Chronic tendinopathy: effectiveness of eccentric exercise

Abstract

This review demonstrates the dearth of high-quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies. Further adequately powered studies that include appropriate randomisation procedures, standardised outcome measures and long-term follow-up are required.

The Role of Mechanical Loading in Tendon Development, Maintenance, Injury, and Repair

“…These oscillations may modulate the therapeutic effects attributed to eccentric exercise regimen 116 . While many have advocated eccentric exercise programs, others have suggested that understanding the mechanisms involved in these regimens is necessary to support the efficacy of these programs for treatment 117,118 . The optimal load, speed of movement, number of repetitions, and duration of contraction remain to be determined and require further investigation 109,116 .…”

Tendinopathy—from basic science to treatment

“…Eccentric exercise therapy has been reported to have some effect in prospective, randomized trials in athletic patients; 54,55 however, a review of 20 published trials found that there was little evidence of a positive effect on clinical outcomes, such as reduction of pain, return to function and patient satisfaction. 56 Shock-wave therapy, which is thought to function on the tenocytes to stimulate repair, might be effective in a carefully selected group of patients, 57 although other studies have reported no significant effect. 58,59 Growth factors have been used for several years in an attempt to improve tendon healing, but there is currently no evidence that these are effective in tendinopathies.…”

Nonoperative Management of Common Shoulder Conditions

“…A review of conservative treatment outcomes for tendinopathy at multiple common sites other than the biceps compared the use of an eccentric exercise programs to control groups including concentric exercise, stretching, splinting, massage, and ultrasound. The review suggests that eccentric exercise may decrease pain at twelve weeks of physical therapy versus twelve weeks of concentric exercise [59]. In cases where conservative treatment fails, patients may undergo surgical intervention consisting of either a biceps tenotomy or tenodesis depending on multiple factors including associated pathology, age, hand dominance, and activity level.…”