{"id":1829,"date":"2020-01-01T02:31:00","date_gmt":"2020-01-01T02:31:00","guid":{"rendered":"https:\/\/www.richardlanemassage.com.au\/blog\/?p=1829"},"modified":"2022-10-08T23:55:42","modified_gmt":"2022-10-08T23:55:42","slug":"tendinopathy-4-great-loading-programs-for-tendinopathy","status":"publish","type":"post","link":"https:\/\/www.richardlanemassage.com.au\/blog\/tendinopathy-4-great-loading-programs-for-tendinopathy\/","title":{"rendered":"Tendinopathy: 4 great loading programs for tendinopathy"},"content":{"rendered":"\n<p>Please note that this page is mainly for my personal reference.   My notes from viewing YouTube video <a href=\"https:\/\/www.youtube.com\/watch?v=8GCBoaNztbA&amp;t=643s\" target=\"_blank\" rel=\"noopener\">https:\/\/www.youtube.com\/watch?v=8GCBoaNztbA&amp;t=643s<\/a><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"Tendinopathy: 4 great loading programmes for tendinopathy plus an uncomfortable truth...\" width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/8GCBoaNztbA?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>First loading option &#8211; <strong>Eccentric<\/strong> loading.  Still most widely used approach for lower limb tendinopathy.  Example &#8211; heel drops.  Research in 90s showed good results but required 180 reps a day!  As pain reduces then progress exercise by increasing loading.  &#8220;Alfredson approach&#8221;<\/p>\n\n\n\n<p>However, there are limitations. Requires about 5 hours per week to be compliant with protocol.  So time consuming.  Goom does not tend to use eccentric loading as go to.<\/p>\n\n\n\n<p>Prefers &#8211; <strong>heavy slow resistance training<\/strong>.  Starts at 15 reps and decreases to 6 by around 12 weeks.  Time under tension helpful for tendon.  Performed about 3 times a week means about less than 2 hours per week.  May lead to greater collagen turnover and adaptation.  Typical program &#8211; 3 exercise for the injured tendon. eg for hamstring one would focus on strengthening knee flexion role of hamstring, one of hip extension role and one with an eccentric bias. <\/p>\n\n\n\n<p><strong>Isometrics<\/strong>.  Researched for pain by Ebony Rio.  More recent by Seth O&#8217;Neill which tried to replicate Rio&#8217;s work but in achilles tendinopathy but the response was much more varied.  Some improvement in some, some detriment in others.  May have a role for some and might be appropriate as a starting point.  <\/p>\n\n\n\n<p>Clifford studied isometric versus isotonic exercise for greather trochanteric pain syndrome.  Both appeared to be effective for reducing pain and improving function (but no between group difference) and a proportion showed no improvement.  So if isotonics are provocative then isometrics may be way to go.<\/p>\n\n\n\n<p>Goom prefers <strong>Combined approaches<\/strong>. Sancho study &#8211; 4 level progressive rehab isometrics calf and hip strengthening plus hopping for achilles tendinopathy.  <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1466853X19303116\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1466853X19303116<\/a><\/p>\n\n\n\n<p>Most approaches that work seem to include progressive loading and monitoring how that person responds.<\/p>\n\n\n\n<p>Uncomfortable truth &#8211; about 40% of patients don&#8217;t get resolution of symptoms of loading programs.  Kinesophobia may be an issue for some,<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Please note that this page is mainly for my personal reference. My notes from viewing YouTube video https:\/\/www.youtube.com\/watch?v=8GCBoaNztbA&amp;t=643s First loading option &#8211; Eccentric loading. Still most widely used approach for lower limb tendinopathy. Example &#8211; heel drops. Research in 90s showed good results but required 180 reps a day! As pain reduces then progress exercise by increasing loading. &#8220;Alfredson approach&#8221; However, there are limitations. Requires about 5 hours per week to be compliant with protocol. So time consuming. Goom does&#8230;<\/p>\n<p class=\"read-more\"><a class=\"btn btn-default\" href=\"https:\/\/www.richardlanemassage.com.au\/blog\/tendinopathy-4-great-loading-programs-for-tendinopathy\/\"> Read More<span class=\"screen-reader-text\">  Read More<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":1826,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[121,122],"tags":[82,123,124],"class_list":["post-1829","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exercise","category-injury","tag-exercise","tag-injury","tag-tendinopathy"],"_links":{"self":[{"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/posts\/1829","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/comments?post=1829"}],"version-history":[{"count":0,"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/posts\/1829\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/media\/1826"}],"wp:attachment":[{"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/media?parent=1829"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/categories?post=1829"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.richardlanemassage.com.au\/blog\/wp-json\/wp\/v2\/tags?post=1829"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}