Eccentric Exercise Michael A. Shaffer PT, ATC, OCS.

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?