Topic Progress:

Eccentric training

Eccentric exercise appears to be one of the most effective, and widely used, treatments for established tendinopathy. Its effectiveness in young athletic patients has been demonstrated in a number of tendons including the Achilles tendon and the patellar tendon.6-8 Its effectiveness in older, more sedentary patients is less clear.

There are a number of important considerations which must be explained to the patient:

  • These exercises are often painful – and this is normal.
  • The athlete must do large numbers of exercises every day – between 90-180 repetitions.
  • The athlete must continue to do the exercise for a minimum of three months.

This is generally a good starting point for most athletes presenting with more chronic tendon pain (tendon disrepair or degeneration).


Isometric exercise

There is currently a lot of interest in the use of isometric exercise to manage pain in tendinopathy. Some preliminary studies have shown that regular isometric holds can reduce the pain associated with tendinopathy.9 They may be a useful pre-match intervention and can also allow those with more significant pain to remain mobile.

The following clip shows how to perform both isometric and eccentric exercises for Achilles tendinopathy.

Palpation is a very useful tool to assess for tendinopathy. An assessment of Achilles tendon length is also very important to exclude tendon rupture.

While eccentric exercises appear effective in patients with mid-portion Achilles tendinopathy (usually 2-6 centimetres above the level of insertion with the calcaneus), they do not seem as effective in those whose pain is at the insertion. Eccentric exercise to ground level only (not off a step) may be more effective in this group.

Dr Ricard Pruna

Sport and Exercise Medicine