Patellar tendinopathy (PT), a chronic tendon disorder marked by load-dependent pain, predominantly affects athletic populations. Current management emphasizes eccentric exercise modalities, particularly heavy slow resistance (HSR) training combining eccentric-concentric phases versus isolated eccentric protocols. Emerging evidence indicates that HSR not only matches traditional eccentric training in pain relief but functional surpasses it in enhancing neuromuscular control and patient-reported outcomes. This review examines HSR's mechanistic foundations and clinical effectiveness to guide evidence-based rehabilitation protocols for PT. Method: This meta-analysis examines HSR's therapeutic efficacy through eight randomized controlled trials (263 patients) from major databases (PubMed, Embase, Cochrane, etc.). Inclusion criteria required: 1) adults with ≥3-month PT confirmed clinically/ultrasonographically; 2) HSR vs conventional therapy; 3) outcomes including VISA-P, VAS, tendon morphology, and quadriceps strength Systematic searches across five databases identified 15,714 records, with eight studies (263 patients: 128 HSR intervention, 135 controls) meeting inclusion criteria (2015-2022 publications). Meta-analysis revealed: 1) Functional outcomes: No between-group difference in Victorian Institute of Sport Assessment-Patellar (VISA-P) scores (MD=3.00; 95%CI -1.62–7.62; p=0.20; I ² =0%). 2) Pain management: HSR demonstrated superior pain reduction (VAS MD=-0.64; 95%CI -1.13–-0.16; p=0.01; I ² =20%). 3) Tendon morphology: Initial cross-sectional area (CSA) analysis showed no difference (SMD=0.23; 95%CI -0.37–0.83; p=0.45; I ² =55%). Post-sensitivity analysis (excluding one outlier) revealed significant CSA improvement (MD=0.49; 95%CI 0.04–0.95; p=0.03; I ² =0%). Heterogeneity originated from inconsistent CSA measurement protocols: precise mid-point vs. maximal area between patellar apex and tibial tubercle. 4) Tissue density: No interventional effect (MD=-0.11; 95%CI -0.70–0.48; p=0.71; I ² =0%). 5)Muscular performance: Comparable quadriceps strength outcomes (MD=0.74; 95%CI -16.59–18.07; p=0.93; I ² =0%). Current evidence demonstrates that heavy slow resistance (HSR) training alleviates pain and improves patellar tendon cross-sectional area in patellar tendinopathy (PT) management, yet shows no therapeutic superiority over conventional interventions in enhancing limb functionality, quadriceps strength, or tendon thickness. Nevertheless, existing clinical investigations remain limited in both sample size and population diversity (predominantly athletic cohorts), necessitating further randomized controlled trials to establish standardized loading protocols and validate their generalizability across broader patient demographics.
Zhang et al. (Thu,) studied this question.