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Achilles and Patellar Tendinopathy Loading Programmes

A Systematic Review Comparing Clinical Outcomes and Identifying Potential Mechanisms for Effectiveness

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Abstract

Introduction

Achilles and patellar tendinopathy are overuse injuries that are common among athletes. Isolated eccentric muscle training has become the dominant conservative management strategy for Achilles and patellar tendinopathy but, in some cases, up to 45 % of patients may not respond. Eccentric-concentric progressing to eccentric (Silbernagel combined) and eccentric-concentric isotonic (heavy-slow resistance; HSR) loading have also been investigated. In order for clinicians to make informed decisions, they need to be aware of the loading options and comparative evidence. The mechanisms of loading also need to be elucidated in order to focus treatment to patient deficits and refine loading programmes in future studies.

Objectives

The objectives of this review are to evaluate the evidence in studies that compare two or more loading programmes in Achilles and patellar tendinopathy, and to review the non-clinical outcomes (potential mechanisms), such as improved imaging outcomes, associated with clinical outcomes.

Methods

Comprehensive searching (MEDLINE, EMBASE, CINAHL, Current Contents and SPORTDiscus) identified 403 studies. Two authors independently reviewed studies for inclusion and quality. The final yield included 32 studies; ten compared loading programmes and 28 investigated at least one potential mechanism (six studies compared loading programmes and investigated potential mechanisms).

Results

This review has identified limited (Achilles) and conflicting (patellar) evidence that clinical outcomes are superior with eccentric loading compared with other loading programmes, questioning the currently entrenched clinical approach to these injuries. There is equivalent evidence for Silbernagel combined (Achilles) and greater evidence for HSR loading (patellar). The only potential mechanism that was consistently associated with improved clinical outcomes in both Achilles and patellar tendon rehabilitation was improved neuromuscular performance (e.g. torque, work, endurance), and Silbernagel-combined (Achilles) HSR loading (patellar) had an equivalent or higher level of evidence than isolated eccentric loading. In the Achilles tendon, a majority of studies did not find an association between improved imaging (e.g. reduced anteroposterior diameter, proportion of tendons with Doppler signal) and clinical outcomes, including all high-quality studies. In contrast, HSR loading in the patellar tendon was associated with reduced Doppler area and anteroposterior diameter, as well as greater evidence of collagen turnover, and this was not seen following eccentric loading. HSR seems more likely to lead to tendon adaptation and warrants further investigation. Improved jump performance was associated with Achilles but not patellar tendon clinical outcomes. The mechanisms associated with clinical benefit may vary between loading interventions and tendons.

Conclusion

There is little clinical or mechanistic evidence for isolating the eccentric component, although it should be made clear that there is a paucity of good quality evidence and several potential mechanisms have not been investigated, such as neural adaptation and central nervous system changes (e.g. cortical reorganization). Clinicians should consider eccentric-concentric loading alongside or instead of eccentric loading in Achilles and patellar tendinopathy. Good-quality studies comparing loading programmes and evaluating clinical and mechanistic outcomes are needed in both Achilles and patellar tendinopathy rehabilitation.

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References

  1. Jozsa L, Bálint BJ, Demel Z. Hypozic alterations of tenocytes in degenerative tendonopathy. Arch Orthop Trauma Surg. 1982;99:243–6.

    Article  PubMed  CAS  Google Scholar 

  2. Khan KM, Bonar F, Desmond PM, et al. Patellar tendinosis (jumper’s knee): findings at histopathologic examination. US and MR imaging. Radiology. 1996;200:821–7.

    PubMed  CAS  Google Scholar 

  3. Danielson P. Reviving the “biochemical” hypothesis for tendinopathy: new findings suggest the involvement of locally produced signal substances. Br J Sports Med. 2009;43:265–8.

    Article  PubMed  CAS  Google Scholar 

  4. Andersson G, Danielson P, Alfredson H, et al. Presence of substance P and the neurokinin-1 receptor in tenocytes of the human Achilles tendon. Regul Pept. 2008;150:81–7.

    Article  PubMed  CAS  Google Scholar 

  5. Cook JL, Khan KM. Etiology of tendinopathy. In: Soo SL-Y, Renstrom PAFH, Arnoczky SP, editors. Tendinopathy in athletes. Malden (MA): Wiley-Blackwell; 2007. p. 10–28.

    Chapter  Google Scholar 

  6. Kingma JJ, de Knikker R, Wittink HM, et al. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med. 2007;41:e3–5.

    Article  PubMed  CAS  Google Scholar 

  7. Wasielewski NJ, Kotsko KM. Does eccentric exercise reduce pain and improve strength in physically active adults with symptomatic lower extremity tendinosis? A systematic review. J Athl Train. 2007;42:409–21.

    PubMed  Google Scholar 

  8. Woodley BL, Newsham-West RJ, Baxter GD. Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med. 2007;41:188–98.

    Article  PubMed  Google Scholar 

  9. Meyer A, Tumilty S, Baxter GD. Eccentric exercise protocols for chronic non-insertional Achilles tendinopathy: how much is enough? Scand J Med Sci Sports. 2009;19:609–15.

    Article  PubMed  CAS  Google Scholar 

  10. Satyendra L, Byl N. Effectiveness of physical therapy for Achilles tendinopathy: an evidence based review of eccentric exercises. Isokinet Exerc Sci. 2006;14:71–80.

    Google Scholar 

  11. Visnes H, Hoksrud A, Cook J, et al. No effect of eccentric training on jumper’s knee in volleyball players during the competitive season: a randomised controlled trial. Clin J Sport Med. 2005;15:225–34.

    Article  Google Scholar 

  12. Gaida JE, Cook J. Treatment options for patellar tendinopathy: critical review. Curr Sports Med Rep. 2011;10:255–70.

    PubMed  Google Scholar 

  13. Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sports. 2007;10:52–8.

    Article  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Br Med J. 2009;339:332–6.

    Article  Google Scholar 

  15. Barton CJ, Munteanu SE, Menz HB, et al. The efficacy of foot orthoses in the treatment of individuals with patellofemoral pain syndrome: a systematic review. Sports Med. 2010;40:377–95.

    Article  PubMed  Google Scholar 

  16. Bizzini M, Childs JD, Piva SR, et al. Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2003;33:4–20.

    PubMed  Google Scholar 

  17. van Tulder M, Furlan A, Bombardier C, et al. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine. 2003;28:1290–9.

    PubMed  Google Scholar 

  18. Bahr R, Fossan B, Loken S, et al. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee): a randomized, controlled trial. J Bone Joint Surg Am. 2006;88:1689–98.

    Article  PubMed  Google Scholar 

  19. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19:790–802.

    Article  PubMed  CAS  Google Scholar 

  20. Kongsgaard M, Qvortrup K, Larsen J, et al. Fibril morphology and tendon mechanical properties in patellar tendinopathy: effects of heavy slow resistance training. Am J Sports Med. 2010;38:749–56.

    Article  PubMed  Google Scholar 

  21. Rompe JD, Nafe B, Furia JP, et al. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 2007;35:374–83.

    Article  PubMed  Google Scholar 

  22. de Jonge S, de Vos RJ, Van Schie HT, et al. One-year follow-up of a randomised controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy. Br J Sports Med. 2010;44:673–7.

    Article  PubMed  Google Scholar 

  23. Silbernagel KG, Thomee R, Eriksson BI, et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35:897–906.

    Article  PubMed  Google Scholar 

  24. Ohberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc. 2004;12:465–70.

    Article  PubMed  Google Scholar 

  25. Ohberg L, Lorentzon R, Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow-up. Br J Sports Med. 2004;38:8–11.

    Article  PubMed  CAS  Google Scholar 

  26. Jensen K, Di Fabio RP. Evaluation of eccentric exercise in treatment of patellar tendinitis. Phys Ther. 1989;69:211–6.

    PubMed  CAS  Google Scholar 

  27. Purdam CR, Jonsson P, Alfredson H, et al. A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy. Br J Sports Med. 2004;38:395–7.

    Article  PubMed  CAS  Google Scholar 

  28. Knobloch K, Kraemer R, Jagodzinski M, et al. Eccentric training decreases paratendon capillary blood flow and preserves paratendon oxygen saturation in chronic Achilles tendinopathy. J Orthop Sports Phys Ther. 2007;37:269–76.

    PubMed  Google Scholar 

  29. Cannell LJ, Taunton JE, Clement JE, et al. A randomised clinical trial of the efficacy of drop squats or leg extensions/leg curl exercises to treat clinically diagnosed jumper’s knee in athletes: pilot study. Br J Sports Med. 2001;35:60–4.

    Article  PubMed  CAS  Google Scholar 

  30. Silbernagel KG, Thomee R, Thomee P, et al. Eccentric overload training for patients with chronic Achilles tendon pain: a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports. 2001;11:197–206.

    Article  PubMed  CAS  Google Scholar 

  31. Young MA, Cook JL, Purdam CR, et al. Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. Br J Sports Med. 2005;39:102–5.

    Article  PubMed  CAS  Google Scholar 

  32. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9:42–7.

    Article  PubMed  CAS  Google Scholar 

  33. Norregaard J, Larsen CC, Bieler T, et al. Eccentric exercise in treatment of Achilles tendinopathy. Scand J Med Sci Sports. 2007;17:133–8.

    PubMed  CAS  Google Scholar 

  34. Alfredson H, Nordstrom P, Pietila T, et al. Bone mass in the calcaneus after heavy loaded eccentric calf-muscle training in recreational athletes with chronic Achilles tendinosis. Calcif Tissue Int. 1999;64:450–5.

    Article  PubMed  CAS  Google Scholar 

  35. Alfredson H, Pietila T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26:360–6.

    PubMed  CAS  Google Scholar 

  36. Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. Br J Sports Med. 2005;39:847–50.

    Article  PubMed  CAS  Google Scholar 

  37. Niesen-Vertommen S, Taunton J, Clement D, et al. The effect of eccentric versus concentric exercise in the management of Achilles tendonitis. Clin J Sport Med. 1992;2:109–13.

    Article  Google Scholar 

  38. Paoloni JA, Appleyard RC, Nelson J, et al. Topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004;86-A:916–22.

    PubMed  Google Scholar 

  39. Petersen W, Welp R, Rosenbaum D. Chronic Achilles tendinopathy: a prospective randomized study comparing the therapeutic effect of eccentric training, the AirHeel brace, and a combination of both. Am J Sports Med. 2007;35:1659–67.

    Article  PubMed  Google Scholar 

  40. Silbernagel KG, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up. Am J Sports Med. 2011;39:607–13.

    Article  PubMed  Google Scholar 

  41. Silbernagel KG, Thomee R, Eriksson BI, et al. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy. Br J Sports Med. 2007;41:276–80.

    Article  PubMed  Google Scholar 

  42. van der Plas A, de Jonge S, de Vos RJ, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46:214–8.

    Article  PubMed  Google Scholar 

  43. Romero-Rodriguez D, Gual G, Tesch PA. Efficacy of an inertial resistance training paradigm in the treatment of patellar tendinopathy in athletes: a case-series study. Phys Ther Sport. 2011;12:43–8.

    Article  PubMed  CAS  Google Scholar 

  44. Knobloch K. Eccentric training in Achilles tendinopathy: is it harmful to tendon microcirculation? Br J Sports Med. 2007;41:2.

    Article  Google Scholar 

  45. Shalabi A, Kristoffersen-Wilberg M, Svensson L, et al. Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med. 2004;32:1286–96.

    Article  PubMed  Google Scholar 

  46. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43:409–16.

    Article  PubMed  CAS  Google Scholar 

  47. Croisier J, Forthomme B, Foidart-Dessalle M, et al. Treatment of recurrent tendinitis by isokinetic eccentric exercises. Isokinet Exerc Sci. 2001;9:133–41.

    Google Scholar 

  48. Gardin A, Movin T, Svensson L, et al. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis. Skeletal Radiol. 2010;39:435–42.

    Article  PubMed  Google Scholar 

  49. Langberg H, Ellingsgaard H, Madsen T, et al. Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports. 2007;17:61–6.

    PubMed  CAS  Google Scholar 

  50. Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Rel Res. 1986;208:65–8.

    Google Scholar 

  51. Alfredson H. Intratendinous glutamate levels and eccentric training in chronic Achilles tendinosis: a prospective study using microdialysis technique. Knee Surg Sports Traumatol Arthrosc. 2003;11:196–9.

    Article  PubMed  Google Scholar 

  52. Roig M, O’Brien K, Kirk G, et al. The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis. Br J Sports Med. 2009;43:556–68.

    Article  PubMed  CAS  Google Scholar 

  53. Westing SH, Cresswell AG, Thorstensson A. Muscle activation during maximal voluntary eccentric and concentric knee extension. Eur J Appl Physiol Occup Physiol. 1991;62:104–8.

    Article  PubMed  CAS  Google Scholar 

  54. Henriksen M, Aaboe J, Bliddal H, et al. Biomechanical characteristics of the eccentric Achilles tendon exercise. J Biomech. 2009;42:2702–7.

    Article  PubMed  Google Scholar 

  55. Katz B. The relation between force and speed in muscular contraction. J Physiol. 1939;96:45–64.

    PubMed  CAS  Google Scholar 

  56. Abbott BC, Bigland B. The effects of force and speed changes on the rate of oxygen consumption during negative work. J Physiol. 1953;120:319–25.

    PubMed  CAS  Google Scholar 

  57. Lieber R. Skeletal muscle structure, function & plasticity. In: Julet T, editor. The physiological basis of rehabilitation. Philadelphia (PA): Lippincott Williams & Wilkins; 2002.

    Google Scholar 

  58. van der Worp H, van Ark M, Roerink S, et al. Risk factors for patellar tendinopathy: a systematic review of the literature. Br J Sports Med. 2011;45:446–52.

    Article  PubMed  Google Scholar 

  59. Malliaras P, Purdam C, Maffulli N, et al. Temporal sequence of gray-scale ultrasound changes and their relationship with neovascularity and pain in the patellar tendon. Br J Sports Med 2010;44:944–7.

    Google Scholar 

  60. Arya S, Kulig K. Tendinopathy alters mechanical and material properties of the Achilles tendon. J Appl Physiol. 2010;108:670–5.

    Article  PubMed  Google Scholar 

  61. Malliaras P, Purdam C, Maffulli N, et al. Temporal sequence of greyscale ultrasound changes and their relationship with neovascularity and pain in the patellar tendon. Br J Sports Med. 2010;44:944–7.

    Article  PubMed  CAS  Google Scholar 

  62. Fredberg U, Bolvig L, Andersen NT. Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. Am J Sports Med. 2008;36:451–60.

    Article  PubMed  Google Scholar 

  63. Archambault JM, Wiley JP, Bray RC, et al. Can sonography predict the outcome in patients with achillodynia? J Clin Ultrasound. 1998;26:335–9.

    Article  PubMed  CAS  Google Scholar 

  64. Kubo K, Ohgo K, Takeishi R, et al. Effects of isometric training at different knee angles on the muscle–tendon complex in vivo. Scand J Med Sci Sports. 2006;16:159–67.

    Article  PubMed  CAS  Google Scholar 

  65. Arampatzis A, Karamanidis K, Albracht K. Adaptational responses of the human Achilles tendon by modulation of the applied cyclic strain magnitude. J Exp Biol. 2007;210:2743–53.

    Article  PubMed  Google Scholar 

  66. Arampatzis A, Peper A, Bierbaum S, et al. Plasticity of human Achilles tendon mechanical and morphological properties in response to cyclic strain. J Biomech. 2010;43:3073–9.

    Article  PubMed  Google Scholar 

  67. Pearson SJ, Burgess K, Onambele GN. Creep and the in vivo assessment of human patellar tendon mechanical properties. Clin Biomech. 2007;22:712–7.

    Article  Google Scholar 

  68. Kubo K, Kanehisa H, Fukunaga T. Effects of different duration isometric contractions on tendon elasticity in human quadriceps muscles. J Physiol. 2001;536:649–55.

    Article  PubMed  CAS  Google Scholar 

  69. Mahieu NN, McNair P, Cools A, et al. Effect of eccentric training on the plantar flexor muscle-tendon tissue properties. Med Sci Sports Exerc. 2008;40:117–23.

    PubMed  Google Scholar 

  70. Potier TG, Alexander CM, Seynnes OR. Effects of eccentric strength training on biceps femoris muscle architecture and knee joint range of movement. Eur J Appl Physiol. 2009;105:939–44.

    Article  PubMed  Google Scholar 

  71. Nelson RT, Bandy WD. Eccentric training and static stretching improve hamstring flexibility of high school males. J Athl Train. 2004;39:254–8.

    PubMed  Google Scholar 

  72. Thrash K, Kelly B. Flexibility and strength training. J Strength Cond Res. 1987;1:74–5.

    Google Scholar 

  73. Ochala J, Lambertz D, Van Hoecke J, et al. Effect of strength training on musculotendinous stiffness in elderly individuals. Eur J Appl Physiol. 2005;94:126–33.

    Article  PubMed  Google Scholar 

  74. Pousson M, Van Hoecke J, Goubel F. Changes in elastic characteristics of human muscle induced by eccentric exercise. J Biomech. 1990;23:343–8.

    Article  PubMed  CAS  Google Scholar 

  75. Brughelli M, Mendiguchia J, Nosaka K, et al. Effects of eccentric exercise on optimum length of the knee flexors and extensors during the preseason in professional soccer players. Phys Ther Sport. 2010;11:50–5.

    Article  PubMed  Google Scholar 

  76. Whitehead NP, Weerakkody NS, Gregory JE, et al. Changes in passive tension of muscle in humans and animals after eccentric exercise. J Physiol. 2001;533:593–604.

    Article  PubMed  CAS  Google Scholar 

  77. Aquino CF, Fonseca ST, Goncalves GG, et al. Stretching versus strength training in lengthened position in subjects with tight hamstring muscles: a randomized controlled trial. Man Ther. 2010;15:26–31.

    Article  PubMed  Google Scholar 

  78. Blazevich AJ, Cannavan D, Coleman DR, et al. Influence of concentric and eccentric resistance training on architectural adaptation in human quadriceps muscles. J Appl Physiol. 2007;103:1565–75.

    Article  PubMed  Google Scholar 

  79. Seynnes OR, de Boer M, Narici MV. Early skeletal muscle hypertrophy and architectural changes in response to high-intensity resistance training. J Appl Physiol. 2007;102:368–73.

    Article  PubMed  CAS  Google Scholar 

  80. Reeves ND, Narici MV. Behavior of human muscle fascicles during shortening and lengthening contractions in vivo. J Appl Physiol. 2003;95:1090–6.

    PubMed  Google Scholar 

  81. Duclay J, Martin A, Duclay A, et al. Behavior of fascicles and the myotendinous junction of human medial gastrocnemius following eccentric strength training. Muscle Nerve. 2009;39:819–27.

    Article  PubMed  Google Scholar 

  82. Morgan DL, Proske U. Popping sarcomere hypothesis explains stretch-induced muscle damage. Clin Exp Pharmacol Physiol. 2004;31:541–5.

    Article  PubMed  CAS  Google Scholar 

  83. Lynn R, Morgan D. Decline running produces more sarcomeres in rat vastus intermedius muscle fibers than does incline running. J Appl Physiol. 1994;77:1439–44.

    PubMed  CAS  Google Scholar 

  84. Lynn R, Talbot JA, Morgan DL. Differences in rat skeletal muscles after incline and decline running. J Appl Physiol. 1998;85:98–104.

    PubMed  CAS  Google Scholar 

  85. Knobloch K, Schreibmueller L, Kraemer R, et al. Gender and eccentric training in Achilles mid-portion tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2010;18:648–55.

    Article  PubMed  Google Scholar 

  86. Kannus P. Tendon pathology: basic science and clinical applications. Sports Exerc Injury. 1997;3:62–75.

    Google Scholar 

  87. Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. 2003;11:334.

    Article  PubMed  Google Scholar 

  88. Wand BM, O’Connell NE. Chronic non-specific low back pain: sub-groups or a single mechanism? BMC Musculoskelet Disord. 2008;9:11.

    Article  PubMed  Google Scholar 

  89. Hortobágyi T, Barrier J, Beard D, et al. Greater initial adaptations to submaximal muscle lengthening than maximal shortening. J Appl Physiol. 1996;81:1677–82.

    PubMed  Google Scholar 

  90. Enoka RM. Eccentric contractions require unique activation strategies by the nervous system. J Appl Physiol. 1996;81:2339–46.

    PubMed  CAS  Google Scholar 

  91. Hortobágyi T, Devita P, Money J, et al. Effects of standard and eccentric overload strength training in young women. Med Sci Sports Exerc. 2001;33:1206–12.

    PubMed  Google Scholar 

  92. Fang Y, Siemionow V, Sahgal V, et al. Greater movement-related cortical potential during human eccentric versus concentric muscle contractions. J Neurophysiol. 2001;86:1764–72.

    PubMed  CAS  Google Scholar 

  93. Rees JD, Lichtwark GA, Wolman RL, et al. The mechanism for efficacy of eccentric loading in Achilles tendon injury: an in vivo study in humans. Rheumatology. 2008;47:1493–7.

    Article  PubMed  CAS  Google Scholar 

  94. Wernbom M, Augustsson J, Thomee R. The influence of frequency, intensity, volume and mode of strength training on whole muscle cross-sectional area in humans. Sports Med. 2007;37:225–64.

    Article  PubMed  Google Scholar 

  95. Morrissey MC, Harman EA, Johnson MJ. Resistance training modes: specificity and effectiveness. Med Sci Sports Exerc. 1995;27:648–60.

    PubMed  CAS  Google Scholar 

  96. Benjamin M, Moriggl B, Brenner E, et al. The “enthesis organ” concept. Arthr Rheum. 2004;50:3306–13.

    Article  CAS  Google Scholar 

  97. Benjamin M, Ralphs JR. Fibrocartilage in tendons and ligaments-an adaption to compressive load. J Anat. 1998;193:481–94.

    Article  PubMed  Google Scholar 

  98. Almekinders LC, Weinhold PS, Maffulli N. Compression etiology in tendinopathy. Clin Sports Med. 2003;22:703–10.

    Article  PubMed  Google Scholar 

  99. Weir JP, Housh TJ, Weir LL, et al. Effects of unilateral isometric strength training on joint angle specificity and cross-training. Eur J Appl Physiol Occup Physiol. 1995;70:337–43.

    Article  PubMed  CAS  Google Scholar 

  100. Knapik JJ, Mawdsley RH, Ramos MU. Angular specificity and test mode specificity of isometric and isokineticsStrength training. J Orthop Sports Phys Ther. 1983;5:58–65.

    PubMed  CAS  Google Scholar 

  101. Shalabi A, Kristoffersen-Wilberg M, Svensson L, et al. Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med. 2004;32:1286–96.

    Article  PubMed  Google Scholar 

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The authors have no conflict of interest to declare that are directly relevant to the content of this review. No funding was received or used to assist in the preparation of this review.

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Malliaras, P., Barton, C.J., Reeves, N.D. et al. Achilles and Patellar Tendinopathy Loading Programmes. Sports Med 43, 267–286 (2013). https://doi.org/10.1007/s40279-013-0019-z

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