British Journal of Sports Medicine 2009;43:276-279
Original articles
Eccentric loading for Achilles tendinopathy — strengthening or stretching?
1 School of Physiotherapy, Curtin University, Perth, Australia
2 Department of Physiotherapy Royal Perth Hospital, Perth, Australia
3 Australian Institute of Sport, Canberra, Australia
Associate Professor Garry T Allison, Associate Professor of Neuroscience and Trauma Physiotherapy, School of Physiotherapy, Curtin University, Perth, Western Australia, Physiotherapy Department, Royal Perth Hospital Perth, Western Australia; g.allison{at}curtin.edu.au
The prescription of eccentric loading is considered as a mainstay of non-operative rehabilitation programmes for mid-substance chronic Achilles tendinopathy. Such exercises have some degree of clinical utility in comparison with concentric training and are often referred to as a strengthening programme. Yet the dose parameters of the eccentric loading do not reflect an optimal strengthening programme and specifically avoid the normal eccentric–concentric coupling typical of the stretch shortening cycle. This manuscript identifies the arguments and counterarguments for why eccentric loading rehabilitation is not an optimal strengthening programme. It is proposed that such exercises reflect a specific stretching programme directed at the passive structures. This has two important clinical implications. Firstly, this reinterpretation of the role of eccentric exercises may direct future research into the underlying mechanisms of tendinopathy and, secondly, it may reinforce the importance of adjunct sports specific strengthening programmes.
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