Eccentric exercises; why do they work, what are the problems and how can we improve them?

Area of Science:

• Sports Medicine
• Rehabilitation Science
• Orthopedic Research

Background:

• Eccentric exercises (EE) are established treatments for chronic tendinopathies, particularly Achilles and patellar.
• Current EE protocols face challenges including time commitment and patient motivation.
• The efficacy of EE varies depending on the specific tendinopathy and lesion location.

Purpose of the Study:

• To review the current understanding of eccentric exercises in tendinopathy management.
• To identify limitations and unanswered questions regarding EE protocols.
• To explore emerging evidence on the mechanisms and optimization of EE.

Main Methods:

• Review of existing literature on eccentric exercises for tendinopathy.
• Analysis of controlled trials and in vivo studies.
• Discussion of clinical observations and emerging research findings.

Main Results:

• EE demonstrate success in controlled trials for specific tendinopathies.
• Efficacy is influenced by lesion location, with insertional Achilles tendinopathy being less responsive.
• New insights into the effects of EE on tendinopathic tissue are emerging.
• In vivo studies offer potential explanations for the therapeutic benefits of EE over concentric exercises.

Conclusions:

• While effective, standard EE protocols require optimization for time and patient adherence.
• Further research is crucial to enhance the effectiveness of EE for diverse tendinopathies.
• Understanding the underlying mechanisms of EE is key to developing improved therapeutic strategies.