Patellar tendon stress between two variations of the forward step lunge

Background: Patellar tendinopathy (PT) or jumper's knee is generally found in active populations that perform jumping activities. Graded exposure of patellar tendon stress through functional exercise has been demonstrated to be effective for the treatment of PT. However, no studies have compared how anterior knee displacement variations during the commonly performed forward step lunge (FSL) affect patellar tendon stress. Methods: Twenty-five subjects (age: 22.69 +/- 0.74 years; height: 169.39 +/- 6.44 cm; mass: 61.55 +/- 9.74 kg) performed 2 variations of an FSL, with the anterior knee motion going in front of the toes (FSL-FT) and the knee remaining behind the toes (FSL-BT). Kinematic and kinetic data were used with an inverse-dynamics based static optimization technique to estimate individual muscle forces to determine patellar tendon stress during both lunge techniques. A repeated measures multivariate analysis was used to analyze these data. Results: The peak patellar tendon stress, stress impulse, quadriceps force, knee moment, knee flexion, and ankle dorsiflexion angle were significantly greater (p < 0.001) during the FSL-FT as compared to the FSL-BT. The peak patellar tendon stress rate did not differ between the FSL-FT and FSL-BT. Conclusion: The use of an FSL-FT as compared to an FSL-BT increased the load and stress on the patellar tendon. Because a graded exposure of patellar tendon loading with other closed kinetic chain exercises has proven to be effective in treating PT, consideration for the prescription of variations of the FSL and further clinical evaluation of this exercise is warranted in individuals with PT. (C) 2019 Published by Elsevier B.V. on behalf of Shanghai University of Sport.