Does the tendon know the difference between eccentric and concentric exercise

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Ved senen om den bliver belastet eksentrisk eller koncentrisk eller hvad den bare om den bliver belastet?

Hvis man kigger på litteraturen er der mange forskellige forklaringer for succesfuld behandling af tendinopatier med både eksentrisk og koncentrisk belastning.

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Craig Purdam slide fra ‘the danish sports congress’ 2016

Hvis man kigger på muskellængde / tension relationen, så har en muskel mulighed til at udvikle mere kraft ved i eksentrisk kontraktion end ved koncentrisk kontraktion i den samme muskellængde (altså udgangsstilling; pga de passive elastiske muskel componenter) og du derfor overload muskel mere. Men det er ikke det samme som at sige en eksentrisk kontraktion producerer mere kraft. Nedenstående studier viser noget andet.

  • No differences in peak tendon force (at same load), (Rees et al 2008, Henriksen et al 2008)
  • No differences in tendon length (in same load) (Rees et al 2008)
  • Reduced EMG activity during eccentric contraction compared to concentratic but patients with tendinopathy generally greater % (Henriksen et al 2009, Hobert Losier et al 2012, Reid 2012)
  • An increase in tendon vibration at high frequencies with eccentric loading was not found with concentrisk loading (rees 2009, Henriksen et al 2008)
  • Decifits in both eccentric and concentric strength (silbernagel et al 2006)

konklusion:

Det er tid til at fokusere mere på justering af belastningsdosis på den specifikke sene, skade og patient så intensitet, nummer af reps er baseret på patientens status. Start med 3 set af max reps op til 15 reps.

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Phase 1: Weeks 1-2

  • Perform exercises once per day
  • Double leg calf raises standing on floor 3 x 10-15 (Figure 1)
  • Single leg calf raise standing on floor 3 x 10
  • Seated calf raise 3 x10
  • Eccentric calf raise standing on floor 3 x10 (up on two feet, down on one) (Figure 2)

Phase 2: Weeks 2-5

  • Perform exercises once per day
  • Double leg calf raises standing on edge of step 3 x 15
  • Single leg calf raise standing on edge of step 3 x 15
  • Seated calf raise 3 x15
  • Eccentric calf raise standing on edge of step 3 x 15 (up on two feet, down on one) (Figure 3)
  • Quick-rebounding double leg calf raise 3 x 20 (do quick calf raises as if you are jumping without the toes leaving the floor. Turn back up when the heel is approximately 1cm from the floor)

Phase 3: Weeks 3-12 (longer if required)

  • Exercise intensity can be increased by increasing the speed of loading or adding load using a backpack or weight machine.
  • Perform exercises once per day and exercise with a heavier load 2-3 times/week
  • Single leg calf raise standing on edge of step with added weight 3 x 15
  • Seated calf raise 3 x15
  • Eccentric calf raise standing on edge of step with added weight 3 x 15 (up on two feet, down on one)
  • Quick-rebounding calf raise 3 x 20 (progress to single leg as able)
  • Plyometric training- progression of this training is monitored by the treating physiotherapist. Incorporate jump rope skipping, hopping and jumping on/off small step/box. Movement must be controlled and explosive, build up to 3 x 20.

Phase 4: Week 12- 6 months (longer if required)

  • Maintenance phase where patient has minimal symptoms and able to participate in sport without difficulty. Continue this phase until patient has no symptoms.
  • Perform exercises 2-3 times/week
  • Single leg calf raise standing on edge of step with added weight 3x 15
  • Eccentric calf raise standing on edge of step with added weight 3×15 (up on two feet, down on one)
  • Quick-rebounding calf raise 3×20

Phase 5: Return to Sport

A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation

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