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. 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 increased. Finally, 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 Legged Squats
The patient starts with double legged squats, thus sharing the load with the ‘good’ leg. The eccentric component is the lowering phase, which should be done slowly.
Progression Schedule
| DayLoad12 x 6 repetitions22 x 8 repetitions32 x 10 repetitions4Rest53 x 8 repetitions63 x 10 repetitions74 x 8 repetitions83 x 12 repetitions9Rest104 x 10 repetitions114 x 12 repetitions124 x 14 repetitions134 x 16 repetitions14Rest154 x 18 repetitions164 x 20 repetitions174 x 22 repetitions184 x 24 repetitions194 x 26 repetitions204 x 28 repetitions214 x 30 repetitions | ||
Single Legged Squats
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
| DayLoadAdded LoadSpeed222 x 6 repetitionsNoneSlow232 x 8 repetitionsNoneSlow242 x 10 repetitionsNoneSlow252 x 10 repetitionsNoneSlow263 x 8 repetitionsNoneSlow27Rest 283 x 10 repetitionsNoneMedium294 x 8 repetitionsNoneMedium303 x 12 repetitionsNoneMedium314 x 10 repetitionsNoneMedium32Rest 334 x 12 repetitionsNoneMedium344 x 14 repetitionsNoneMedium354 x 16 repetitionsNoneMedium364 x 18 repetitionsNoneMedium374 x 20 repetitionsNoneMedium38Rest 394 x 22 repetitionsNoneMedium404 x 24 repetitionsNoneMedium414 x 26 repetitionsNoneMedium424 x 28 repetitionsNoneMedium434 x 30 repetitionsNoneMedium44Rest 454 x 30 repetitions2 x 2.5kg dumbellsSlow464 x 30 repetitions2 x 2.5kg dumbellsMedium474 x 30 repetitions2 x 2.5kg dumbellsFast484 x 30 repetitions2 x 5kg dumbellsSlow494 x 30 repetitions2 x 5kg dumbellsMedium504 x 30 repetitions2 x 5kg dumbellsFast514 x 30 repetitions2 x 7.5kg dumbellsSlow524 x 30 repetitions2 x 7.5kg dumbellsMedium534 x 30 repetitions2 x 7.5kg dumbellsFast544 x 30 repetitions2 x 10kg dumbellsSlow554 x 30 repetitions2 x 10kg dumbellsMedium564 x 30 repetitions2 x 10kg dumbellsFast | ||
Once this progression has been folowed successfully, the next stage is a gradual return to functional activities. Again this should be graduated – i.e. start with a slow jog for 5 minutes and increase in 5 minute increments, before increasing the speed.