Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats

Background. Recent studies have shown excellent clinical results using eccentric squat training on a 25° decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats.Methods. Thirteen subjects performed unilateral eccentric squats on flat—and a 25° decline surface. During the squats, electromyography activity was obtained in eight representative muscles. Also, ankle, knee and hip joint goniometry was obtained. Additionally, patellar tendon strain was measured in vivo using ultrasonography as subjects maintained a unilateral isometric 90° knee angle squat position on either flat or 25° decline surface.Findings. Patellar tendon strain was significantly greater (P < 0.05) during the squat position on the decline surface compared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (P < 0.001, P < 0.05). Normalized mean electromyography amplitudes of the knee extensor muscles were significantly greater during the decline compared to the standard squats (P < 0.05). Hamstring and calf muscle mean electromyography did not differ, respectively, between standard and decline squats.Interpretation. The use of a 25° decline board increases the load and the strain of the patellar tendon during unilateral eccentric squats. This finding likely explains previous reports of superior clinical efficacy of decline eccentric squats in the rehabilitative management of patellar tendinopathy.