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Why are Eccentric Exercises Effective for Achilles Tendinopathy?

I really enjoyed reading the latest edition of the International Journal of Sports Physical Therapy. One article that caught my eye was…..

Why are Eccentric Exercises Effective for Achilles Tendinopathy?

Authors: O’Neill S, Watson PJ, Barry S


A couple of years ago I was honored to speak at the Sanford Sports Medicine Symposium in Sioux Falls South Dakota. The folks there really put on a fine program. One of the speakers was Dr. Jill Cook from Monash University in Melbourne Australia. She presented many interesting papers on tendinopathy and treatment backed up by many interesting studies that authors O’Neill et al mentioned. She really opened my eyes to this science. The authors of this article n IJSPT do also.

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I’ve heard the story…legend, urban myth, or the truth….that a Swedish orthopedic surgeon had developed a bad case of Achilles tendon pain that was diagnosed as tendinopathy. It was hindering his aggressive workouts. He wanted it operated on! But, the waiting list for surgery for this type of problem was 6 months in Sweden. An Achilles rupture was treated as an emergency with immediate surgery. He told himself that he knew how to turn his tendinopathy into a rupture. He started aggressive eccentric training, working through pain….no way he was going to wait! Strange thing, it healed!

Well our author’s review of the literature dispels the belief that eccentrics change the tendon structure and point to neuromuscular output as the most promising reason. A great read!

Of course I was interested in this paper because I have an Achilles tendon that is twice the size of the opposite side and has been quite tender. I’ve been working the eccentrics! I’m better. But I found my diagnostic skills were a little off after I had an opportunity to visit one of the three ultrasound booths at the AOSSM in Orlando this summer. My tendon looked pristine!!…not from my exercises but because I just have a really bad tenosynovitis. Probably rest, ice, and NSAIDS are the reason for my improvement!