"Good vibrations" Efficacy of whole body vibration to treat patellar tendinopathie

Tendinopathy is a common degenerative tendon disorder among athletes and inactive persons. The main symptoms consist tendon swelling, pain and pain during activities leading to functional restrictions. Common (trainings-) therapies are not always successful, often painful and demanding and therefore not suitable for everyone. Vibration training is a novel therapy which was already successfully used to enhance bone density, muscle mass and strength in risky groups, with additional positive effects on tendon anabolism. Therefore, the efficiency of this intervention method to treat patellar tendinopathy should be investigated within a close collaboration of the University of Salzburg department of sport science and kinesiology together with the University Hospital Salzburg Institute of Physical Medicine and Rehabilitation Paracelsus Medical University Salzburg. It is assumed, that the vibration intervention will be at least as successful as the strength training in 1) reducing clinical symptoms and 2) enhancing muscle strength and tendon properties. Hence, male and female chronic patellar tendinopathy patients (age: 18-40 yrs.) will be recruited and assigned to a 12-week vibration or strength training intervention program. The strength training contains bilateral slow exercises for the leg extensors with high loads. Patients of the vibration group will stand 10-times for 60 seconds in a static position on a vibration platform and are exposed to sinusoidal oscillations. Before and after the 12 week intervention phase patients will be extensively clinically and sport scientifically investigated. The clinical investigations contain a pain questionnaire, ultrasound screening and palpation of the patellar tendon. The sport scientific investigations contain strength measurements of knee extensors and the measurements of tendon stiffness using ultrasonography. In addition, the patellar tendon will be investigated using magnet resonance imaging before and after the intervention phase. The clinical assessments will be a third time six months after the last training to proof the sustainability of the trainings. A successful vibration intervention would constitute a new intervention strategy to treat tendinopathy, which would be easier to implement and suitable for a broader population. Additionally, this therapy could help patients whereby common therapies showed no permanent success.

Tendons are more than a force transmitting tissue between muscles and bones. Their role in power amplification, energy conservation, and power attenuation is essential for movement. However, overuse can lead to degenerations and cause chronic loading dependent pain. The so-called tendinopathy occurs in active and recreational athletes and can lead to long-lasting functional impairments. Conventional exercise therapies can effectively reduce symptoms, but can be demanding, painful, time-intensive and need access to strength training devices. In the Salzburger "Good Vibrations" clinical trial, we investigated vibration training as easy to implement alternative and compared it to a conventional strength training intervention. To date, the effects of tendinopathy on tendon function is not fully understood. Therefore, in a side study, we compared tendinopathic tendon properties to healthy controls. Symptomatic tendons showed an increased cross-sectional area, but reduced stiffness. This could in turn increase the risk of further injuries. The capability to store and release energy was not affected by the pathology, however. After three months of intervention, there was a significant improvement in maximum pain and functional limitations in both groups, whereas the latter was more visible in the strength training group. Six months after the last training session, the improvements were still apparent. Both therapies did not affect functional or structural tendon properties. Thus, vibration training seems to be an effective, easy to implement and sustainable alternative to conventional strength training therapies.