The exercise or loading approaches to treatment of tendinopathy have been at the forefront of treatment options for the last 30 years. Prior to that, the predominance of the inflammatory model prescribed that rest, ice and anti-inflammatory medication was the only suitable approach. This approach was overwhelmingly unsuccessful; failure to recover and recurrence were common.
In the 70′s Curwin and Stanish reported that eccentric loading was beneficial for tendinopathy, and although this received some notice in the clinical world, the Alfredson paper in 1995 resulted in an explosion of interest in eccentric load for tendinopathy. Since then much research has confirmed the benefits of eccentric exercise, however the reasons for its effectiveness have not been elucidated. The effectiveness appears to be specific to rehabilitation of active people; eccentric exercise in season, and in the inactive population was less successful. The specificity of eccentric-only exercise has also been questioned- although eccentric clearly has to be part of the programme, it has been shown to be effective when combined with concentric exercise and with quite high loads.
Is there more progress to be made in the area of exercise-based rehabilitation? If the continuum model is correct, then consideration of loading in different stages is essential, remembering that the eccentric programme was shown to be most effective in chronic degenerative tendinopathy. Reactive tendinopathy is likely to require different loading regimes, as will the common clinical presentation of reactive on degenerative tendinopathy. Power and energy storage loads have not been considered in research, although clinically they are a critical part of rehabilitation. Research in these areas is likely to be complex and require multi-centre trials; it may be up to the people at this conference to prioritise this research as a group.
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