European Journal of Biomedical and Pharmaceutical Sciences

COMPARATIVE EFFECTIVENESS OF PROGRESSIVE TENDON-LOADING EXERCISE WITH NEUROMUSCULAR TRAINING VERSUS PROGRESSIVE TENDON-LOADING EXERCISE ALONE ON PAIN, DYNAMIC BALANCE, LANDING BIOMECHANICS, AND RETURN-TO-SPORT IN ATHLETES WITH PATELLAR TENDINOPATHY

Muhammad Ajmal Khan, Prof. Dr. M. Riaz Baig Chughtai, Dr. M. Danial Baig Chughtai, Dr. Sana Nawaz, Seerat Fatima, *Dr. Hafiza Mubashra

ABSTRACT

Background: Patellar tendinopathy affects up to 45% of elite volleyball and basketball players, yet optimal rehabilitation protocols remain debated. Recent evidence suggests that combining progressive tendon-loading exercises with neuromuscular training may yield superior outcomes compared to tendon-loading alone. Objective: To compare the effectiveness of progressive tendon-loading exercise combined with neuromuscular training (PTLN group) versus progressive tendon-loading exercise alone (PTL group) on pain reduction, dynamic balance, landing biomechanics, quadriceps strength, and return-to-sport outcomes in competitive athletes with patellar tendinopathy. Methods: This double-blind, randomized controlled trial enrolled 164 athletes (ages 18-35) with confirmed patellar tendinopathy diagnosed via ultrasound. Participants were randomized to either the PTLN group (n=82) or PTL group (n=82) and followed an 12-week intervention protocol. Primary outcomes included pain (Visual Analog Scale), dynamic balance (Y-Balance Test), landing mechanics (3D motion capture), quadriceps strength (dynamometry), and return-to-sport status at 12 weeks and 6-month follow-up. Results: The PTLN group demonstrated significantly greater improvements in pain reduction (mean difference -2.8 points on VAS, 95% CI -3.4 to -2.2), with 78% achieving clinically meaningful pain reduction compared to 52% in the PTL group. Dynamic balance improved by 12.4% in the PTLN group versus 7.8% in PTL (p=0.012). Landing mechanics showed normalization of knee flexion angles and reduced valgus collapse in the PTLN group (8.9° mean correction versus 4.2° in PTL, p=0.008). Quadriceps strength gains were comparable between groups (21% PTLN vs 19% PTL). Return-to-sport at 12 weeks: 64% PTLN versus 48% PTL (p=0.038). Conclusion: Adding neuromuscular training to progressive tendon-loading exercises significantly enhanced clinical outcomes in athletes with patellar tendinopathy, particularly regarding pain reduction, dynamic stability, and landing biomechanics. These findings support a multimodal rehabilitation approach for optimal recovery and return-to-sport.

Keywords: Patellar tendinopathy, jumper's knee, neuromuscular training, rehabilitation, return-to-sport, proprioception, landing biomechanics.