The latest publication on tendinopathy (patellar) with three of the regular leaders in the field; Jill Cook, Sean Docking & Ebonie Rio: http://www.jsams.org/article/S1440-2440(15)00231-5/pdf
Discussed on episode 92 of PT Inquest: http://ptpodcast.com/pt-inquest-episode-92-isometrics-vs-i…/
and on Peter Malliaras’ blog: http://tendinopathyrehab.com/isometrics-vs-isotonics-insea…/
– In the treatment of tendinopathy, exercise is the primary and most effective treatment available
– There has been a shift in the literature away from isolated eccentrics for the rehabilitation of patellar tendinopathy
– Eccentric exercise in-season may have no effect or even WORSENS patellar tendinopathy symptoms – provocative loads for the patellar tendon should be avoided.
– Beneficial effects from rehabilitation for tendons require HIGH LOAD per repetition
– *Despite the positive effect of exercise for tendinopathy, both in research labs and in the clinic, the precise mechanism of effect, optimal dosage and loading strategy has not yet been determined*
– Previous studies suggest it may be that isometric exercises have a greater effect in reducing acute pain, while isotonic exercise may cause a more gradual decrease in pain
– it is still unclear if pain is physiological or pathophysiological or a combination in patellar tendinopathy
Eccentric exercises protocols became popular two decades ago but going back as far as 2007 they were already coming unstuck “Limited levels of evidence exist to suggest that eccentric has a positive effect on clinical outcomes such as pain, function and patient satisfaction/return to work when compared to various control interventions such as concentric exercise (CE), stretching, splinting, frictions and ultrasound.” http://bjsm.bmj.com/content/41/4/188 and again in 2013 “There is little clinical or mechanistic evidence for isolating the eccentric component” http://link.springer.com/article/10.1007%2Fs40279-013-0019-z yet they still hang around like a bad smell.