Achilles and patellar tendinopathy treatments usually include tendon loading, to promote tissue healing and return to activity. This review compares the clinical outcomes (improved neuromuscular performance, improved imaging, ) of different tendon loading programmes.
Although the Alfredson protocol (isolated eccentric loading, 3x15reps 2/day, 12 weeks) is the most popular, evidence seems to question its superiority in terms of clinical outcomes.
For Achilles tendinopathies, the Silbernagel-combined programme (exercises progressing from eccentric-concentric to eccentric while increasing speed and load, including balance and plyometrics, 1/day, 12 weeks) seems at least equivalent to the Alfredson protocol. For both programmes, there does not seem to be any correlation between clinical outcomes (jump performance, torque, work, endurance) and imaging results (measured tendon thickness, intra-tendinous vascularisation).
For patellar tendinopathies, there is more evidence for the Heavy-Slow-Resistance programme described by Kongsgaard (slow loaded double-leg squats and leg press exercises, progressing from 15RM to 6RM, 3/week, 12 weeks). Moreover, HSR loading clinical outcomes were associated with imaging improvements as well as measured tendon adaptations (collagen turnover). > From: Malliaras, et al., Sports Med 43 (2013) 267-286. All rights reserved to Springer International Publishing Switzerland.