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Eccentric Exercise
Michael A. Shaffer
PT, ATC, OCS
Concentric Exercise Muscle is loaded as it
shortens i.e. muscle force > load
Eccentric Exercise Muscle is loaded as it
lengthens i.e. muscle force < load
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
Length- Tension Curve
Length- Tension Curve
Force- Velocity Curve
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
Desmin
Titin
DOMS Treatment
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
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
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
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
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
Patellar Tendonitis
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
Patellar Tendonitis Decline vs. Step Down
Pain and Outcome score Essentially Equal Recommended Decline
Young et al Br J Sports Med 2005
Eccentric Exercise- ACL Rehabilitation It’s not just for tendons any more
Safety, Strength
Gerber et al JOSPT 2007
1 year F/U
Gerber et al PT 2009
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
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
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
Application
LOAD! Pain 3-7/10
But slowly increase Concentric first?
Continue activity? Visnes et al Clin J Sports Med 2005
Everything I ever really needed to know I learned……
From an Icelandic Blog
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
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?