REVIEW

Chronic tendinopathy: effectiveness of eccentric exercise

Brett L Woodley¹, Richard J Newsham-West¹, G David Baxter¹

¹ Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand

Correspondence to:
Brett Woodley
c/o Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand; brettandsteph@xtra.co.nz

Accepted 10 October 2006

Objectives: To determine the effectiveness of eccentric exercise (EE) programmes in the treatment of common tendinopathies.

Data sources: Relevant randomised controlled trials (RCTs) were sourced using the OVID website databases: MEDLINE (1966–Jan 2006), CINAHL (1982–Jan 2006), AMED (1985–Jan 2006), EMBASE (1988–Jan 2006), and all EBM reviews – Cochrane DSR, ACP Journal Club, DARE, and CCTR (Jan 2006). The Physiotherapy Evidence Database (PEDro) was also searched using the keyword: eccentric.

Review methods: The PEDro and van Tulder scales were employed to assess methodological quality. Levels of evidence were then obtained according to predefined thresholds: Strong–consistent findings among multiple high-quality RCTs. Moderate–consistent findings among multiple low-quality RCTs and/or clinically controlled trials (CCTs) and/or one high-quality RCT. Limited–one low-quality RCT and/or CCT. Conflicting–inconsistent findings among multiple trials (RCTs and/or CCTs). No evidence–no RCTs or CCTs.

Results: Twenty relevant studies were sourced, 11 of which met the inclusion criteria. These included studies of Achilles tendinopathy (AT), patella tendinopathy (PT) and tendinopathy of the common wrist extensor tendon of the lateral elbow (LET). Limited levels of evidence exist to suggest that EE has a positive effect on clinical outcomes such as pain, function and patient satisfaction/return to work when compared to various control interventions such as concentric exercise (CE), stretching, splinting, frictions and ultrasound. Levels of evidence were found to be variable across the tendinopathies investigated.

Conclusions: 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.

Abbreviations: AT, achilles tendinopathy; CCT, clinically controlled trial; CE, concentric exercise; EE, eccentric exercise; FAOS, foot and ankle outcome score; LET, lateral elbow; PED, physiotherapy evidence database; PT, patella tendinopathy; RCT, randomised controlled trial; RR, relative risk; VAS, visual analogue scale WMD, weighted mean difference

Keywords: tendinopathy; eccentric; systematic review

The first 150 words of the full text of this article appear below.

Tendinopathy is the preferred term used to describe various tendon pathologies, including paratendinitis, tendinitis and tendinosis in the absence of biopsy-proven histopathologic evidence.¹ Tendinopathy of the Achilles tendon (AT) alone has been reported to constitute 7–9% of total injuries in top-level runners.² Other tendinopathies are also prevalent:1–2% of the general population have been reported as experiencing tendinopathy in the common wrist extensor origin of the lateral elbow (LET),³ and 20% of all knee injuries (n = 266) assessed in a sports clinic setting over six months were diagnosed as patella tendinopathy (PT).⁴ Other common sites of tendinopathy include the proximal hamstring insertion, the rotator cuff tendons, and the wrist flexor tendon insertion at the medial elbow.⁵ Considering the prevalence of these tendinopathies, the determination of modalities effective in treating tendon pathology remains important.^3,6

Various modalities have been recommended as appropriate treatment options for tendinopathy, depending upon the phase of presentation. . . . [Full text of this article]

M Kjær²

² Bispebjerg Hospital, Sports Medicine Research Unit, Copenhagen, Denmark; m.kjaer@mfi.ku.dk

M S Koehle³

³ Allan McGavin Sport Medicine Centre, University of British Columbia, Vancouver, Canada; koehle@interchange.ubc.ca

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