Does eccentric exercise reduce pain and improve strength in physically active adults with symptomatic lower extremity tendinosis? A systematic review.

OBJECTIVE: To critically review evidence for the effectiveness of eccentric exercise to treat lower extremity tendinoses. DATA SOURCES: Databases used to locate randomized controlled trials (RCTs) included PubMed (1980-2006), CINAHL (1982-2006), Web of Science (1995-2006), SPORT Discus (1980-2006), Physiotherapy Evidence Database (PEDro), and the Cochrane Collaboration Database. Key words included tendon, tendonitis, tendinosis, tendinopathy, exercise, eccentric, rehabilitation, and therapy. STUDY SELECTION: The criteria for trial selection were (1) the literature was written in English, (2) the research design was an RCT, (3) the study participants were adults with a clinical diagnosis of tendinosis, (4) the outcome measures included pain or strength, and (5) eccentric exercise was used to treat lower extremity tendinosis. DATA EXTRACTION: Specific data were abstracted from the RCTs, including eccentric exercise protocol, adjunctive treatments, concurrent physical activity, and treatment outcome. DATA SYNTHESIS: The calculated post hoc statistical power of the selected studies (n = 11) was low, and the average methodologic score was 5.3/10 based on PEDro criteria. Eccentric exercise was compared with no treatment (n = 1), concentric exercise (n = 5), an alternative eccentric exercise protocol (n = 1), stretching (n = 2), night splinting (n = 1), and physical agents (n = 1). In most trials, tendinosis-related pain was reduced with eccentric exercise over time, but only in 3 studies did eccentric exercise decrease pain relative to the control treatment. Similarly, the RCTs demonstrated that strength-related measures improved over time, but none revealed significant differences relative to the control treatment. Based on the best evidence available, it appears that eccentric exercise may reduce pain and improve strength in lower extremity tendinoses, but whether eccentric exercise is more effective than other forms of therapeutic exercise for the resolution of tendinosis symptoms remains questionable.