Physiotherapists prescribe eccentric exercises to promote healing of tendons and tendon insertions. In fact eccentric strengthening is far and away the most supported treatment for tendon repair. Eccentric exercises were first shown to be effective in a 1998 Swedish study on Achilles tendinopathy, and is now the gold standard for treatment as its efficacy has been repeated in a number of other studies since. The exercise protocol used in the original study included the lowering portion of a calf raise being done on one foot and the raising done by both legs. 10-15 repetitions of the exercise were performed twice a day, over a step and even if there was pain involved (unless it was debilitating). They were also done in both the straight leg (B) as well as the bent leg positions (C). It was a twelve week program. Weight was added to the exercises when the exercises were completely pain free. The results were remarkable as 100% of the subjects assigned to the eccentric program were able to return to pre-injury activity levels at the end of the program and their pain as measured by visual analogue scale (VAS) decreased from 81.2 to 4.8 (± 6.5) out of 100!
The exact mechanism of eccentric strengthening has yet to be elucidated but it has been shown that these exercises improve the quality of tendon structure.
Examples of using this type of exercise for other types of tendon or insertional tendinopathies are as follows:
- Patellar tendon: leg press pushing with two legs, and lowering with one
- Lateral epicondylitis (tennis elbow): wrist extensions with a small weight (2lb to start)- using the good hand to lift the weight and the bad hand to slowly lower.
- Medial epicondylitis (golfer's elbow): as above but wrist curl
- Biceps tendinopathy; biceps curl using small weight lifting your bad forearm up with the good one and then slowly lowering with the bad arm
So now you know why eccentric exercises are pushed by your physiotherapist... and why you should do them!!
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