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Eccentric Exercise

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

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Eccentric Exercise

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

  2. 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

  3. 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

  4. Length- Tension Curve

  5. Length- Tension Curve

  6. Force- Velocity Curve

  7. 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 Titin Desmin

  8. DOMS Treatment

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. Patellar Tendonitis

  15. 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

  16. Patellar Tendonitis • Decline vs. Step Down • Pain and Outcome score • Essentially Equal • Recommended Decline Young et al Br J Sports Med 2005

  17. Eccentric Exercise- ACL Rehabilitation It’s not just for tendons any more

  18. Safety, Strength Gerber et al JOSPT 2007

  19. 1 year F/U Gerber et al PT 2009

  20. 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

  21. 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

  22. 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

  23. Application • LOAD! • Pain 3-7/10 • But slowly increase • Concentric first? • Continue activity? • Visnes et al Clin J Sports Med 2005

  24. Everything I ever really needed to know I learned…… • From an Icelandic Blog

  25. 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

  26. 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?

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