Eccentrics for tendinopathy?

What is tendinopathy?

“Tendinopathy” is an umbrella term for any painful condition going on within a tendon. And remember, tendons are what connect muscles to their origins and insertions on bones. These types of conditions come about from things like overuse injuries – like “runner’s knee”, which stems from overuse of the patellar tendon from logging too many miles, for example.

Those dealing with tendinopathies typically experience:

  • Pain with activity
  • Tenderness when palpated
  • Lack of ability to tolerate tension
  • Decreased functional strength

As you can imagine, this is a frustrating thing to deal with – especially since tendinopathies take a while to resolve, the rehab process can be painful, and it can be discouraging to be forced to stop the activity that resulted in the overuse injury in the first place.

Who is at risk?

Looking at how physical activity can result in tendinopathies, here are some risk factors that stem from improper training plans:

  • Excessive mechanical loading
  • Training errors (over-training, progressing too much too quickly, running on uneven surfaces, improper technique, etc.)
  • Faulty equipment (shoes that don’t fit correctly, seat height of a bike, etc.)
  • Sports and activities with repetitive movements

How can we treat it?

Employing eccentric exercises for the treatment of tendinopathies is the way to go, and it’s something we focus on at Symmetry.

When we use our muscles, there a concentric and eccentric phase. The concentric phase is what you typically think of when lifting weights – lifting the dumbbell up during a biceps curl, when your muscle is contracting. The eccentric phase refers to lowering the weight down, when your biceps muscle is elongating. You might’ve also heard of this phase as the “negative” phase or “negative training” – focusing on lowering and decelerating the movement in a slow fashion, like coming up fast for a pull-up and slowly lowering yourself down again.

So why does this type of eccentric training come into play when treating tendinopathies?

When we take a look at what’s going on physiologically with eccentric exercise, there are some stand-out key points that make it optimal for tendinopathy treatment:

  • When a muscle is eccentrically lengthened, the energy requirement is significantly less than when compared to concentric contractions.
  • During negative work, there’s less muscle activity required to maintain the same force.
  • Exerting a force requires the recruitment of fewer muscle fibers
  • With increased heat production in concentric contractions. This also results in increased cellular metabolism. Simply this means more waste products are produced, and this can lead to further irritation and pain

Check out the video below to see an example of eccentric training that we typically employ with patellar tendinopathy – notice the controlled descent into the chair, paired with the quicker rise up from the chair.

The descent into the chair is the eccentric phase for the quadriceps muscle in this example – it’s when the muscle is lengthening and decelerating the movement into the chair. When our client rises up from the chair, that refers to the concentric phase – when the muscle is contracting and shortening.

It may look simple, but give it a shot – you’ll be surprised at the level of difficulty and the burn you’ll feel!


Are you dealing with body aches related to activity or exercise? We are here to help! At Symmetry, we will provide you with a comprehensive physical therapy assessment to get to the root cause of your problem. Check out our Youtube channel for more tips and easy to follow exercises videos. Making key changes to your footwear and movement strategies can help prevent a small problem from getting worse.

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