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Let’s stop saying eccentric exercise is the “gold standard” for Achilles tendinitis

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

“Eccentric” muscle contractions are contractions while lengthening, also called braking contractions. Dr. Peter Malliaris:

“Can authors please stop using this phrase: ‘the current gold standard for the treatment of Achilles tendinopathies is eccentric exercises.’ If ‘gold standard’ means the best available, the evidence does not support this.”

I do not use “gold standard” in my Achilles tendinitis guide. What I do say is this: “If exercising eccentrically is actually useful in rehab, it is not clearly established yet.” And it’s unlikely to get there.

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