Current Concepts in Tendinopathy Management: What Happened to Eccentrics?WHAT HAPPENED TO ECCENTRICS?
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• Treated with soft tissue mobilization & eccentric exercise
• Complains of pain after activity and stiffness after rest
• Recovery course
PATHOPHYSIOLOGY MODELS
• Neglects role of central pain processing
• No direct relationship between structure, pain, and dysfunction
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Cook et al. 2015
PATHOPHYSIOLOGY MODELS
COLLAGEN DYSREPAIR
• Initially thought of as “kinking” of collagen fibers • Currently thought of as under-stimulation of tendon
• Served as basis for use of cross friction mobilization
Cook et al. 2015
Cook et al. 2015
• Neurovascular ingrowth
• Conflicting evidence on neovessels
Tol et al. 2012
centrally
• Characterized by mechanical or thermal sensory gain
• Reduced pressure pain threshhold Plinsinga et al. 2015
Littlewood et al. 2013
Tompra et al. 2016
• Does not emphasize pathophysiology
• Explains changes over time
Cook et al. 2015
• Decreased inherent stiffness
• Increased cellular turnover
STRETCH-SHORTEN CYCLE (SSC)
“an active stretch (eccentric contraction) of a muscle followed by an immediate shortening (concentric contraction) of that same muscle.”
Energy storage and release
Irritable: provocation lasting greater than 24 hours
Stable: settles within 24 hours
Malliaris et al. 2015
Compression Catabolic ↓ tensile strength
Grimaldi et al. 2015
• Lying on side
• High load test – progression of testing • Rotator cuff testing • Extensor/flexor tendon testing • Single leg bridge • Single leg decline squat (see video 1)
• Single leg heel raise
PRODUCE THE SAME RESULTS
loading
Eccentrics
(ECC)
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Isometrics (ISO)
Contractions in which joint angle and muscle length do not change
BE AN EXERCISE EXPERT
Improved pain and
Clinician familiarity > Collagen turnover
Longer research history ↓ Swelling/vascularization
ISOMETRICS
Rio et al. 2015
Naugle et al. 2012
TENDONS
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“Activity within reactivity”
• Percutaneous procedures
• Tenex/Tenotomy/Tendon scraping
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P-lyometric/Play
JJKUCZ@GMAIL.COM
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