Torque visuo-motor feedback training: A new way to manage patellar tendinopathy.

This project aims to enhance the management of Patellar Tendinopathy, a persistent degenerative condition affecting the patellar tendon. It is characterized by structural changes within the tendon, leading to pain and diminished functional performance. While prevalent in the athletic community (with a prevalence ranging from 7% to 18.3%), Patellar Tendinopathies also frequently occur in the general population, with an incidence of approximately 1.6 per 1000 person-years.

Dealing with Patellar Tendinopathy poses a significant challenge, as traditional exercise interventions have shown limited effectiveness, with only up to 50% improvement in clinical symptoms at three to six months. Consequently, a considerable number of patients fail to respond favourably to conventional treatments, contributing to the persistence of chronic symptoms. This project strives to address these limitations and introduce more effective strategies for managing Patellar Tendinopathy, with the ultimate goal of improving patient outcomes and quality of life.

The main aims and objectives of the research study.

This project encompasses two primary objectives.

Objective 1: to evaluate the efficacy of a novel intervention involving slow-speed visuo-motor torque feedback training on various aspects of patellar tendinopathy, including changes in pain levels, functional abilities, quadriceps neuromuscular activity, and the mechanical and structural properties of the patellar tendon. A comparative analysis will be conducted between the outcomes of this intervention and the conventional patellar tendinopathy management provided by the NHS, which primarily consists of home-based eccentric exercises. The proposed intervention aims to enhance rehabilitation outcomes for patellar tendinopathy and the proposed measurements aim to contribute novel evidence regarding the neuromechanical changes induced by this innovative approach.

Objective 2: a comparison of morphomechanical properties of the patellar tendon and the firing properties of quadriceps motor units between individuals with patellar tendinopathy and healthy controls. The overarching goal is to identify novel mechanisms contributing to declines in strength, reductions in the control of knee-extension muscle force, and increased pain in individuals with patellar tendinopathy. This comparative analysis aims to deepen our understanding of the underlying factors associated with patellar tendinopathy, paving the way for more targeted and effective interventions.

How this research is going to help address MSK health.

This research aims to evaluate the effectiveness of a novel training intervention for managing patellar tendinopathy and seeks to identify the underlying mechanisms that contribute to motor function impairments to determine whether these can be ameliorated through the proposed treatment. The successful implementation of this intervention will have direct benefits for both patients suffering from patellar tendinopathy and clinicians involved in prescribing therapeutic exercises. Additionally, the findings from this research could have implications for the management of other tendinopathies, as the proposed approach can be adapted to different joints.

The utilisation of state-of-the-art methods, such as Shearwave elastography and high-density surface electromyography (HDsEMG), will also provide valuable insights for other researchers investigating the neural and mechanical interactions involved in the development of tendinopathies. Furthermore, the results of this research will lay the groundwork for the development of a cost-effective device, enabling a more affordable implementation of the proposed therapeutic approach in clinical settings.

The main research methods, or datasets being used.

The researchers will systematically gather data on alterations in clinical symptoms, specifically pain, and perceived disability using specialized questionnaires such as the Victorian Institute of Sport Assessment-Patella (VISA-P). To assess muscle strength and control in quadriceps muscle force, we will employ an isokinetic dynamometer. Additionally, they will track changes in tendon morphology and estimate Patellar tendon stiffness through b-mode ultrasound imaging and shearwave elastography. Additionally, high-density surface electromyography (HDsEMG) will be utilized to measure motor unit activity in the quadriceps muscles, employing state-of-the-art signal processing methods based on blind source separation. These comprehensive parameters will be continuously monitored throughout the proposed intervention, providing a thorough and multifaceted evaluation of its impact.

Researcher: Dr Eduardo Martinez Valdes.

Supervisor: Professor Francesco Negro.  

University: University of Birmingham.

Award stream: Early Career Research Fellowship.

Award duration: 2 years.

Amount rewarded: £105,300.

Collaborations/ partners: Professor Francesco Negro (the University of Brescia, Italy) and Dr Patricio Pincheira (the University of Southern Queensland, Australia).