Extended Restitution Between Sessions Does Not Enhance the Benefits of 12 Weeks Exercise-Based Treatment for Patellar Tendinopathy: A Randomized Controlled Clinical Trial (The TEREX Trial).

When treating patellar tendinopathy with loading exercises, one open question has been how much rest is needed between sessions for the tendon to adapt. This trial compared two exercise schedules over 12 weeks: one group trained three days a week, the other just once a week, with matched resistance exercises for the leg muscles and restricted running and jumping in both groups. The result was that training once a week was not superior to training three times a week on any outcome measured, including symptoms, pain, strength, jumping ability, or tendon structure on ultrasound.

Both groups improved in symptoms and muscle strength over the 12 weeks, but neither group showed improvement in jumping performance or tendon structure, and satisfaction with treatment did not differ between groups. The main limitation is that this was a fairly small trial with 52 participants, and because both groups improved similarly, the study cannot say whether these gains were caused by the exercise program itself rather than other factors like time or reduced activity.

If you're managing patellar tendinopathy, also known as jumper's knee, you may have wondered whether spacing out your exercise sessions more gives your tendon extra time to heal and leads to better results. This study tested exactly that question, comparing people who did tendon-loading exercises three days a week against those who did the same exercises just once a week, over 12 weeks. The finding was that doing exercises just once a week did not lead to better results than doing them three times a week.

People in both groups reported similar improvements in knee symptoms and pain, and both groups got stronger, but neither group saw improvements in jumping ability or in the tendon's appearance on ultrasound scans. People in both groups were equally satisfied with their progress and treatment at the end. This was a relatively small study involving 52 people, and because both groups improved by similar amounts, it isn't possible to say for certain that the exercise program itself, rather than other factors, caused the improvement.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomized controlled trial compared restitution intervals for exercise-based rehabilitation of chronic patellar tendinopathy, randomizing 52 participants to a short restitution group (three exercise days per week) or an extended restitution group (one exercise day per week), both performing leg press and knee extension resistance training progressing from roughly 60% to 75% of one-repetition maximum, with impact activities restricted in both arms. After 12 weeks, no statistically significant between-group differences were detected on any outcome, including VISA-P (function and symptoms), pain during activity on the numeric rating scale, functional testing, or ultrasound measures of tendon vascularization and swelling. Self-reported improvement and satisfaction with function and treatment at week 12 also did not differ between groups.

Within-group analyses showed significant improvements in clinical outcomes and muscular strength in both arms, but neither group showed improvement in jumping height or tendon structure on imaging. The absence of a control or no-treatment comparator and the modest sample size limit conclusions about whether the observed within-group changes reflect a specific treatment effect versus natural history or other non-specific factors. The findings do not support extending restitution time beyond a once-weekly schedule as offering any additional benefit over three sessions per week for this population.