Thursday, March 1, 2012

How Eccentric Exercises can Help Tendonitis

Eccentric Things You Can Do To Help Yourself

Eccentric Exercise (Part III)

by Dr. Peter Borten, Acupuncturist and Herbalist at The Dragontree

In part one and part two on this topic, I discussed the whats and hows of eccentric (“ek-centric”) exercise. The nutshell version is: Most of our exercise focuses on the concentric phase, in which we’re working to shorten a muscle or muscles, often against weight. The biceps curl is a good example. Bringing the weight up toward the shoulder is concentric contraction. But there is work also involved in lowering the weight, especially if we do it slowly. The resistance we exert to prevent a muscle from lengthening too quickly is eccentric contraction. And it can be as beneficial in an exercise regimen as the concentric phase can be. I recommend you read my other posts on the topic if you’re interested.

Besides being a neglected aspect of exercise and a way to get stronger faster, eccentric resistance can actually help in the repair of certain kinds of muscular problems, specifically tendonitis (AKA tendinitis). At one or both ends of a muscle, the fleshy muscle tissue merges into firmer springy material called tendon, that attaches the muscle to bone. The work of a muscle/tendon unit – the shortening and lengthening – occurs in the muscle part, and this length-change is transmitted through the tendon which causes a joint to move or holds a bone in place. Both muscle and tendon are susceptible to damage through overwork, over-lengthening, or impingement. When this occurs to a tendon, especially repeatedly or without rest or treatment, tendonitis – tendon inflammation – is often the result.

Tennis elbow and golfer’s elbow often involve tendonitis. Achilles tendonitis is common in athletes, and occurs at the thick tendon at the back of the ankle. Patellar tendonitis (jumper’s knee) is inflammation of the tendon that envelops and extends below the knee cap. Hamstring tendonitis is inflammation of the thick tendons that run along the back of the thigh. It’s usually felt near the bony area at the base of the butt, though it could also occur near the back or outside of the knee. Biceps tendonitis occurs at the front of the shoulder, above the bulkier part of the biceps muscle. Tendonitis can occur in a number of other locations, such as the shoulder, neck, wrist, or ankle.

Treatment for tendonitis is usually pretty conservative – rest, ice, compression, sometimes a cortisone injection nearby, and taking anti-inflammatory drugs. But repeated, slow eccentric contractions of the muscle involved can be tremendously helpful – sometimes an outright cure.

Here are the basics. (I cannot say if this therapy is appropriate for you without knowing the particulars of your pain, so, if you have tendonitis, consult with your doctor before undertaking any new treatment program. This is provided for informational purposes only.) Typically, the muscle will be set up with a concentric contraction with help from a friend or the use of a more functional part of your body. Then you’ll slowly return to starting position using just the affected muscle (over a period of about 3 seconds). This is done 10 to 15 times, usually for 3 sets, with a minute or two of rest in between. And the whole process can be done once or twice a day.

Now for an example. For Achilles tendonitis, you could stand with the balls of your feet on a stair or a block (such that the heel is unsupported). Then use both feet to press yourself up to your tiptoes. Next, lift up the good leg (just a simple bend of the knee is fine) so that all your weight is on the hurt leg. Then, slowly lower yourself down completely. This is one rep. After progressing for a few weeks, it is sometimes helpful to begin adding extra weight (by strapping weights to your belt or wearing a weighted backpack).

For patellar tendonitis, you can do a one-legged squat to eccentrically contract the affected tendon. This is ideally done while standing on a slight decline (like a wedge of about 30 degrees). Bend the good leg back, then slowly squat on the injured leg. You don’t need to go down to the deepest squat possible. Even just a 45 degree thigh is fine. Then put the other foot on the wedge, and use both legs to straighten up again. This is one rep. As with the Achilles exercise, you can gradually add weight as you progress with this.

A novel approach to delivering eccentric contraction to the extensors of the forearm was developed by Dr. Timothy Tyler using a rubber resistance bar (cheaply available on Amazon and sporting goods stores in a few different grades of firmness). This exercise is now famous with physical therapists, who refer to it as the “Tyler Twist.” You can check it out here . And for golfer’s elbow, there’s a similar maneuver called the “Reverse Tyler Twist.”

I hope you have become more eccentric as a result of reading this series! I’d love to hear about your experience with eccentric exercise.

Be well,

Dr. Peter Borten

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