Tendinopathy: How eccentric training can help improve your pain

Tendinopathy is considered an overuse injury occurring in more active individuals who regularly participate in a particular sport like tennis, golf and AFL. Rafael Nadal is an example of someone who has suffered on and off over the years with tendinopathy with his extensive training regime. You don’t have to be an elite athlete to suffer from tendinopathy, it can also affect those who are not so active but have jobs that require repetitive tasks. Pain that generally accompanies tendinopathy can occur at the point where the tendon attaches to the muscle, at the mid-point of the tendon or where the tendon attaches to the bone. Tendinopathy can often be tender to touch at either of these sites, have an inability to tolerate tension, pain with activity and at times when resting and can result in a decrease in functional strength. Those who suffer from tendinopathy can miss a great deal of sport, general activity or work due to the pain and decrease in functional strength. Which when you love what you do can be disheartening.

Tendinopathy can develop from both intrinsic and extrinsic factors. The intrinsic factors include older age, over-weight, diabetic, high blood pressure and being genetically predisposed.  The extrinsic factors include excessive mechanical loading, training errors (overtraining/overuse, poor technique), surface type, equipment used and repetitiveness of tasks.

Fortunately, exercise can help manage tendinopathy along with other modalities of treatment such as rest, medication and orthotics. Research has shown that eccentric strength training can be an effective tool in treating tendinopathy, but first we must look at what is eccentric strength training and how it differs from other training types. Our bodies can produce three types of muscular contractions: a) Isometric contraction where muscle length stays the same. b) Concentric contractions where the muscle shortens. c) Eccentric contractions where the muscle lengthens, this is what we will look at in more detail.

Eccentric training has shown to be beneficial in treating and managing multiple types of tendinopathy including achilles, lateral elbow, patellar and rotator cuff. Eccentric exercises involve the lengthening of the muscular unit while a load is applied, this load can be either body weight or an external resistance such as a theraband dumbbell or cable.  The load is applied to the affected area with a recommended 3 sets of 15 repetitions once to twice per day for at least 12 weeks.

When considering eccentric training there are three basic rules to follow when taking part in a training regime:

  • Length of tendon: if the tendon is pre-stretched the resting length of the tendon is increased and there will be less strain on that tendon during movement.
  • Load: Progressively increase the load exerted on the tendon, resulting in an increase in strength of the tendon.
  • Speed by increasing the speed of the contraction greater force will be produced.

It is also important to consider that when starting eccentric training, the exercises should initially be performed slowly with speed of movement increased as the tolerance to the exercise progresses. Patients may experience some pain in the first few weeks of eccentric training, this pain should be no more than the tendon pain they have previously experienced and not be progressive or disabling.

Like any exercise regime, each individual’s tolerance to exercise will differ and it is important to consult with a professional before starting these regimes to see if they will be helpful to you. At Absolute balance we have a team of accredited exercise physiologist who can assist in finding the right training regime for you. If you would like more information on eccentric training for tendinopathy or other rehabilitation programmes that Absolute Balance can provide, please don’t hesitate to contact us at info@absolutebalance.com.au.


Claire Hills  (B.EXSpSc, Grad.Dip.(Clin.Ex.Phys))

Accredited Exercise Physiologist (AEP) (ESSAM)

Sayana, M., & Maffulli, N. (2007). Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. Journal Of Science And Medicine In Sport10(1), 52-58. doi: 10.1016/j.jsams.2006.05.008

Murtaugh, B., & M. Ihm, J. (2013). Eccentric Training for the Treatment of Tendinopathies. Current Sports Medicine Reports12(3), 175-182. doi: 10.1249/jsr.0b013e3182933761