Applied Evidence

Consider these exercises for chronic musculoskeletal conditions

J Fam Pract. 2018 September;67(9):534-538,540-543

From The Journal of Family Practice | 2018;67(9):534-538,540-543.

References

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Achilles tendinopathy

Achilles tendinopathy (also referred to as chronic Achilles tendinitis) is a degenerative condition of the Achilles tendon related to overuse that leads to pain, swelling, and impaired performance. It accounts for approximately 18% of injuries in runners and 4% of all patients presenting to sports medicine clinics.³¹ Eccentric muscle loading has become the dominant conservative intervention strategy for chronic Achilles tendinopathy.

For chronic tendinopathies, eccentric exercises subject greater force than concentric exercises through a controlled lengthening of a muscle-tendon unit, resulting in a greater remodeling stimulus of the tendon.³² Classically, the Alfredson protocol has been used to treat chronic Achilles tendinopathy. This program of eccentric heel-drop exercises recommends completion of 180 eccentric repetitions a day for up to 12 weeks (FIGURE 4).³³ Exercises are performed slowly, and load can be increased when exercises are performed without pain or perhaps with mild nondisabling pain.

A variation of this protocol has allowed a gradual escalation of repetitions over a week up to the recommended 180 repetitions, and has shown improvements in pain reduction and function similar to that achieved with the primary protocol.³⁴ Additionally, a 6-week “do as tolerated” program of eccentric exercises did not lead to lesser improvement for individuals with midportion Achilles tendinopathy.³⁵

Several systematic reviews have supported the use of eccentric exercises for chronic Achilles tendinopathy,^31,36,37 but no specific protocol or exercise regimen has demonstrated superiority. However, with the Alfredson protocol, improvement in pain and function in patients with chronic Achilles tendinopathy has persisted for up to 5 years.³⁸

Lateral epicondylitis

Lateral epicondylitis (also called lateral epicondylosis or “tennis elbow”) is a disabling musculoskeletal condition that leads to pain and tenderness around the extensor mass of the lateral elbow. It is caused by microtrauma to the tendon, usually sustained through repetitive movement in a sporting activity, industrial work, or hobby. Affecting up to 3% of the US population, lateral epicondylitis is associated with pain and functional disability, as well as emotional and psychosocial consequences.³⁹

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