eccentric exercise michael a. shaffer pt, atc, ocs
TRANSCRIPT
![Page 1: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/1.jpg)
Eccentric Exercise
Michael A. Shaffer
PT, ATC, OCS
![Page 2: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/2.jpg)
Concentric Exercise Muscle is loaded as it
shortens i.e. muscle force > load
Eccentric Exercise Muscle is loaded as it
lengthens i.e. muscle force < load
![Page 3: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/3.jpg)
Eccentric Contractions
“Braking” contractions Stepping down Arm deceleration after ball release (pitching) Control of foot pronation in stance phase Controlling knee extension during swing phase
![Page 4: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/4.jpg)
Length- Tension Curve
![Page 5: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/5.jpg)
Length- Tension Curve
![Page 6: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/6.jpg)
Force- Velocity Curve
![Page 7: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/7.jpg)
DOMSDelayed Onset Muscle Soreness
Micro-tearing of Connective Tissue i.e. “passive” elements
Inflammatory ~ 48 hours post
Not ischemia Immediate
Not lactate 30-60 minutes post
Desmin
Titin
![Page 8: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/8.jpg)
DOMS Treatment
![Page 9: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/9.jpg)
DOMS Treatment
Protective Effect Neural
EMG changes Type I Motor Units Decreased amplitude, duration
LaStayo et al J Strength Conditioning Res 2008
Mechanical Intramuscular CT
Cellular Changes in inflammatory response
McHugh Scand J Med Sci Sports 2003
![Page 10: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/10.jpg)
30 recreational athletes 15 “failed” traditional management
Awaiting surgery
15 treated with eccentric training 0/15 went on to surgery All returned to running 6 mos post-op = 3 months Non-op
![Page 11: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/11.jpg)
Eccentric Training 3 x 15 reps 2 Positions Passive concentric motion 2x/ daily Pain OK…..stop if “disabling” Add weight when pain free or easy
![Page 12: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/12.jpg)
Achilles Tendonitis RCT
Concentric vs. Eccentric Exercise 44 patients 12 week follow up Outcome measure= satisfaction
18/22 Eccentric 8/22 Concentric
Mafl et al KSSTA 2001
![Page 13: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/13.jpg)
Achilles Tendonitis
Better for midportion vs insertional Achilles tendon
Changed protocol Insertional tendonopathy DF only to neutral vs. true DF 4 month F/U Pain/ Satisfaction Improved 18 Patients
Jonsson et al Br J Sports Med 2008
![Page 14: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/14.jpg)
Patellar Tendonitis
![Page 15: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/15.jpg)
Patellar Tendonitis
Standard Squat Vs. Decline Squat 17 Patients
Better return to sport Pain ↓’d with decline Maintained rest of protocol
Purdam et al Br J Sports Med 2004
![Page 16: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/16.jpg)
Patellar Tendonitis Decline vs. Step Down
Pain and Outcome score Essentially Equal Recommended Decline
Young et al Br J Sports Med 2005
![Page 17: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/17.jpg)
Eccentric Exercise- ACL Rehabilitation It’s not just for tendons any more
![Page 18: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/18.jpg)
![Page 19: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/19.jpg)
![Page 20: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/20.jpg)
![Page 21: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/21.jpg)
Safety, Strength
Gerber et al JOSPT 2007
![Page 22: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/22.jpg)
1 year F/U
Gerber et al PT 2009
![Page 23: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/23.jpg)
The Next Step
Older patients Slow progression ↑’d strength w/o inflammation
LaStayo et al J Geriatric Phys Ther 2007
Cardiac patients ↑’d strength lower oxygen cost
Meyer et al MSSE 2003
![Page 24: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/24.jpg)
Why does it work?
Improved strength Microstructure of tendon
Collagen deposition Steroids
Neovascularization Ohberg & Alfredson
KSSTA 2004
Raises the pain threshold
Achilles Tendon before and after
12 weeks of eccentric training
![Page 25: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/25.jpg)
Application
3 x 15 Reps 2x/ daily Passive concentric 12 week program
Mid-portion Achilles Full DF
Insertional DF to neutral
Patellar Tendon Decline Board
![Page 26: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/26.jpg)
Application
LOAD! Pain 3-7/10
But slowly increase Concentric first?
Continue activity? Visnes et al Clin J Sports Med 2005
![Page 27: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/27.jpg)
Everything I ever really needed to know I learned……
From an Icelandic Blog
![Page 28: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/28.jpg)
Level 6 Evidence- My take
Alfredson vs. other authors (4 Systematic Reviews in 2007)
Work through pain (3-7/10) Outcome Measures 12 week outcomes (i.e. short) 12 weeks of training (i.e. long)
Recreational athletes= best results
![Page 29: Eccentric Exercise Michael A. Shaffer PT, ATC, OCS](https://reader036.vdocument.in/reader036/viewer/2022062715/56649db05503460f94a9eadd/html5/thumbnails/29.jpg)
My questions
12 weeks duration?
Load need to be painful? Tendonopathy vs. ACLR
If yes, should we limit activity?
If this makes tendonopathy better, can we be this aggressive with other conditions?