217

REVIEW

The evolution of eccentric training as treatment for patellar

tendinopathy (jumper’s knee): a critical review of exercise
programmes
Håvard Visnes, Roald Bahr
...................................................................................................................................
Br J Sports Med 2007;41:217–223. doi: 10.1136/bjsm.2006.032417

Background and aim: Eccentric training has become a popular treatment for patellar tendinopathy. Our
purpose was to review the evolution of eccentric strength training programmes for patellar tendinopathy with
a focus on the exercise prescriptions used, to help clinicians make appropriate choices and identify areas
needing further research.
Methods: A computerised search of the entire MEDLINE database was performed on 1 September 2006 to
See end of article for
authors’ affiliations identify prospective and randomised clinical trials with a focus on clinical outcome of eccentric training for
........................ patellar tendinopathy.
Results: 7 articles with a total of 162 patients and in which eccentric training was one of the interventions, all
Correspondence to:
Dr R Bahr, Oslo Sports published after 2000, were included. The results were positive, but study quality was variable, with small numbers
Trauma Research Center, or short follow-up periods. The content of the different training programmes varied, but most were home-based
Norwegian School of Sport programmes with twice daily training for 12 weeks. A number of potentially significant differences were identified
Sciences, PO Box 4014, in the eccentric programmes used: drop squats or slow eccentric movement, squatting on a decline board or level
Ullevaal Stadion, 0806
Oslo, Norway; roald@ ground, exercising into tendon pain or short of pain, loading the eccentric phase only or both phases, and
nih.no progressing with speed then loading or simply loading.
Conclusion: Most studies suggest that eccentric training may have a positive effect, but our ability to
Accepted20November2006
Published Online First recommend a specific protocol is limited. The studies available indicate that the treatment pro-
26 January 2007 gramme should include a decline board and should be performed with some level of discomfort, and that
........................ athletes should be removed from sports activity. However, these aspects need further study.

C
hronic tendinopathies are common in both recreational research interest in this treatment form was limited until
and elite athletes. The prevalence of jumper’s knee is high Alfredson et al13 published their paper on Achilles tendinopathy
in sports characterised by high demands on leg extensor in 1998. Their training model had some potentially important
speed and power, such as volleyball, basketball, soccer and differences from the Curwin and Stanish12 model, mainly that
athletics, where as many as 40–50% of participants are the eccentric movement was defined as a slow movement, that
affected.1–3 Moreover, the symptoms are often serious, resulting treatment progressed by adding not speed but load, and that
in chronic impairment of athletic performance, and the the patients were instructed to exercise despite pain during the
condition can severely limit or even end an athletic career.1 4 eccentric movement (fig 2 and box 2).
The aetiology and pathogenesis of chronic tendon pain is not The first studies evaluating eccentric training as treatment of
fully understood, although histopathological and biochemical Achilles tendinopathy concluded that eccentric training is an
evidence indicates that it is not an inflammatory condition.5 6 The appropriate treatment for mid-portion Achilles tendinopathy.13–
15
incomplete understanding of the underlying pathology limits our The results of these prospective studies were good, and many
ability to establish effective treatment options. Surgery is chronic patients became pain-free. Since then, further studies
advocated by some authors in recalcitrant cases,1 7 8 although on the Achilles tendon have focused less on clinical outcome
the benefits of open tenotomy can be questioned on the basis of and more on changes in tendon structure as evaluated by MRI
the result of a recent randomised, controlled study.9 Conservative or ultrasonography.6 16 17
treatment for patellar tendinopathy may include rest, use of anti- The advent of the Alfredson13 protocol for Achilles tendino-
inflammatory drugs, taping, massage, electrotherapy, ultrasound, pathy has spurred recent research interest in eccentric training
laser therapy, extra-corporeal shock wave therapy and other as treatment for patellar tendinopathy. The purpose of this
modalities.10 11 However, non-surgical treatment methods also review is to describe the evolution of eccentric strength training
need to be evaluated in well-controlled clinical studies. programmes for patellar tendinopathy with a focus on the
Eccentric training as a treatment option for tendinopathy exercise prescriptions used, to help clinicians make appropriate
was first presented by Curwin and Stanish12 in 1984, with choices, and to identify areas needing further research.
encouraging results. Their book presents a treatment pro-
gramme that includes warm-up and stretching before the METHODS
eccentric exercise, and stretching and ice afterwards. The A computerised search of the entire MEDLINE database was
programme was based on eccentric drop squats (fig 1 and performed on 1 September 2006. Table 1 lists the keywords
box 1). When the training became pain-free, load was increased used in the search. The search was limited to literature in
by first increasing the speed of the eccentric phase, and then English. All articles relevant to the subject were retrieved. In
adding weight. order to be included in this review, the design had to be a
Although eccentric training has been used by some to treat prospective study or a randomised clinical trial. The paper had
patients with various forms of tendinopathy since the mid-80s, to focus on clinical outcome and had to document how this was

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218 Visnes, Bahr

Figure 1 Patient drops (or lowers)

to a semi-squatting position.12
Box 1 The Stanish and Curwin programme 1 2

The eccentric exercise programme for jumper’s knee starts with

a general, whole-body warm-up exercise not involving knee
extension. The stretching is a static stretch of quadriceps and
hamstrings. The patients should hold these at least for 30 s and
repeat the exercise three times. The main programme starts
with the squatting movements. Patients were instructed to focus
primarily on the rapid deceleration phase between the down-
ward and upward movement phases. The progression was
defined as no added resistance on days 1 and 2 (slow) and
increased speed on days 3–7. In week 2, resistance was added
(10% of body weight). In weeks 3–6, 4.5–13.5 kg was added
progressively. Subjects were instructed to do three sets of 10
repetitions once daily, which was reduced to three sets of 10
after 6 weeks, three times weekly. Every session ended with the
same static stretch exercise as in the warming-up phase. The
patients were also instructed to use ice on patellar tendon for
5 min after programme.

activity by 12 weeks, as did six of the nine subjects who

performed the leg extension/curl programme (no significant
difference). It should be noted that there was no extended
follow-up after the end of the treatment period.
The most notable difference between this and the subsequent
studies is that these employed training programmes based on
the Alfredson13 model, with painful, slow eccentric exercise. In
the first of these, a small, non-randomised study by Purdam et
al,19 single-leg eccentric training on a decline board was
defined. The references selected were reviewed by the authors compared with performing the same exercise with the foot on
and judged on their contribution to the body of knowledge. a flat surface. The training programme was the same for both
Review articles and editorial comments were not included. In groups; the only difference was the use of a decline board. The
addition, reference lists of articles selected from this search, exercise was completed with the trunk in an upright position,
and previous review papers were searched for relevant articles. and subjects were instructed to perform the exercise by slowly
bending the knee to 90˚ of flexion. They were told to perform
RESULTS the eccentric loading on the quadriceps muscles only and to
We identified seven articles on the clinical effects of eccentric return to the starting position using the non-injured side. If
training on patellar tendinopathy,9 18–23 all published after 2000, they had bilateral tendinopathy, the arms and both legs were
and including a total of 162 patients. Of these, 112 patients used to return to starting position. Subjects were asked to
were included in the groups assigned to various forms of increase the load with weights in a backpack once the exercise
eccentric training. Table 2 presents the main study character- could be completed without pain. As prescribed in the
istics. Alfredson programme,13 load was increased so that exercises
The first paper describes a small pilot study by Cannell et al,18 were always performed with some pain or discomfort. Subjects
comparing eccentric drop squat with concentric leg extension/ were not allowed to continue their competitive sporting activity
curl exercise. Their eccentric model was based on the Curwin during the first 8 weeks of the treatment period. After 4 weeks
and Stanish12 programme, using eccentric drop squats with a of the eccentric training regimen, they were allowed to
rapid deceleration phase, performed by starting from a standing complement it with slow jogging on flat ground, and cycling
position and unlocking the knees rapidly. Subjects were advised and water activities, if these could be performed without sharp
to use the quadriceps muscles of both legs to stop their fall just pain in the patellar tendon. After 8 weeks, the patients were
short of the thighs being parallel to the ground. Subjects were allowed to return gradually to previous activity. The results
encouraged to ice their patellar tendons after performing the showed that after 12 weeks, there was a significant decrease in
drop squat programme, and were treated with anti-inflamma- the amount of pain during activity in the nine patients in the
tory drugs and relative rest in the first 2 weeks. When they decline squat group, and no change in the flat floor group. Only
could do three sets of 20 drops easily, they progressed to the one of nine returned to sport in the standard flat floor group,
next level. The programme prescribed a detailed progression compared with six of eight patients in the decline board group.
through four different levels, which included adding gradually However, of these six, only four were still active at pre-injury
increasing weights and an alternate daily running programme levels when they were followed up after 15 months.
beginning with 1 km and increasing by 1 km every third run, In a paper from the same group, Young et al21 compared
with intensity increasing from one level to the next. One eccentric training performed on a decline board with eccentric
notable feature of this exercise programme is that both legs drop squat training performed with the foot placed flat on a
were trained at the same time. The control group performed a 10 cm box. The decline training group used the same
similar programme of leg extension and curl exercises, which programme as Purdam et al,19 the only changes being that the
were performed slowly to provide concentric loading. After squats were completed to about 60˚ of knee flexion instead of
12 weeks, both groups had a significant reduction of pain, but 90˚, and that they specified that load was increased by adding
there was no difference between the groups. Nine of 10 subjects weight to a backpack in 5 kg increments. In contrast, the flat
who performed the drop squat programme returned to sporting step group was instructed to exercise with minimal tendon pain

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Eccentric training programmes for patellar tendinopathy 219

A B C

Figure 2 The Alfredson Achilles tendon programme:13 from an upright position and standing with all weight on the forefoot and the ankle joint in plantar
flexion (A), the calf muscles are loaded eccentrically by having the patient lower the heel with the knee straight (B) or slightly flexed (C).

only and progress their speed from slow to fast, as outlined in programme was built on the principles of the Alfredson
the Curwin and Stanish protocol,12 completing both compo- programme,13, although it was performed only three times a
nents of the squat on the symptomatic leg. When subjects could week. Subjects used unilateral, slow eccentric squats, and the
complete their squats at a fast speed, they increased load in the leg was unloaded in the concentric phase as the non-injured leg
same manner as the decline board group. Both groups used was used to get back to the starting position. Subjects were told
single (affected) leg training. The results showed that both to go ahead with the exercise even if they experienced mild
groups had significantly improved scores on the Victorian pain, but to stop if the pain was disabling. The authors claimed
Institute of Sport Assessment (VISA) and a visual analogue a 100% success rate in the eccentric group, but no validated
scale (VAS) during the 12-week training period, and that this outcome measures were used and the patients were followed
improvement was maintained after 12 months, but that there for only 3 months after the 4-week treatment period.
was no difference between groups for either outcome measure In a randomised trial on competitive volleyball players,
at any time. Visnes et al22 used a similar treatment programme to the decline
Stasinopoulos and Stasinopoulos20 compared eccentric train- groups in the studies by Purdam et al19 and Young et al.21 The
ing with two other treatment methods: pulsed ultrasound and main difference was that the athletes were allowed to train and
transverse friction. The eccentric training programme also compete as usual during the treatment period. Otherwise, the
included static stretching exercises before and after the training same principles with slow, painful decline squats were applied
session, as described by Jensen and Di Fabio.24 The eccentric by the eccentric training group (fig 3 and box 3). The control
group continued to train as normal. The results showed that
there was no change in VISA score during the intervention
period in the training or control group, nor was there any
Box 2 The Alfredson eccentric Achilles tendon change during the follow-up period at 6 weeks or 6 months.
programme 1 3 ) This indicates that it may not be possible to combine sports
participation and eccentric exercises twice daily, and that the
The patients were instructed to do their eccentric exercises two total load on the tendon was too high, resulting in increasing
times daily, 7 days/week, for 12 weeks. Running activity was tendon soreness.
allowed if it could be performed with only mild discomfort and Jonsson and Alfredson23 compared an eccentric training
no pain. Two types of eccentric exercises were used. The calf programme using a decline board with a concentric programme
muscle was eccentrically loaded both with the knee straight on a decline board. The starting position for the eccentric
and, to maximise the activation of the soleus muscle, also with quadriceps training was standing on the 25˚ decline board with
the knee bent. Each of the two exercises included 15 repetitions the entire body weight on the injured leg. From that position,
done in three sets. The patients were told that muscle soreness the knee was slowly flexed to 70˚. The starting position for the
during the first 1–2 weeks of training was to be expected. In the concentric quadriceps training was standing on the 25˚ decline
beginning, the loading consisted of the body weight, and the board with the entire body weight on the injured leg and with
patients were standing with all their body weight on the injured
leg. From an upright body position, the calf muscle was loaded
by having the patient lower the heel beneath the forefoot. They Table 1 Results from MEDLINE search (1966–September
were only loading the calf muscle eccentrically; no concentric 2006)
loading was used. Instead, the non-injured leg was used to Number of
return to the start position. The patients were told to go ahead Search terms Hits papers identified
with the exercise even if they experienced pain. However, they
Eccentric training
were told to stop the exercise if the pain became disabling. If and patellar tendinopathy 7 3
they could perform the eccentric loading exercise without and tendinopathy 30 4
experiencing any minor pain or discomfort, they were and jumper’s knee 4 3
instructed to increase the load by adding weight. This was and tendinosis 33 2
Patellar tendinopathy 191 6
done by using a backpack that was successively loaded with Jumper’s knee 101 4
weight. If very high weights were needed, the patients were told
to use a weight machine.

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 220

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Table 2 Studies on the effect of eccentric training on patellar tendinopathy
Number of Number in
Treatment patients eccentric
Author and publication period Further included training Group
year Design Intervention Exercise prescription Comparison (weeks) follow-up (tendons) group Patients Main outcome* difference
18
Cannell et al 2001 Randomised Eccentric drop 3 sets of 20 drops Leg extension/curl 12 No 19 10 Patients recruited Pain (VAS) No
clinical trial squats once a day 5 days (concentric training) from different sports
per week
19
Purdam et al 2004 Non- Eccentric 3 sets of 15 Eccentric training 12 15 months 17 17 Patients recruited Return to sport Yes
randomised training on a repetitions 2 times on flat floor from a sports and VAS
pilot study decline board daily medicine clinic
Stasinopoulos and Randomised Eccentric 3 sets of 15 1 Pulsed ultrasound 4 3 months 30 10 Recruited from a Patient Yes
Stasinopoulos 200420 clinical trial training and repetitions 3 days and 2 transverse friction rehabilitation and satisfaction on
stretching per week rheumatology centre pain in two
categories
Young et al 200521 Randomised Eccentric 3 sets of 15 Eccentric training drop 12 1 year 17 17 Patients recruited VISA and VAS No
clinical trial training on a repetitions 2 times squats with flat heel on from high-level scores
decline board daily a step volleyball, but
intervention was off
season
22
Visnes et al 2005 Randomised Eccentric 3 sets of 15 Regular sports training; 12 6 months 29 15 Patients recruited VISA score No
clinical trial training on a repetitions 2 times no special programme from high-level
decline board daily volleyball, and
intervention was
during the season
Jonsson and Prospective Eccentric 3 sets of 15 Concentric training on a 12 33 months 15 (but 19 8 (10 Patients recruited Pain (VAS) and Yes
23
Alfredson 2005 randomised training on a repetitions 2 times decline board tendons) tendons) from a sports clinic VISA score
study decline board daily from different sports
9
Bahr et al 2006 Randomised Eccentric 3 sets of 15 Surgical treatment 12 12 months 35 (40 35 (40 Patients recruited Return to sport No
clinical trial training on a repetitions 2 times tendons) tendons) from different sports and VISA score
decline daily but had severe
board problems

VAS, visual analogue scale; VISA, Victorian Institute of Sport Assessment.

*VISA Score was designed specifically to quantify knee function in subjects with patellar tendinopathy.
Visnes, Bahr
Eccentric training programmes for patellar tendinopathy 221

the knee in 70˚flexion. From that position, the knee was slowly
straightened to full extension. All patients were instructed to Box 3 The eccentric training programme on the
cease sporting activities for the first 6 weeks. At the 12-week patellar tendon 2 2
follow-up, pain scores were significantly lower and VISA scores
significantly higher in the eccentric training group compared The players performed the eccentric training programme on a
with the concentric training group, and the patients were 25˚ decline board. Each training session was to be completed
satisfied with treatment for 9 of 10 tendons. In the concentric two times daily with three sets of 15 repetitions in each session.
group, pain levels remained high and no patient was satisfied The exercises could be performed without warming up. The
with the result of the treatment. At follow up .2 years later, downward component (eccentric component) was on the
patients in the eccentric group were still satisfied and active in affected leg, and the upward component on the asymptomatic
sports, whereas all patients in the concentric group had been leg. If both legs were injured, the subjects were instructed to use
treated surgically or by sclerosing injections. The study had their arms to assist during the concentric phase and train only
aimed to include 20 patients in each group, but was stopped at one leg at a time. They were instructed to take 2 s for each
the half-time control because of poor results in the control eccentric component of each exercise, and to avoid bending
group. forward but keep the back as vertical as possible throughout the
In the most recent study on eccentric training, Bahr et al9 squat. The squat went to 90˚ of knee flexion, which ensured that
compared the effect of eccentric training with that of surgical the subjects went past 60˚ of knee flexion, the joint angle
treatment with open tenotomy. Subjects in the surgical thought to place maximal load on the patellar tendon. The
treatment group also performed the same eccentric training subjects were instructed to exercise despite pain during
programme as part of their rehabilitation after surgery. The exercise, but to stop if the pain became disabling. They were
eccentric programme was the same programme as that used by recommended to have a pain value of 4–5 on a visual
Visnes et al22 (fig 3 and box 3). During the first 8 weeks of analogue scale during the eccentric training sessions (0, no
treatment, the patients were not allowed to take part in sports- pain and 10, the worst pain ever). Load was increased as pain
specific training. After 4 weeks, they were allowed to cycle, to decreased, and they added load in a backpack in 5 kg
jog on a flat surface or to exercise in water, if these activities increments. Those with pain ,3–4 on the VAS were
could be done without pain. After 8 weeks, the patients were recommended to increase the weight. Players with pain .6–7
allowed to gradually return to their sport if there was no or on the VAS during the exercises were recommended to do the
minimal pain. The results showed that, although both treat- exercise with less weight.
ment options resulted in a definite improvement in knee
function, there was no measurable difference between the
groups. Only half of all patients were able to return to sport tendinopathy. Even if the results should be interpreted with
within 1 year after treatment with either option, and even caution, the effect of the treatment could be estimated to give
fewer had relief of all symptoms. the patients a 50–70% chance of improvement of knee function
and pain, so that they could return to pre-injury level of sports
activity. However, the quality of the studies is variable; some
DISCUSSION
are non-randomised, some are pilot studies with small numbers
All seven studies included concluded that eccentric training has
and some have not followed the patients for a sufficient post-
an important role in the conservative treatment of patellar
treatment period.
Moreover, this review shows that there are a number of
potentially significant differences in the different eccentric
A B programmes used: drop squats or slow eccentric movement,
squatting on a decline board or level ground, exercising into
tendon pain or short of pain, loading the eccentric phase only or
both phases, and progressing with speed, then loading or
simply loading. On the basis of these differences in the exercise
prescription, it would be inappropriate to attempt a quantitative
meta-analysis of the clinical outcome after eccentric training for
patellar tendinopathy. Thus, in the current review, we have
chosen to focus on the training protocols, to examine whether
there is sufficient evidence to provide guidance for clinicians,
and possibly also inspire research directed at defining the most
appropriate treatment protocol.
To date, no study has made a direct comparison of the effect
of slow eccentric training based on the Alfredson programme13
with that of drop squat exercise based on the Curwin and
Stanish model12; further studies are needed to investigate this
issue. Young et al21 compared slow eccentric training with drop
squats, but the groups also differed in other respects. The slow
eccentric training group was trained with pain or discomfort
and on a decline board, whereas the drop squat group was
trained with no pain and on a 10 cm flat surface step.
A decline board has been used in five studies,9 19 21–23 and all
the more recent studies in this review use the same principle.
The introduction of the decline board was based on a
Figure 3 The patellar training programme. (A) Starting position for
biomechanical study by Purdam et al,25 which suggested that
eccentric training on a 25˚ decline board with the entire weight on the the load on the patellar tendon could be maximised by
injured leg. From this position, the knee was slowly flexed to 90˚. (B) End performing the squats on a 25˚ decline board. In the same
position for eccentric training. way, the rationale for keeping the trunk in the upright position

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222 Visnes, Bahr

was to minimise involvement of the hip extensors. This theory

has recently been supported by Kongsgaard et al,7 who showed What is already known on this topic
that patellar tendon strain is significantly greater, stop angles of
the ankle and hip joints are significantly smaller, and N Eccentric training has become a popular conservative
electromyographic (EMG) amplitudes of the knee extensor treatment model for patellar tendinopathy.
muscles are significantly greater during the decline compared
with standard squats. Purdam et al19 made a direct comparison,
using the same eccentric training programme, between using a
decline board and exercising on a flat floor. In this pilot study, What this study adds
decline board training resulted in improved pain scores,
whereas there was no short-term change in the regular squat N Even if most studies suggest that eccentric training may
group. Thus, although the evidence is limited, based on these have a positive effect, our ability to specify which
results and the biomechanical rationale, the decline board now protocol component is responsible for the observed
seems to have become a standard component of most eccentric effects is limited.
training programmes.
A major change was Alfredson’s principle of exercising into
N The studies available indicate that the treatment pro-
gramme should include a decline board, should be
tendon pain. In contrast, the original Curwin and Stanish performed with some level of discomfort, and that
programme12 prescribes that ‘‘the intensity of the exercise should athletes should be removed from sports activity.
be such that pain, or discomfort, is experienced in the last set of 10
repetitions’’. However, there are no studies comparing slow
eccentric training with pain versus training with minimal or no In conclusion, even if most studies suggest that eccentric
pain, and therefore there is no documentation on how much pain training may have a positive effect, our ability to specify which
and discomfort should be recommended. Further research is protocol component is responsible for the observed effects is
clearly needed to deal with this issue. limited. The studies available, which are small and of variable
Most programmes load only during the eccentric phase, and quality, indicate that the treatment programme should include
patients were instructed to use their non-affected leg and/or a decline board, should be performed with some level of
arms in the concentric phase of the movement. Jonsson and discomfort, and that athletes should be removed from sports
Alfredson23 showed that eccentric training alone was effective, activity. However, these aspects need further study.
while concentric training only produced no effect. However,
whether the affected leg can be trained in both phases has not ACKNOWLEDGEMENTS
been studied in patients with patellar tendinopathy. The Oslo Sports Trauma Research Center has been established at the
Progressing was done by adding weight or by increasing Norwegian School Sport Sciences through generous grants from the
speed and then adding weight. However, these contrasting Norwegian Eastern Health Corporate, the Royal Norwegian Ministry of
prescriptions have not been compared directly in studies. In Culture, the Norwegian Olympic Committee and Confederation of
Sport, and Norsk Tipping AS.
addition, there are large variations on when and how other
training (running, sports-specific training) is introduced. Most .......................
studies do not allow other training during the first 6 weeks of
Authors’ affiliations
eccentric training. Visnes et al,22 in contrast, tried to combine Håvard Visnes, Roald Bahr, Oslo Sports Trauma Research Center,
treatment with eccentric training with regular volleyball Department of Sports Medicine, Norwegian School of Sport Sciences,
competition and training at the same time. In this study, the Oslo, Norway
treatment group did not show any improvement. The authors’
Competing interests: None declared.
interpretation was that the combined load of the treatment
programme and volleyball training exposed the tendon to too
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EDITORIAL BOARD MEMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kim Bennell

K
im Bennell is an academic physiotherapist and currently
Professor and Foundation Director of the Centre for
Health, Exercise and Sports Medicine at the University of
Melbourne, Australia. Here she leads a multidisciplinary team
from physiotherapy, medicine, science and human movement.
She completed a PhD in 1996 investigating the effects of
exercise on bone and stress fractures in athletes. Her current
research has focused on the role of physiotherapy strategies,
including exercise, in the management of musculoskeletal
diseases specifically knee osteoarthritis, osteoporosis and
shoulder pain. Kim has received numerous awards for her
research excellence including the prestigious Australian Society
for Medical Research 2004 Amgen Award for outstanding
achievement in translational research. She has presented over
40 keynote and invited conference presentations, has more
than 100 peer-reviewed original research articles in leading
sports medicine, rehabilitation and medical journals, two text
books and 18 invited book chapters in international texts. She
has successfully supervised 13 PhD/MDs and four Masters to
completion. Kim is committed to ensuring that her work
impacts at the clinical and public health level. This has led to
her serving on a number of professional and community
committees and taskforces. She is also on the editorial board of
five international sports medicine journals.

doi: 10.1136/bjsm.2006.031898

Figure 1 Kim Bennell.

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