Eccentric vs. Concentric Exercises: What is Most Effective for Tendon Pain?

in this video we will discuss which

exercise mode is most effective for

Lowell and tendinopathy are eccentric is

really more effective than concentric or

isometrics enroll in our online course

now link is in the video description hi

and welcome back to physio tutors

traditionally eccentric exercise has

been described in the management of

lower limb tendinopathy and much

research has shown its effectiveness in

Achilles and patellar tendinopathy up

until today the Alfredson protocol is

probably the most widely used exercise

program for Achilles tendinopathy and we

have also made a video about it that you

can watch in the top right corner

but it's eccentric exercise really

superior to concentric and isometric

exercise or combination thereof let's

look at what the evidence has to say

about this first of all via a tower in

the year 2015 compared eccentric

exercise to heavy slow resistance

exercises for mid portion Achilles

tendinopathy they found that there was

no difference in pain and function on

the visa scale at 12 months and

satisfaction was higher in the heavy

snow resistance group compared to the

Alfredsson protocol a problem with the

Alfredsson protocol is that patients

need to perform an almost insane amount

of volume it requires three sets of 15

repetitions of eccentric single leg

conferences with the knee bent followed

by three sets of 15 repetitions of

eccentric single leg calf raises with a

knee straight twice daily that's a

hundred and eighty repetitions per day

however studied by two multi at are in

the year 2016 and Steven Saddam in a

year 2014 showed that an eccentric

program twice a week or self dost is at

least as effective as the Alfredsson

program so what does the evidence say

about the patellar tendon

a study by Kong Scott at our in the year

2009 compared eccentric exercises to

heavy slow resistance exercises and

found no difference in outcome pain and

function on the fast and visa skills at

six months follow-up again the

satisfaction was higher in the heavy

slow resistance group compared to the

eccentric program molera said all in the

year 2015 looked at patellar tendon

adaption in relation to load intensity

and contraction type they did find the

greatest improvements in force stiffness

and modulus in the eccentric group

however this was a pure result of the

higher load that was achieved through

his Centrex when loads were equalized

there were equal adaptions in the

patellar tendon irrespective of the

loading type to sum it up the choice of

the exercise mode is not that important

it seems to be easier for patients to

perform a simple concentric eccentric

exercise program in a heavy slow manner

more important is a gradual progressive

loading program for at least 12 weeks

excepting mild to moderate pain levels

and it is feasible for patient for at

least twice a week while this is well

researched for your Achilles and

patellar tendons evidence for plantar

fasciitis gluteal tendinopathy and

hamstring tendinopathy is sparse so when

does it make sense to integrate

eccentric exercise into a program for

lower limb tendinopathy eccentric Tsar a

good way to push heavier for patients

who are really weak and a great way of

maximizing loads in patients who are

already advanced be careful though that

it can induce severe delayed onset

muscle soreness

alright this was our video on the mode

of exercise for lower limb tendinopathy

if you are curious about the Alfredson

protocol click on a video right next to

me as always thanks a lot for tuning in

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