Load progression criteria in exercise programmes in lower limb tendinopathy: a systematic review

Area of Science:

• Sports Medicine
• Rehabilitation Science
• Orthopedics

Background:

• Lower limb tendinopathies are common musculoskeletal conditions.
• Loading exercise programs are a primary treatment modality.
• Progression criteria guide exercise intensity and volume adjustments.

Purpose of the Study:

• To summarize and analyze current literature on progression criteria in lower limb tendinopathy loading exercise programs.
• To evaluate the evidence and effectiveness of these criteria.
• To propose a new classification for existing progression criteria.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) from PubMed, Embase, Scopus, and PEDro.
• Inclusion of studies on midportion Achilles, patellar, or gluteal tendinopathy with progressive exercise monotherapy.
• Narrative synthesis of data, including Cohen's d and percentage change in outcomes; methodological quality assessed using the PEDro scale.

Main Results:

• Thirty studies detailing progression criteria were included.
• Six types of criteria were identified, categorized as pain-based (primary) or pain/symptom control-based (secondary).
• Pain-based criteria were most frequently applied, followed by conditioning stages; other criteria were used less often.

Conclusions:

• Predominant use of pain-based criteria in tendinopathy treatment lacks strong supporting evidence.
• There is a need for studies comparing exercise programs with different progression criteria.
• A novel classification system for progression criteria, emphasizing pain as a primary or secondary factor, is proposed.