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Infographic. Achilles and patellar tendinopathy rehabilitation: strive to implement loading principles not recipes
  1. Peter Malliaras1,
  2. Jorge Rodriguez Palomino2,
  3. Christian J Barton2,3
  1. 1 Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
  2. 2 La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
  3. 3 Department of Surgery, St. Vincent’s Hospital, University of Melbourne, Fitzroy, Victoria, Australia
  1. Correspondence to Dr Christian J Barton, La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, VIC 3086, Australia ; christian{at}completesportscare.com.au

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In 2013, our group published a systematic review of Achilles and patellar tendinopathy rehabilitation programmes.1 Eccentric loading involving slow lengthening muscle contractions was, and among many still is, regarded as the first choice rehabilitation option for these lower limb overuse conditions. The rise in popularity followed Hakan Alfredson’s 1998 publication demonstrating 100% return to preinjury function with isolated eccentric loading in Achilles tendinopathy.2 This publication has had 1072 citations in Google Scholar in February 2018.

However, subsequent studies were not all able to replicate these impressive outcomes. For example, Sayana et al 3 reported that up to 45% with Achilles tendinopathy did not respond to isolated eccentric loading (defined as less than a 10% change in a disease-specific pain and function outcome).

The objective of our 2013 …

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