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1st Oct

2012

Eccentric Exercise for Overuse Tendinopathy

Overuse injuries are the most common type of injuries seen in sports and recreational activities. Tissues that suffer the first are those which have low metabolism and blood and nutrient supply. Therefore, they also take longer to heal once injured, as compared to e.g. muscles which have ample blood supply. Tendons, which connect the muscles to bones, belong to this category of frequently injured tissues. Overuse irritation of tendons is termed tendinopathy, but commonly referred to as tendinitis. If the injury and strain is chronic, we often develop tendinosis, which refers to degenerative changes in the tendon.

Common injuries in this category include Achilles tendinopathy, patellar tendinopathy or “jumper’s knee”, rotator cuff tendinopathy, lateral epicondylitis or “tennis elbow” and medial epicondylitis or “golfers elbow”. Plantar fasciitis can also be included in this group of injuries.

Many of these injuries become chronic and last for many months or even years, in part because of the tissues’ low metabolism, and in part due to continued over training and prescription of inappropriate treatment and exercise.

The most commonly performed inappropriate exercise is conventional strengthening exercises, where the joint is repeatedly moved back and forth against resistance. In tendinopathy, the tissue oxygen uptake is reduced, and therefore, performing an exercise which uses much oxygen will lead to continued overuse irritation. When we perform an exercise to shorten a muscle, a concentric contraction, such as doing a heel raise or standing up from a squat, we use 70-75% more oxygen, than if we do the opposite, i.e. drop the heel down or sit down into a squat, which is an eccentric or lengthening contraction exercise. The joint is then returned to its starting position by some external means (e.g. use of arms). This form of exercise is ideal especially during the acute phase of tendinopathy.

The eccentric exercise can be performed with as much force as tolerated, without causing increase in pain or loss of coordination. Numerous studies have shown such training to effectively accelerate the repair of collagen, which makes up the majority of the tendon, and increase its tolerance to strain. Today, authorities such as Rivard and Grimsby recommend 1-2 sets of 10-15 repetitions, performed twice a day. The exercises can be gradually progressed in intensity by adding external load or body weight, and by increasing range of motion (e.g. at first performing a heel drop to the floor and later off a step).

It is also helpful to exercise surrounding muscles, but not the involved tendon, with high repetition concentric exercises, to increase blood flow and nutrient supply to the area of the tendon. Furthermore, it is advised to avoid stretching and heat treatment, as this can weaken the collagen in the tendon. Studies have typically found tendons not to be inflamed in tendinopathies, and therefore, anti-inflammatory medications should be used sparingly, since they can slow down the tissue repair.

You may be familiar with this form of training from our clinic, but many people are not and continue to suffer from these injuries.

Enjoy our beautiful but slightly hot autumn.

Best Wishes,

Gunnar

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