Eccentric Exercise

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Eccentric Exercise

• Michael A. Shaffer
• PT, ATC, OCS

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• Concentric Exercise
• Muscle is loaded as it shortens
• i.e. muscle force gt load

• Eccentric Exercise
• Muscle is loaded as it lengthens
• i.e. muscle force lt load

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Eccentric Contractions

• Braking contractions
• Stepping down
• Arm deceleration after ball release (pitching)
• Control of foot pronation in stance phase
• Controlling knee extension during swing phase

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Length- Tension Curve
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Length- Tension Curve
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Force- Velocity Curve
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DOMSDelayed Onset Muscle Soreness

• Micro-tearing of Connective Tissue
• i.e. passive elements
• Inflammatory
• 48 hours post
• Not ischemia
• Immediate
• Not lactate
• 30-60 minutes post

Titin
Desmin
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DOMS Treatment
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DOMS Treatment

• Protective Effect
• Neural
• EMG changes
• Type I Motor Units
• Decreased amplitude, duration
• LaStayo et al J Strength Conditioning Res 2008
• Mechanical
• Intramuscular CT
• Cellular
• Changes in inflammatory response
• McHugh Scand J Med Sci Sports 2003

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• 30 recreational athletes
• 15 failed traditional management
• Awaiting surgery
• 15 treated with eccentric training
• 0/15 went on to surgery
• All returned to running
• 6 mos post-op 3 months Non-op

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• Eccentric Training
• 3 x 15 reps
• 2 Positions
• Passive concentric motion
• 2x/ daily
• Pain OK..stop if disabling
• Add weight when pain free or easy

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Achilles Tendonitis RCT

• Concentric vs. Eccentric Exercise
• 44 patients
• 12 week follow up
• Outcome measure satisfaction
• 18/22 Eccentric
• 8/22 Concentric
• Mafl et al KSSTA 2001

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Achilles Tendonitis

• Better for midportion vs insertional Achilles
  tendon
• Changed protocol
• Insertional tendonopathy
• DF only to neutral vs. true DF
• 4 month F/U
• Pain/ Satisfaction Improved
• 18 Patients
• Jonsson et al Br J Sports Med 2008

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Patellar Tendonitis
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Patellar Tendonitis

• Standard Squat Vs. Decline Squat
• 17 Patients
• Better return to sport
• Pain ?d with decline
• Maintained rest of protocol
• Purdam et al Br J Sports Med 2004

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Patellar Tendonitis

• Decline vs. Step Down
• Pain and Outcome score
• Essentially Equal
• Recommended Decline

Young et al Br J Sports Med 2005
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Eccentric Exercise- ACL Rehabilitation Its not
just for tendons any more
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Safety, Strength
Gerber et al JOSPT 2007
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1 year F/U
Gerber et al PT 2009
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The Next Step

• Older patients
• Slow progression
• ?d strength w/o inflammation
• LaStayo et al J Geriatric Phys Ther 2007
• Cardiac patients
• ?d strength lower oxygen cost
• Meyer et al MSSE 2003

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Why does it work?

• Improved strength
• Microstructure of tendon
• Collagen deposition
• Steroids
• Neovascularization
• Ohberg Alfredson
• KSSTA 2004
• Raises the pain threshold

Achilles Tendon before and after 12 weeks of
eccentric training
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Application

• 3 x 15 Reps
• 2x/ daily
• Passive concentric
• 12 week program

• Mid-portion Achilles
• Full DF
• Insertional
• DF to neutral
• Patellar Tendon
• Decline Board

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Application

• LOAD!
• Pain 3-7/10
• But slowly increase
• Concentric first?
• Continue activity?
• Visnes et al Clin J Sports Med 2005

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Everything I ever really needed to know I
learned

• From an Icelandic Blog

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Level 6 Evidence- My take

• Alfredson vs. other authors
• (4 Systematic Reviews in 2007)
• Work through pain (3-7/10)
• Outcome Measures
• 12 week outcomes (i.e. short)
• 12 weeks of training (i.e. long)
• Recreational athletes best results

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My questions

• 12 weeks duration?
• Load need to be painful?
• Tendonopathy vs. ACLR
• If yes, should we limit activity?
• If this makes tendonopathy better, can we be this
  aggressive with other conditions?