The prescription of eccentric loading is considered as a mainstay of non-operative rehabilitation programs for mid-substance chronic Achilles tendinopathy. Such exercises have some degree of clinical utility in comparison to concentric training and are often referred to as a strengthening program. Yet the dose parameters of the eccentric loading do not reflect an optimal strengthening program and specifically avoid the normal eccentric-concentric coupling typical of the stretch shortening cycle. This manuscript identifies the arguments and counter arguments for why eccentric loading rehabilitation is not an optimal strengthening program. It is proposed that such exercises reflect a specific stretching program directed at the passive structures. This has two important clinical implications. Firstly, this re-interpretation of the role of eccentric exercises may direct future research into the underlying mechanisms of tendinopathy and secondly, reinforce the importance of adjunct sports specific strengthening programs.
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