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World J Orthop. Nov 18, 2014; 5(5): 634-644
Published online Nov 18, 2014. doi: 10.5312/wjo.v5.i5.634
Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives
Paula R Camargo, Francisco Alburquerque-Sendín, Tania F Salvini
Paula R Camargo, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP 13565-905, Brazil
Francisco Alburquerque-Sendín, Department of Physical Therapy, University of Salamanca, 37008 Salamanca, Spain
Tania F Salvini, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP 13565-905, Brazil
Author contributions: All authors contributed to this work.
Correspondence to: Paula R Camargo, PT, PhD, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP 13565-905, Brazil.
Telephone: +55-16-33066696 Fax: +55-16-33512081
Received: January 24, 2014
Revised: April 29, 2014
Accepted: July 17, 2014
Published online: November 18, 2014

Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects.

Keywords: Cellular, Mechanotransduction, Rehabilitation, Shoulder Impingement, Supraspinatus, Tendon injuries

Core tip: Eccentric training can be considered a new and ambitious treatment approach for several tendinopathies. The paper establishes the basic principles for explaining the effects on the tendon of an intense mechanical load, as the eccentric training. Further, the authors bring other possible explanations of the success of this training for tendinopathies, as the individualization of the exercise programs and the motivation of the patients who reach specific goals. Negative and side effects are also identified. Finally, the main evidence afforded by original articles is commented and future research purposes are defined.