patellar tendon eccentric exercise questions

[extraultralowbass]

hello and happy new year without injuries!

i suffer from patellar tendonitis or tendonopathy.don't know,but my pattelar tendon hurts!i do weightlifting(olympic).

i have tried eccentric exercises for my achilles tendon with full success in summer.before trying eccentrics i used diclofenac without success at all.i tried eccentrics and healed in less than a week!

i would like to try the same for my patellar but don't understand the pics.

i don't understand in the pics what leg is the injured.

in fig.2 what is injured leg?the bended or the straight?

in fig.3 it says that you must bend your leg 90degrees.what leg is this?the injured?

in fig.4 for how long should i keep this positions?

in fig 5.after lifting the leg,what should i do?the same from the begining?how many reps?

i think it's missing the fig 6.

do you have any other links about this exercise with pics or videos?

many thanks!!!

[Rod Whiteley]

i tried eccentrics and healed in less than a week!

Firstly, that's extraordinary, and unlikely to be a 'permanent' change in your Achilles tendon. 12 weeks is usual, (for long-term changes to begin) and a more recent follow-up paper showed that the tendons didn't normalise until a period of years, and that ongoing eccentric exercise was required for some time after the subjects became pain free for the tendons to normalise. It's great that you're feeling better, but stick with the programme.



i would like to try the same for my patellar but don't understand the pics.

I don't know which pictures you are referring to, but the key is that for patellar tendinopathy (which is not insertional in nature) eccentric exercise is required. A simple way to do this (if you live in a city) is to catch the lift up a few flights, and walk down the fire stairs. Every step down you do is one eccentric one leg squat for that leg. Don't walk back up the stairs as this is concentric, and the opposite of what you want.
It seems that the eccentric programme doesn't really work with the insertional tendinopathies (tendon damage that is at the junction of the tendon and its attachment to bone), so you should really check with someone to see what you've got.
Good Luck

[extraultralowbass]

Firstly, that's extraordinary, and unlikely to be a 'permanent' change in your Achilles tendon. 12 weeks is usual, (for long-term changes to begin) and a more recent follow-up paper showed that the tendons didn't normalise until a period of years, and that ongoing eccentric exercise was required for some time after the subjects became pain free for the tendons to normalise. It's great that you're feeling better, but stick with the programme.


I don't know which pictures you are referring to, but the key is that for patellar tendinopathy (which is not insertional in nature) eccentric exercise is required. A simple way to do this (if you live in a city) is to catch the lift up a few flights, and walk down the fire stairs. Every step down you do is one eccentric one leg squat for that leg. Don't walk back up the stairs as this is concentric, and the opposite of what you want.
It seems that the eccentric programme doesn't really work with the insertional tendinopathies (tendon damage that is at the junction of the tendon and its attachment to bone), so you should really check with someone to see what you've got.
Good Luck

this is the pics i'm refering to

http://www.injuryupdate.com.au/injuries/knee/quads_eccentric_exercises.php?menu=injury_details&menu2=knee

[sydunisportsmed]

In the pictures on the website, left leg is the injured one. Main principle is putting body weight through the injured leg when it is going from straight to bent, but having it in mid-air when it is going from bent to straight. Fig 6. would show straightened left leg in mid-air. Fig 7 might be jumping back up on the step (using right 'good' leg) to get back to Fig 1.

Agree with Rod that downstairs walking would load the patellar tendon more (along with quads + hip flexors) whereas upstairs walking loads the calf and hamstrings more. However, I think that any 'natural' movement involves both stretch-shortening cycles (i.e. eccentric and concentric movements) so that downstairs walking isn't strictly eccentric only.

Also agree that the only real hard category 1 evidence in favour of eccentric exercise relates to mid-substance Achilles tendinopathy (and not the insertional tendinopathies). However, eccentric strengthening has been used for insertional tendon problems for many years with apparently good clinical results and the studies haven't disproved that the eccentric strengthening works, just haven't been able to demonstrate the benefit.

A recent histopathological study showed that achilles mid-substance and patellar tendon insertional tendinopathies had very similar microscopic appearance, which suggests that there are related and perhaps that therapy that works for one may be applicable to the other.

Also, it makes good 'sense' that a tendon with respond positively to loaded stretch (causing crimped up disordered fibres to straighten somewhat) more so than compression (which might cause nice straight good functional fibres to crimp).

It also may be that eccentric only movements are submaximal loading (with maximal being the stretch-shorten of a full eccentric-concentric movement) and that therefore eccentric-only movements fit nicely into the 'moderately load but don't overload advice'.

We will be waiting a long-time for full evidence-base in this area though.