Eccentric Strengthening
An eccentric contraction is defined as a contraction where the muscle is lengthening, as opposed to a concentric contraction where the muscle is shortening, or an isometric contraction where there is no change in the muscle length.
There is nothing magical about eccentric muscle strengthening in the role of alleviating tendon problems. The key is the controlled progression of exercise, which elicits an adaptation in the tendon that produces increased tensile strength. Research has shown that eccentric muscle contractions generate more tension than isometric or concentric contractions and it is often a neglected component of strength training. By using just eccentric work this variable can be controlled.
It is important to note that the load and number of repetitions must be carefully recorded and progressively increased. This ensures that the overload on the tendon is carefully controlled and gradually the speed of the exercise is increased, making the exercises more sports specific.
IMPORTANT: These exercises should only be started once the pain has settled. There should be no pain during or following these exercises. These exercises should be carried out under the supervision of a Chartered Physiotherapist.
Double Leg Calf Raises
The patient starts with double legged calf raises, thus sharing the load with the ‘good’ leg. The eccentric component is the lowering phase, which should be done slowly.
Progression Schedule
| Day | Load |
| 1 | 2 x 6 repetitions |
| 2 | 2 x 8 repetitions |
| 3 | 2 x 10 repetitions |
| 4 | Rest |
| 5 | 3 x 8 repetitions |
| 6 | 3 x 10 repetitions |
| 7 | 4 x 8 repetitions |
| 8 | 3 x 12 repetitions |
| 9 | Rest |
| 10 | 4 x 10 repetitions |
| 11 | 4 x 12 repetitions |
| 12 | 4 x 14 repetitions |
| 13 | 4 x 16 repetitions |
| 14 | Rest |
| 15 | 4 x 18 repetitions |
| 16 | 4 x 20 repetitions |
| 17 | 4 x 22 repetitions |
| 18 | 4 x 24 repetitions |
| 19 | 4 x 26 repetitions |
| 20 | 4 x 28 repetitions |
| 21 | 4 x 30 repetitions |
Single Leg Calf Raises
The progression is to do the exercise on the affected leg and gradually increase
the load by introducing weights. Then the speed of the exercise is increased.
Progression Schedule
| Day | Load | Added Load | Speed |
| 22 | 2 x 6 repetitions | None | Slow |
| 23 | 2 x 8 repetitions | None | Slow |
| 24 | 2 x 10 repetitions | None | Slow |
| 25 | 2 x 10 repetitions | None | Slow |
| 26 | 3 x 8 repetitions | None | Slow |
| 27 | Rest | ||
| 28 | 3 x 10 repetitions | None | Medium |
| 29 | 4 x 8 repetitions | None | Medium |
| 30 | 3 x 12 repetitions | None | Medium |
| 31 | 4 x 10 repetitions | None | Medium |
| 32 | Rest | ||
| 33 | 4 x 12 repetitions | None | Medium |
| 34 | 4 x 14 repetitions | None | Medium |
| 35 | 4 x 16 repetitions | None | Medium |
| 36 | 4 x 18 repetitions | None | Medium |
| 37 | 4 x 20 repetitions | None | Medium |
| 38 | Rest | ||
| 39 | 4 x 22 repetitions | None | Medium |
| 40 | 4 x 24 repetitions | None | Medium |
| 41 | 4 x 26 repetitions | None | Medium |
| 42 | 4 x 28 repetitions | None | Medium |
| 43 | 4 x 30 repetitions | None | Medium |
| 44 | Rest | ||
| 45 | 4 x 30 repetitions | 2 x 2.5kg dumbells | Slow |
| 46 | 4 x 30 repetitions | 2 x 2.5kg dumbells | Medium |
| 47 | 4 x 30 repetitions | 2 x 2.5kg dumbells | Fast |
| 48 | 4 x 30 repetitions | 2 x 5kg dumbells | Slow |
| 49 | 4 x 30 repetitions | 2 x 5kg dumbells | Medium |
| 50 | 4 x 30 repetitions | 2 x 5kg dumbells | Fast |
| 51 | 4 x 30 repetitions | 2 x 7.5kg dumbells | Slow |
| 52 | 4 x 30 repetitions | 2 x 7.5kg dumbells | Medium |
| 53 | 4 x 30 repetitions | 2 x 7.5kg dumbells | Fast |
| 54 | 4 x 30 repetitions | 2 x 10kg dumbells | Slow |
| 55 | 4 x 30 repetitions | 2 x 10kg dumbells | Medium |
| 56 | 4 x 30 repetitions | 2 x 10kg dumbells | Fast |