Infographic: Loading Programs for Patellar and Achilles Tendinopathies


Eccentric Training and Lower Limb Tendinopathy:

  • Athletic overuse injuries of the patellar and Achilles tendons are common
  • Eccentric muscle training is a popular conservative treatment approach
  • Up to 45% of patients do not respond to eccentric-only loading treatment

Common Loading Approaches to Tendinopathy Treatment:

  • Eccentric-concentric, progressing to eccentric-only
  • Eccentric-concentric, heavy slow resistance (HSR)
  • Eccentric-only

Research Questions:

  • What is the quality of the evidence in studies comparing loading programs?
  • What are the non-clinical outcomes associated with clinical outcomes?/span>

Research Methods:

  • 32 studies reviewed
  • 10 studies compared loading programs
  • 28 studies investigated potential mechanisms
  • 6 studies did both


  • There is limited evidence that eccentric-only loading is superior to other loading programs
  • There is equivalent evidence for Silbernagel Combined loading for Achilles treatment, and greater evidence for HSR loading for patellar treatment
  • Improved neuromuscular performance was the only mechanism consistently associated with improved clinical outcomes
  • HSR loading and Silbernagel Combined loading both had equivalent or higher evidence compared to eccentric-only loading