From the Guidelines
For tendinopathy, a progressive loading strategy is most effective, starting with isometric exercises and progressing to eccentric and heavy slow resistance training, as this approach promotes collagen synthesis and tendon remodeling while avoiding excessive inflammation 1.
Key Principles of Loading Strategies
- Begin with isometric exercises (holding contractions without movement) for 30-45 seconds, 3-5 sets daily to reduce pain
- After 1-2 weeks, progress to slow eccentric exercises (controlled lowering movements) performed 3 times weekly with 3 sets of 15 repetitions
- Gradually increase weight as tolerated
- After 4-6 weeks, incorporate heavy slow resistance training with heavier weights and slower movements (3 seconds up, 3 seconds down) 2-3 times weekly
Importance of Pain Management and Recovery
- Maintain activity within pain limits (pain should not exceed 3-4/10 during exercise and should return to baseline within 24 hours)
- Ensure 48-hour recovery between intense sessions of the same tendon
- Avoid complete rest as it leads to tendon weakening; instead, modify activities to stay within pain tolerance while healing progresses
Additional Considerations
- Supplement with adequate protein intake (1.6-2g/kg body weight daily) to support tendon healing
- Cryotherapy, such as icing, can provide short-term pain relief and may be beneficial in acute inflammatory tendinopathies 1
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can effectively relieve tendinopathy pain, but their use should be limited to short-term pain relief due to potential side effects 1
From the Research
Loading Strategies for Tendonopathy
The best loading strategies for tendonopathy involve a combination of exercises and therapies. Some of the most effective loading strategies include:
- Eccentric exercises, which have been shown to be effective in the management of chronic tendinopathy, particularly of the Achilles and patellar tendons 2, 3, 4
- Heavy slow resistance training, which can be effective for specific tendinopathies when combined with extracorporeal shockwave therapy (ESWT) 5
- Tissue-specific stretching, which can be used in combination with ESWT and eccentric training to improve outcomes in the treatment of tendinopathies 5
- Dry needling combined with therapeutic exercises, which can improve pain and function for various tendinopathies, especially when including eccentric exercises 6
Key Principles of Eccentric Exercises
The key principles of eccentric exercises for tendonopathy include:
- Load, which is the amount of weight or resistance used in the exercise 3
- Speed, which refers to the rate at which the exercise is performed 3
- Frequency of contractions, which refers to the number of times the exercise is repeated 3
Combination Therapies
Combination therapies, such as ESWT and exercise, or dry needling and therapeutic exercises, can be effective in improving outcomes in the treatment of tendinopathies 5, 6. However, the effectiveness of these combination therapies can vary depending on the specific tendinopathy being treated, and further research is needed to determine the most effective treatment strategies 5, 6, 3.