuries.The aim of this study was to investigate the effects of a 12-week decline squat eccentric quadriceps rehabilitation program with progressive loading on postural control in athletes with PT. MethodsIn this randomized controlled trial, 40 athletes from local volleyball, basketball and handball teams suffering from PT were randomized to either the eccentric exercise group (EEG) or control group (CG).The EEG also followed a 12-week progressive load eccentric rehabilitation program using decline squats.The CG continued their regular sports activities only.Static postural control was assessed using a stabilometric platform with the eyes opened (EO) and closed (EC), with the mean center of pressure velocity (CoPv) serving as the outcome measure.Dynamic postural control was evaluated using the Y-Balance Test (YBT).Isometric strength of quadriceps was measured with a dynamometer.Pain was quantified using the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire.For YBT, maximal voluntary isometric contraction (MVIC), visual analog scale (VAS), and VISA-P outcomes, data were analyzed using repeated-measures ANOVAs to examine the J o u r n a l P r e -p r o o f effects of group and session.For CoPv, repeated-measures ANOVAs were used to assess the effects of group and session, and visual control. ResultsFollowing 10 withdrawals, 30 participants were included in the final analyses.The CoPv decreased statistically significantly (P=0.04) after the intervention compared to preintervention in the EEG only, mainly under the EC condition (mean difference=2.64mm/s) in the bipedal posture on the foam surface and in the unipedal posture on the firm surface (mean difference=19.58mm/s).The reach distances and the composite score (CS) of the YBT increased statistically significantly (ANT: mean difference=9.21%;PM: mean difference=9.59%;PL: mean difference=9.78%;CS: mean difference=9.52%)postintervention compared to baseline in the EEG only.For the secondary outcomes, the quadriceps strength (mean difference=99N) and pain (mean difference=20.24)improved statistically significantly (P<0.01)post-intervention in the EEG only. ConclusionThis study highlights the effectiveness of eccentric decline squat in improving postural control in athletes with PT.

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