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Purpose Patellar tendinopathy is a common, painful, overuse disorder. Although many different treatment methods have been described, there is no consensus regarding the optimal treatment for this condition. The purpose of this study was to systematically review, summarize, and compare treatments for patellar tendinopathy from published randomized controlled trials. Methods Database searches were performed for randomized prospective controlled trials comparing treatment methods for patellar tendinopathy. The thirteen articles considered relevant were scrutinized according to quality assessment guidelines and levels of evidence. Results Strong evidence was found for the use of eccentric training to treat patellar tendinopathy. Moderate evidence was found for conservative treatment (heavy slow resistance training) as an alternative to eccentric training. Moderate evidence suggests that low-intensity pulsed ultrasound treatment did not influence treatment outcomes. Limited evidence was found for surgery, sclerosing injections, and shockwave therapy. Conclusion Physical training, and particularly eccentric training, appears to be the treatment of choice for patients suffering from patellar tendinopathy. However, type of exercise, frequency, load, and dosage must also be analyzed. Other treatment methods, such as surgical treatment, sclerosing injections, and shockwave therapy, must be investigated further before recommendations can be made regarding their use. Ultrasound can likely be excluded as a treatment for patellar tendinopathy. There is a persistent lack of well-designed studies with sufficiently long-term follow-up and number of patients to draw strong conclusions regarding therapy. Level of evidence II.

RCT. Lateral elbow tendinopathy is a common clinical condition. eccentric exercises. eccentric-concentric loading and, isometric exercises are indicated to reduce and manage tendon pain. To compare the effectiveness of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. A randomized clinical trial was carried out in a rheumatology and rehabilitation center. A group of 34 patients with later elbow tendinopathy was randomly allocated to Group A (n = 11) who underwent eccentric training, Group B had eccentric-concentric and Group C who had eccentric-concentric and isometric training. All patients received 5 treatments per week for 4 weeks. Pain was evaluated using a visual analog scale and function using a visual analog scale and pain-free grip strength at the end of the 4-week course of treatment (week 4) and 1 month (week 8) after the end of treatment. The eccentric-concentric training combined with isomentric contractions produced the largest effect in the reduction of pain and improvement of function at the end of the treatment (P < .05) and at any of the follow-up time points (P < .05). The eccentric-concentric training combined with isomentric contractions was the most effective treatment. Future well-designed studies are needed to confirm the results of the present trial. III.

The purpose of this study was to compare the effects of hamstring eccentric (NHE) strength training versus sprint training programmed as complements to regular soccer practice, on sprint performance and its mechanical underpinnings, as well as biceps femoris long head (BFlh) architecture. In this prospective interventional control study, sprint performance, sprint mechanics and BFlh architecture variables were compared before versus after six weeks of training during the first six preseason weeks, and between three different random match-pair groups of soccer players: \"Soccer group\" (n = 10), \"Nordic group\" (n = 12) and \"Sprint group\" (n = 10). For sprint performance and mechanics, small to large pre-post improvements were reported in \"Sprint group\" (except maximal running velocity), whereas only trivial to small negative changes were reported in \"Soccer group\" and \"Nordic group\". For BFlh architecture variables, \"Sprint\" group showed moderate increase in fascicle length compared to smaller augment for the \"Nordic\" group with trivial changes for \"Soccer group\". Only \"Nordic\" group presented small increases at pennation angle. The results suggest that sprint training was superior to NHE in order to increase BFlh fascicle length although only the sprint training was able to both provide a preventive stimulus (increase fascicle length) and at the same time improve both sprint performance and mechanics. Further studies with advanced imaging techniques are needed to confirm the validity of the findings.

To compare the effects of different neck eccentric training devices on the neck strength and endurance of aviation cadets, and to explore their roles in the prevention of neck injuries, providing a basis for introducing specialized neck training in adolescent aviation schools. Two intervention groups used a helmet-style neck training device and elastic bands for neck training, respectively, while the control group underwent regular resistance physical training without additional neck intervention. Tests were conducted on neck flexion, extension, lateral flexion, and rotation in six directions before the intervention, and after 6 and 12 weeks. Significant time and group interaction effects were found in all six directions of neck strength indicators (F-values were 4.834, 8.496, 10.359, 6.849, 3.324, 2.405, p<0.05). The neck strength in all six directions significantly increased for both intervention groups at 6 and 12 weeks (P<0.05). In the control group, a significant increase in strength was observed in all directions except for extension at 6 weeks (P<0.05), but no significant changes were observed after 6 weeks (P>0.05). A significant time and group interaction effect was also found for endurance indicators (F=6.204, P<0.01). All three groups showed a significant increase in neck endurance at 6 weeks, but no significant changes were observed in the elastic band group and the control group after 6 weeks (P>0.05); the helmet group showed significantly higher neck endurance at 12 weeks (103.55 ±47.68) seconds, (P<0.01). Both 12-week helmet-style neck training and elastic band neck training can enhance trainee neck strength and flexural endurance, with the helmet-style training showing a more significant improvement in neck endurance.

This study investigated the effects of concentric and concentric-eccentric strength training on speed and strength performance in sub-elite soccer players. Thirty-four healthy Czech soccer players were randomly assigned to a concentric group (CONG, n  = 13), concentric/eccentric group (ECCG, n  = 12), or control group (CG, n  = 9). All participants completed the study. Over an 8-week intervention period, the CONG and ECCG groups accomplished 16 training sessions focused on leg curl and leg extension exercises. Speed and strength assessments were performed at baseline and post-intervention. While no significant improvements were observed in speed performance ( p  > 0.05), both intervention groups demonstrated significant gains in strength parameters. One-repetition maximum (1RM) knee extension increased by 17.5% (CONG, p  < 0.001) and 18.3% (ECCG, p  < 0.001), and the 1RM knee flexion improved by 10.5% (CONG, p  < 0.001) and 12.2% (ECCG, p  < 0.001, compared to the CG, with moderate and clear effect sizes. ANOVA analysis revealed significant interaction effects for knee extension 1RM ( p  < 0.001), knee flexion 1RM ( p  = 0.022), and isometric knee extension of the dominant leg ( p  = 0.033). Despite these gains in muscle strength, speed performance showed only minor, non-significant changes, with the CONG group experiencing a 2.8% improvement in the 10-meter sprint. In conclusion, both concentric and concentric-eccentric strength training protocols effectively enhanced lower-limb strength in soccer players, with the concentric-eccentric approach showing slightly better results. However, neither training method significantly improved speed. Coaches should use concentric-eccentric exercises to enhance strength but consider other methods to boost speed and overall performance.

Hamstring strain injuries remain among the most problematic and most frequent sport injuries. Two of the most effective methods for prevention and rehabilitation of the hamstring strain injuries are: classic eccentric training using the Nordic hamstring exercise (NHE) and eccentric training in a lengthened position using the glider exercise. Both exercises have disadvantages that could be fixed by adding hip flexion during the NHE. Thus, the purpose of the study was to compare peak hamstring activity (measured by electromyography) between three eccentric exercises: the standard NHE, the modified NHE and the glider. Differences were statistically tested with the analysis of the variance for repeated measurements and the paired 2-tailed post-hoc t-test. Hamstring activity during the modified NHE was significantly lower compared to the NHE and significantly higher compared to the glider. The results indicate that implementing the modified NHE could increase the effectiveness of already established rehabilitation protocols and help reduce the risk of hamstring (re-)injury.

There is considerable debate about the existence of a real eccentric overload in flywheel exercises. This study aimed to analyse the differences in concentric: eccentric mechanical output ratios between different loads and variables in the flywheel squat exercise. Twenty physically active men (22.9±2.2 years, height: 1.8±0.1 m, weight: 79.6±8.2 kg) performed a loading test using five moments of inertia. Angular speed was measured using a rotary encoder, while the vertical force was measured using force plates. For each variable (angular speed, angular acceleration, power, vertical force, and torque), mean and peak values were calculated for concentric and eccentric phases to allow comparisons across the loads. We tested the possible differences in Load×Phase (concentric and eccentric) and Load×Variable. The level of significance was established as p < 0.05. A significant Load×Phase interaction was found in mean angular speed, peak vertical force, peak angular acceleration, peak power and peak torque. Higher eccentric overload values were observed with speed-derived variables (angular speed, angular acceleration and power). In conclusion, speed-derived peak variables and lower loads are more likely to show an eccentric overload and can be used to monitor responses to flywheel training.

PurposeThe multidimensional role of hamstring muscle group strength in athletic performance and injury prevention is well documented, and nordic hamstring exercise (NHE) is a popular method for the development of hamstring strength. Our aim was to examine the EMG characteristics of the eccentric NHE as well as the effects of long-term eccentric NHE training on muscle strength and vertical jump performance in 10- to 11-year-old female handball players.MethodsPlayers from the same handball team were randomly assigned to an eccentric NHE training (13 players) or a control group (10 players). Both groups continued their regular handball training routine, but the NHE group performed additional eccentric NHE exercises once or twice a week, with progressively increasing volume, over 20 weeks. To test training effects, countermovement jump (CMJ) height, eccentric hamstring impulse, peak torque, and angle of peak torque were evaluated before, during and after the training period. In the pre-exercise test, EMG activity of the medial and lateral hamstring muscle was also assessed during NHE.ResultsHamstring activities ranged between 98 and 129%. Lateral hamstring activity was greater than medial only in the right leg during NHE. Eccentric hamstring impulse improved in both legs at 10 weeks in both groups. Then, at 20 weeks, it remained unchanged in the NHE but decreased in controls. A similar adaptation was seen in eccentric hamstring torque, without change in the optimum knee angle. CMJ height improved only in the NHE.ConclusionIt is concluded that NHE activates the hamstring musculature effectively, and a favourable mechanical adaptation to long-term NHE exercise in girls can be triggered as early as 11 years of age.

PurposeDue to its eccentric nature, downhill running (DR) training has been suggested to promote strength gains through neuromuscular adaptations. However, it is unknown whether short-term chronic DR can elicit such adaptations.MethodsTwelve untrained, young, healthy adults (5 women, 7 men) took part in 4 weeks’ DR, comprising 10 sessions, with running speed equivalent to 60–65% maximal oxygen uptake (V˙O2max, assessed at weeks 0 and 4). Isometric and isokinetic knee-extensor maximal voluntary torque (MVT), vastus lateralis (VL) muscle morphology/architecture (anatomical cross-sectional area, ACSA; physiological CSA, PCSA; volume; fascicle length, Lf; pennation angle, PA) and neuromuscular activation (VL EMG) were assessed at weeks 0, 2 and 4.ResultsMVT increased by 9.7–15.2% after 4 weeks (p < 0.01). VL EMG during isometric MVT increased by 35.6 ± 46.1% after 4 weeks (p < 0.05) and correlated with changes in isometric MVT after 2 weeks (r = 0.86, p = 0.001). VL ACSA (+2.9 ± 2.7% and +7.1 ± 3.5%) and volume (+2.5 ± 2.5% and +6.6 ± 3.2%) increased after 2 and 4 weeks, respectively (p < 0.05). PCSA (+3.8 ± 3.3%), PA (+5.8 ± 3.8%) and Lf (+2.7 ± 2.2%) increased after 4 weeks (p < 0.01). Changes in VL volume (r = 0.67, p = 0.03) and PCSA (r = 0.71, p = 0.01) correlated with changes in concentric MVT from 2 to 4 weeks. V˙O2max (49.4 ± 6.2 vs. 49.7 ± 6.3 mL·kg−1·min−1) did not change after 4 weeks (p = 0.73).ConclusionJust 4 weeks’ moderate-intensity DR promoted neuromuscular adaptations in young, healthy adults, typically observed after high-intensity eccentric resistance training. Neural adaptations appeared to contribute to most of the strength gains at 2 and 4 weeks, while muscle hypertrophy seemed to contribute to MVT changes from 2 to 4 weeks only.

Tendinopathies are prevalent in athletic populations, particularly in sports requiring repetitive high-load activities. Eccentric training is widely recommended for rehabilitation, yet variability in protocols and inconsistent methodological reporting limit standardization. This scoping review aimed to map existing evidence on eccentric training for tendinopathies in athletes, characterize intervention parameters, evaluate clinical outcomes and safety, and identify methodological gaps to inform future practice and research. Searches of PubMed, Scopus, and Web of Science were conducted. Eligible studies included athletes with tendinopathy undergoing eccentric training interventions. Randomized and non-randomized controlled trials were considered. Data extraction included intervention design, tendon site, loading parameters, outcomes, and adverse events. Critical appraisal was performed using RoB 2 and ROBINS-I tools. Thirty-one studies were included. Most examined patellar tendinopathy in volleyball and basketball players or Achilles tendinopathy in runners and soccer athletes. Protocols varied substantially in load, frequency, and progression strategies. Pain monitoring was integral, often allowing exercise into moderate discomfort. Eccentric training consistently improved pain and function, with heavy slow resistance and adjunct modalities showing comparable or additive effects. Return-to-sport rates were high, and adverse events were minimal. However, performance outcomes, tendon structure, and safety reporting were inconsistently assessed. Eccentric training consistently reduces pain and improves function in athletes with tendinopathy. Evidence is less consistent regarding performance outcomes, tendon remodeling, and comparative superiority over alternative interventions. Standardized reporting of protocols, safety, and sport-specific adaptations is needed to strengthen recommendations for athletic rehabilitation.