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2006/01/26, 12:03 AM
Found this in the pubmed archives:
Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.
Alfredson H, Pietila T, Jonsson P, Lorentzon R.
Department of Orthopaedic Surgery, University Hospital of Northern Sweden, Umea, Sweden.
We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.
Supposedly there was an article out there that went into more detail. Will try to find and post. Pretty spectacular results.
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Pain is only temporary, it is in your mind. If you can still walk, then you can still run.
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Quoting from 7707mutt:
The squat cage is holy ground.
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2006/01/26, 12:23 AM
heres more, but not what i was looking for...
Eccentric Training of the Gastrocnemius-Soleus Complex in Chronic Achilles Tendinopathy Results in Decreased Tendon Volume and Intratendinous Signal as Evaluated by MRI
Adel Shalabi, MD, PhD*, Maria Kristoffersen-Wilberg, Leif Svensson, Peter Aspelin and Tomas Movin
From Karolinska University Hospital, Huddinge Karolinska Institute, Stockholm, Sweden
* Address correspondence to Adel Shalabi, MD, Center for Surgical Sciences, Division of Radiology, Huddinge University Hospital, SE-141 86 Stockholm, Sweden (e-mail: adel.shalabi@cfss.ki.se).
Background: Satisfactory treatment results have been reported after eccentric calf muscle strength training in patients with chronic Achilles tendinopathy.
Hypothesis: Magnetic resonance imaging may be a useful adjunct in the evaluation of the effect of 3 months of eccentric calf muscle strength training.
Study Design: Prospective cohort study.
Methods: Using magnetic resonance imaging, the Achilles tendons were investigated in 25 patients (16 men and 9 women) ranging in age from 28 to 70 years (median, 51 years) before and after training. Five different magnetic resonance imaging sequences were used. Tendon volume and mean intratendinous signal were calculated using a new seed-growing technique showing 99.3% and 96.6% intraobserver reliability, respectively. The clinical outcome was categorized according to pain level and performance using a questionnaire completed by the patient.
Results: The eccentric training resulted in a 14% (mean) decrease of tendon volume measured on T1-weighted images, from 6.6 ± 3.1 cm3 to 5.8 ± 2.3 cm3 (P <.05). The intratendinous signal in the symptomatic Achilles tendon measured on proton density–weighted images decreased 23% (mean), from 227 ± 77 signal units to 170 ± 83 signal units (P <.05). The gadolinium contrast agent–enhanced images did not add further value compared with other sequences.
Clinical Outcome: The clinical outcome was categorized as excellent in 10, good in 3, fair in 5, and poor in 8 patients. The {Delta} signal correlated significantly with the pain level (P < .05).
Conclusions: Eccentric training resulted in decreased tendon volume and intratendinous signal and was correlated with an improved clinical outcome. Magnetic resonance imaging techniques can be used as an adjunct to clinical evaluation by monitoring morphologic effects in clinical treatment studies of Achilles tendinopathy.
Key Words: Achilles tendon • tendinopathy • magnetic resonance (MR) • eccentric training • calf muscle
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Pain is only temporary, it is in your mind. If you can still walk, then you can still run.
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Quoting from 7707mutt:
The squat cage is holy ground.
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2006/01/26, 08:58 AM
What is eccentric training??
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Even if you are on the right track, you will get run over if you just sit there.
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2006/01/26, 12:26 PM
Eccentric is the giving portion of the lift. If you were doing a bench press, it would be the part of the lift where you lower the bar to your chest.
Concentric is the movement portion of the lift. If you were doing a bench press, it would be the part of the lift where you press the bar up from your chest.
Should have said that after posting those.
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Pain is only temporary, it is in your mind. If you can still walk, then you can still run.
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Quoting from 7707mutt:
The squat cage is holy ground.
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2006/01/26, 02:58 PM
So how would one do just eccentric training??
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2006/01/26, 03:16 PM
For eccentric based training, I like to use overloaded eccentrics. Basically moving the weight with two limbs, and then doing the eccentric portion with one.
An example would be like this: For the tricep push down, you would pick a weight a little less than you usually do with two hands. Push the weight down with 2 hands, and then do the eccentric portion with only one.
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Pain is only temporary, it is in your mind. If you can still walk, then you can still run.
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Quoting from 7707mutt:
The squat cage is holy ground.
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2006/01/26, 03:58 PM
Interesting...I'll have to try and think of a way to incorporate this to work on my shoulder tendonitis...maybe a lat push down bar with hands close together so I can let go with one hand on the eccentric portion...hmmm...have to think about this one...
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2006/01/26, 04:16 PM
If you have a partner, partner assisted lateral raises might be an option.
This is one of those few times I would try and stick with isolation movements.
If I come across anything in the archives, I'll post it here.
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Pain is only temporary, it is in your mind. If you can still walk, then you can still run.
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Quoting from 7707mutt:
The squat cage is holy ground.
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2006/01/26, 04:46 PM
Thanks wrestler. I guess I could do them at home and get my husband or kids to help out-I'm sure I have some light weights kicking around. I appreciate seeing anything you come across. You are a wealth of information:)
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2006/01/30, 06:34 PM
Eccentric Exercise
A Solution to Tendonitis?
by Peter Blanchonette
It seems like you've been adding weight to the stack each time you do triceps pushdowns. The veins in your neck stick out like a garden hose as you power through the sticking point, and the cable starts cutting into your neck, just like your idol, Tom Platz. You stop, however, before it cuts through and leaves a bloody mess on the floor.
After you finish the gruelling set, you walk over to the mirror and hit a side triceps pose. But it looks like a big, fat blob! Wait a minute, there's a fat guy standing between you and the mirror! Never mind. He moves and you see that your horseshoe looks like it came straight from a Clydesdale!
Trouble is, your elbows have started to twinge at the end of your workout. You pop a couple of aspirin and figure it's the price you have to pay if you want 20-inch guns. But as the weeks progress, the twinge turns to a deep ache and you have to face the fact that you've got a serious injury on your hands.
This is a situation I faced many years ago when I first developed triceps tendonitis in both elbows. Initially, I thought some rest would cure the problem and I would be back to my usual weights in a few weeks. Boy, was I wrong! Each time I tried to slowly increase the weight I used for triceps exercises, the pain would return with a vengeance.
Maybe you're in the same boat as me, and rather than work out, you sit at home waiting for the damn elbow or knee tendonitis to heal. Well, there might be a way out. Granted, it's not accepted theory, but hey, since when does this mag ever shy away from new stuff?
I'm going to first tell you about the cause of tendonitis, the usual treatments, and then I'll discuss a new treatment that has shown some exciting results.
What is Tendonitis?
Tendonitis is an overuse injury that results in inflammation of the tendon and, of course, pain. This injury is most likely to occur when a weight trainer changes the type, intensity, or duration of their training.(3) For example, increasing the number of sets performed or increasing the weight too quickly while trying to impress the 21-year-old, silicon-enhanced babes in the gym can cause you to feel a twinge in a place where such a twinge is undesirable.
In science nerd terms, overuse injuries result from repetitive microtrauma that leads to inflammation and/or local tissue damage in the form of cellular and extracellular degeneration. In layman's terms, the tendon is overloaded and isn't able to recover adequately. This tissue damage can then culminate in tendonitis, for example.
Standard Treatment
Typically, when you go to a sports medicine doctor for treatment they'll give you NSAIDs (non-steroidal anti-inflammatory drugs) and instruct you in the use of RICE (rest, ice, compression, and elevation). Sometimes, they'll even put a little raw fish and wasabi on this RICE in hopes you'll forget the pain, but that never works.
And often, if the tendonitis persists, a doctor may also give you a shot of cortisone around (but not into) the troubled tendon. My wonderful doctor even suggested I take up walking instead of weight training. "Yes Sir, Mr. Pencil-Neck Geek, whatever you say." And yes, I tried all the standard modalities available in my native country, Australia: anti-inflammatories, ultrasound, interferential, cross-friction massage and acupuncture (great if you like being a pincushion).
While cross-friction massage (a deep massage working across the tendon) provided some relief, it couldn't repair the problem enough for me to resume lifting for heavy sets of 8 reps. Unfortunately, with conditions like chronic Achilles tendonitis, for example, about 25% of patients don't respond to conservative treatment and require surgery which means a long lay off before you can see the inside of the gym again.(2)
Eccentric Solution
Surfing the web one day, I came across a posting on a newsgroup that described a study done on runners with long-term, chronic Achilles tendonitis. The study involved a new treatment that achieved remarkable results in only 12 weeks.
My interest piqued, I ordered a copy of the article through my library. The study, done in Sweden, used two groups of fifteen middle-aged ex-runners who couldn't run due to chronic Achilles tendonitis.(1) One group had surgery on the injured Achilles, while the other completed a special exercise program. To give you an idea of the extent of the subjects' injuries, 21 of the 30 patients had pain just walking and all 30 reported morning stiffness. One patient had suffered Achilles pain for over eight years!
At the start of the study, the researchers measured the strength of each subject's injured and normal calf, as well as the perceived pain of the patient. In each case, the strength of the injured calf was significantly lower than the non-injured one. Also, using a visual analogue scale, the patients in the exercise group described the level of their pain as 81 out of a maximum possible rating of 100 (severe pain). Up until now conservative (non-surgical) treatment offered little help for chronic soft tissue injuries like these.
Exercise Program
The special exercise program involved performing calf raises with the legs both straight and slightly bent twice a day, seven days a week for three sets of 15 repetitions (to hit both the gastros and soleus). The subjects performed the concentric part of the exercise (raising the heel) with the uninjured ankle and used the injured side to do the eccentric lowering phase in a slow, controlled fashion. They were told to ignore the pain unless it became debilitating. Once they could perform the exercises with little or no pain using just their bodyweight, they were instructed to add resistance by using a weighted backpack.
The Results
At the end of the twelve-week period, all the patients in the exercise group had returned to running at their pre-injury level. Measurement of the strength of the muscles showed significant improvement. And the patients described their level of pain as 4 out of 100 (i.e., very low level of pain). In a recent two-year follow up of the fifteen runners in the exercise group, fourteen were still running pain free, while one had elected to have surgery on his Achilles.(2)
In my mind, this is a really exciting result for athletes everywhere. In contrast, the patients in the surgery group still had significantly less strength in the injured calf 24 weeks after surgery. If you've ever had to deal with tendonitis, you'll appreciate what truly impressive results these are.
Why is it So Effective?
The researchers aren't exactly sure why this technique is so effective. However, they've speculated on several potential reasons. These include increasing the tensile strength of the tendon, or the effect of "lengthening the muscle-tendon unit and consequently less strain during ankle joint motion." They also speculated that since the energy pathways in the tendon become more anaerobic (without oxygen) as we age, the tendon might need to adapt to these anaerobic demands to avoid injury. Whatever the reason, you can't ignore the impressive success rate of this study.
My Rehabilitation
Being a science nerd, the very impressive results of this study made me think an eccentric exercise program may be the solution to my triceps problems. I decided to try a modified approach to the problem as I thought that twice-daily training (such as proposed by the study) might be a bit much for my frayed triceps tendons. I decided on a three times a week routine and I chose an exercise that would minimize the stress on the tendon, the pushdown movement.
I used two hands to push the bar towards my thighs (the concentric contraction) and then on the eccentric phase I would remove one hand and slowly return the weight to the starting position. Starting at about 30 pounds and using 3 sets of 15 repetitions for each arm, I slowly increased the weight until I could do heavy sets of six reps without a problem. Using this exercise regime, my tendons returned to about 95% of their original strength over a period of five months. While not perfect, they're well enough to allow me to blast away in the 8-rep range without feeling the consequences the next days in my elbows.
Rehabilitating Other Joints
Exercises regimens for other common areas of tendonitis, such as the patella tendon (the thick tendon below your kneecap) can also be devised. Using the leg press you can press the weight up using both legs, pause briefly at the top of the movement to remove one foot, and then lower with the other leg, eccentrically loading the injured tendon. Hamstring tendonitis can also be treated using two legs to complete the concentric part of the leg curl and then removing one foot from the pads and loading the injured hamstring eccentrically. By using machines and maybe a training partner, exercises can probably be adapted to treat tendonitis in virtually any tendon.
Conclusion
Given that my tendon problem had dogged me for ten years, I was incredibly happy with this treatment regimen. I hope the information presented in this article might help you cure any tendon problems you're currently experiencing. Of course, please consult your doctor before trying anything recommended in the article. However, if he recommends you take up walking, lock the door and gag him before you beat him senseless.
References:
Alfredson, H., Pietila, T., Jonsson, P. & Lorentzon, R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998 May-Jun;26(3):360-6
Alfredson, H. & Lorentzon, R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. 2000 Feb;29(2):135-46.
O'Connor, F.G.; Howard, T.M.;.Fieseler, C.M. &. Nirschl, R.P. Managing overuse injuries: a systematic approach The Physician And Sportsmedicine 25(5) May (1997)
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Iron and chalk.
Pain is only temporary, it is in your mind. If you can still walk, then you can still run.
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2006/01/31, 09:23 AM
This article helps a lot! I have a 1gal water bottle in my office that is about 1/2 filled with water. It has a nice little handle on the top, so I lifted it with my good arm and the lowered it, with control, with my "bad' arm, using a front "raise' motion. I think this will work well for an eccentric exercise. I also tried the same thing in a lat raise motion-starting with arm out front and rotating it to the side and then down- and it works as well. I can sure feel the weakness in that shoulder, but I don't get any sharp pain. I'm going to try 3 sets of 12, 1X/day (at home I'll try it with a 5lb ball I have). I'll up the weight slowly as it gets stronger. I sure hope this helps my shoulder...I can't even swim breast stroke anymore:(
Thanks wrestler!
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Even if you are on the right track, you will get run over if you just sit there.
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2006/01/31, 01:50 PM
flyonethewall- your our official guinea pig, as for the first time in my life, im relatively injury free- Minus that toe I keep breaking.
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Iron and chalk.
Pain is only temporary, it is in your mind. If you can still walk, then you can still run.
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2006/02/06, 03:10 PM
"while trying to impress the 21-year-old, silicon-enhanced babes in the gym can cause you to feel a twinge in a place where such a twinge is undesirable. "
They should have rephrased this.
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2006/02/13, 03:46 AM
LOL sstump
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2006/04/13, 01:33 AM
I've been doing the eccentric training for my achilles and it is working great. Though I've only been doing it 3 times a week with my hip stuff, it's working. Also, I'm taking Cissus RX.
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I firmly believe that any man's finest hour, the greatest fulfillment of all that he holds dear, is the moment when he has worked his heart out in a good cause and lies exhausted on the field of battle-victorious.
--Vince Lombardi
"Decide what you want, decide what you are willing to exchange for it. Establish your priorities and go to work." H. L. Hunt
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2006/04/15, 11:49 AM
Excellent thread, my tricep tendon has flared up just this week. I felt a twinge (without those "silicon enhanced babes" several have referenced earlier) following Tuesdays workout. I just wrote it off to a good workout. Didn't think much of it until after yesterdays triceps pulldowns. That bag of frozen beans against the burning tricep last evening numbed the pain nicely!
I'll be starting eccentric training on this area soon. But first, I'll let this area rest a bit. Then I look at modifying the tricep pulldowns.....
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The whole of science is nothing more than a refinement of everyday thinking.
Albert Einstein (1879–1955)
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2006/05/13, 11:55 PM
Any idea which exercise to use to for tendinitis in the wrist (from computer use)?
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2006/06/03, 03:33 AM
Now just to figure out an exercise for my tennis elbow and golfers elbow.........most likely wrist curls and reverse arm curls.....
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2006/06/18, 12:55 AM
Good stuff here from Dr. Strickland....
Tendinitis is frequently diagnosed among otherwise healthy people who play golf, tennis and other sports, or who participate in activities that require repetitive motion. Most people let the problem go for a time, even a period of many weeks, until pain becomes severe. Doctors typically then tell them they have tendinitis, an inflammation of a tendon, and to take NSAIDs (nonsteroidal anti-inflammatory drugs including ibuprofen, naproxen and others) to calm the inflammation. So it was a surprise to read an editorial from the Clinical Journal of Sport Medicine that reported there is seldom a reason to take NSAIDs for tendon issues. The reason -- most so-called tendinitis is actually an entirely different condition. Some experts are calling this situation the tendinitis myth.
TENDON MYTHOLOGY
For more information, I called Sabrina M. Strickland, MD, assistant attending orthopedic surgeon at the Hospital for Special Surgery in New York City. Dr. Strickland explains that nearly all cases labeled tendinitis are in fact tendinosis, a condition that has nothing to do with inflammation. According to an article in the British Medical Journal (BMJ), animal studies show that within two to three weeks of an initial tendon injury, tendinosis is already present and inflammatory cells are absent. The problem is that many tendon injuries start out as tendinitis... however, the inflammation is not treated immediately. By waiting, the injury degrades into the damaged tissue of tendinosis. The ending "itis" refers to inflammation, but the "osis" ending means degeneration and that is what tendinosis is -- degeneration of a tendon, most commonly in the elbow, knee, shoulder and/or ankle. Although some people associate age with degenerating tendons, in fact age affects only tendons in the shoulders.
In tendinitis there is redness and swelling -- seen best in the hand or wrist where there is little soft tissue to mask the telltale evidence. In tendinosis, which is visible only through MRI, the affected area of the tendon is whitish and gray because it is dead tissue. Dr. Strickland agrees that there is no biological basis for taking NSAIDs to treat tendinosis since there is no inflammation present to reduce -- although the drugs may help ease pain of tendinosis caused by the surrounding vital tissue becoming tender due to the proximal dead tissue. A better approach is to follow a plan to resolve tendinosis and its pain.
THE RIGHT WAY TO TREAT
So, if NSAIDs are the wrong way to treat tendinosis, what is the right way to treat?
According to Dr. Strickland, the first order of business when tendon pain develops is to quiet the affected area. Stop the particular activity, ice the joint (she recommends warmth only for muscle spasms and those are nearly always in the back) and wear a special cuff or band, found in sporting-goods stores or drug stores, just below the area. The band decreases stress on the tendon and is good for pain management as well.
Physical therapy: Interestingly, most tendon injuries are not from overusing a tendon, but from incorrect form, such as flexing the wrist incorrectly when gardening or playing tennis. Consequently, working with a coach or other expert or physical therapist on the proper physical motions to use for a given activity is crucial.
Therapists design individualized exercise programs to improve range of motion and strength. The exercise technique used in the last few years to treat tendinosis is called eccentric loading, which involves stressing the muscles in the extended phase rather than the more usual contracted phase. For example, therapists may have a patient squat on the stronger leg and lift the weaker (eccentric) leg -- the one being rehabilitated. Therapists also, and importantly, help refine proper techniques for patients to use in the sport or activity that caused the tendon injury in the first place.
Dr. Strickland also urges flexibility training. Interestingly, she says that if you stretch regularly, for example, with yoga, Pilates, stretch classes or others, there is no need to stretch before or after an activity. The key is to have and maintain ongoing flexibility.
Finally, strengthening exercises are good as well because building muscles around the joint will help protect it from additional stress. Again, work with a physical therapist on appropriate exercises to build the muscles around the tendons.
Dr. Strickland suggests that people follow this action plan for several weeks, but if the tendinosis hasn't resolved itself by then, check back with the doctor regarding additional steps. Note: Doctors used to give corticosteroid shots for tendinosis, but, like with NSAIDs, these shots treat inflammation, so while they may relieve pain temporarily, they do not have any lasting affect on healing. One exception for using corticosteroid shots is in treating shoulder cuff tendinosis because bursa, fluid-filled sacs between tendons and bones that provide a slippery surface, sit atop the rotator cuff, and these often are inflamed and respond to anti-inflammation treatment -- at least temporarily.
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Maximus from Gladiator....Strength and Honor!
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2006/06/19, 11:27 AM
Excellent information Ron and I agree with this 100%. Through physical therapy, coaching on proper lifting form (especially bench) and building strength in the stabalizing muscles of my shoulder, my tendonitis (or I should say tendonosis) is finally abating. However, when ever I over use it, especially with poor form, it flares up again...makes sense! I've been trying the eccentric loading as well--based on advice from wrester, and although I don't remember to do it often, I'm sure it's helping.
Thanks for the great info!
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Even if you are on the right track, you will get run over if you just sit there.
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2007/04/11, 08:49 PM
How about tendonitis in the cuboid and the fifth metatarsal in the left foot?
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2009/01/11, 05:46 AM
im new at this soo... my job has my shoulder, elbow tendonitus flared up i go to physio therapy but are there any other suggestions on calming the flare ups, so i will eventually be able to lift some weight to gain definition in my arms
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tendonitis solution
