Title : Good Health and Tough Love: Eccentric exercise for lateral elbow pain. Elvonda
link : Good Health and Tough Love: Eccentric exercise for lateral elbow pain. Elvonda
Good Health and Tough Love: Eccentric exercise for lateral elbow pain. Elvonda
Some issues in physical therapy just seem counterintuitive upon first glance. An emerging treatment method used in the management of tendonopathy is eccentric training. While eccentric training has obviously been around for years, researchers are beginning to see its utility in managing chronic tendon disease.Adding mechanical stress to a tissue that is already mechanically stressed didn't match my intuition early in my career. Fortunately for many of my patients, I still had a lot to learn. We are now learning that many cases of chronic tendonopathy bear little resemblance to the inflammatory process of tendonitis. In fact, some histochemical studies of chronic tendonopathies have revealed no evidence of inflammatory tissue.
With a more sophisticated understanding of the pathophysiology of tendon disease, researchers have begun to explore treatment options that fall out of the typical inflammation-based treatment paradigms. Another (perhaps even more significant) driving force behind these investigations is that our current methods are meeting with mixed results. An emerging treatment option is the use of eccentric training in the management of chronic tendon disease.
Today's article published in the British Journal of Sports Medicine provides a framework for using exercise to manage lateral elbow pain (LEP). While not a clinical trial, the article provides a solid framework for utilizing supervised eccentric training coupled with static stretching to treat recalcitrant LEP. The authors acknowledge that more work needs to be done in this are to determine the optimal mechanical load for the lateral elbow that would elicit positive adaptations without exceeding the tissue tolerance of the musculotendinous complex.
Although I wasn't bowled over by the caliber of this report, I think it does indicate that we are moving into a more sophisticated and precise way of handing tendonopathy. The use of eccentric training reflects a deeper understanding of the pathophysiology of chronic tendon disorders. Upon first glance, it certainly doesn't fit the paradigm of a how we traditionally handled these types of problems. Good thing we are giving these issues a second glance.
Stasinopoulos, D. (2005). An exercise programme for the management of lateral elbow tendinopathy. British Journal of Sports Medicine, 39(12), 944-947. DOI: 10.1136/bjsm.2005.019836
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