From the Guidelines
Eccentric exercises are crucial for post-tendinitis rehabilitation as they have been proven to be effective in stimulating collagen production and guiding normal alignment of newly formed collagen fibers, thereby keeping the tendon strong and promoting healing. The best approach for post-tendinitis rehabilitation involves a progressive, structured exercise program combined with appropriate pain management, as recommended by studies such as 1 and 1.
Key Components of Rehabilitation
- Relative rest to reduce inflammation, using NSAIDs like ibuprofen (400-600mg three times daily with food) for 7-10 days if needed, along with ice therapy (15-20 minutes several times daily) as suggested by 1
- A three-phase rehabilitation program:
- First, gentle stretching and isometric exercises holding for 30-45 seconds
- Second, eccentric strengthening exercises (3 sets of 15 repetitions every other day) where you slowly lower weight against the affected tendon, which has been shown to be effective in treating tendinopathy 1
- Third, sport or activity-specific movements to rebuild functional strength
- Avoiding activities that cause pain rated above 3-4 on a 10-point scale, as this can prevent further damage and promote healing, as noted in 1
Rationale for Eccentric Exercises
Eccentric exercises have been specifically highlighted in studies such as 1 for their effectiveness in treating Achilles tendinopathy, and their benefits can be generalized to other forms of tendinopathy. The controlled loading from eccentric exercises stimulates tendon remodeling and collagen synthesis, while progressive resistance improves tendon strength and elasticity, leading to better outcomes in terms of morbidity, mortality, and quality of life.
Duration and Consistency
Complete rehabilitation typically takes 6-12 weeks, though this varies based on injury severity and location, as indicated by 1. Consistency is crucial—performing prescribed exercises regularly even after pain resolves helps prevent recurrence, emphasizing the importance of adherence to the rehabilitation program for optimal outcomes.
From the Research
Importance of Eccentric Exercises in Post-Tendinitis Rehabilitation
Eccentric exercises are considered a crucial component of rehabilitation programs for tendinopathies, including post-tendinitis rehabilitation. The effectiveness of eccentric exercises in treating tendinopathies has been demonstrated in several studies 2, 3, 4, 5, 6.
Comparison with General Strengthening Exercises
While general strengthening exercises can be beneficial for overall muscle strength, eccentric exercises have been shown to be particularly effective in treating tendinopathies. However, there is no convincing clinical evidence to demonstrate that isolated eccentric loading exercise improves clinical outcomes more than other loading therapies 4.
Key Considerations for Eccentric Exercise Protocols
Several factors should be considered when designing an eccentric exercise protocol for post-tendinitis rehabilitation, including:
- Load magnitude: The optimal load for eccentric exercises is still unknown, and further research is needed to determine the most effective dosage 2, 5.
- Speed of movement: Exercises should be performed at a slow speed to maximize the effectiveness of the eccentric contraction 2.
- Recovery period: The recovery period between exercise sessions is also an important consideration, although the optimal duration is still unknown 4.
- Compliance: Highly variable compliance rates can result in similar positive outcomes, highlighting the need for further investigations 5.
Mechanisms of Eccentric Exercises in Treating Tendinopathies
The mechanisms by which eccentric exercises affect tendinopathies are not fully understood, although several theories have been proposed. These include tendon adaptation, muscle alterations, and the ability of the plantarflexor muscles to shield the Achilles tendon 6. Further research is needed to fully understand the mechanisms of eccentric exercises in treating tendinopathies.
Best Approach for Post-Tendinitis Rehabilitation
The best approach for post-tendinitis rehabilitation is likely to involve a combination of eccentric exercises and other loading therapies, tailored to the individual's specific needs and circumstances. Further research is needed to determine the most effective exercise protocols and to fully understand the mechanisms of eccentric exercises in treating tendinopathies 2, 3, 4, 5, 6.