When treating tendonosis, which type of exercises should be prioritized initially?

Eccentric exercises are prioritized initially when treating tendonosis because they have been shown to be highly effective in promoting healing and strengthening of the affected tendon. During eccentric exercises, the muscle lengthens under tension, which helps to promote collagen remodeling and vascularization in the tendon. This is particularly beneficial in cases of tendonosis, where degenerative changes have occurred in the tendon structure.

Research has established that eccentric loading can reduce pain and improve function in individuals with tendonosis. It not only helps to strengthen the tendon but also improves its capacity to handle load, which is crucial for recovery and return to normal activities.

While isometric exercises can provide some immediate pain relief by reducing muscle contractions around the tendon, they do not promote the same level of adaptations in the tendon tissue as eccentric exercises do. Stretching exercises might be helpful in addressing flexibility but are not effective as a primary treatment modality for tendonosis. Similarly, concentric exercises may not adequately address the underlying issues of tendon degeneration that are characteristic of tendonosis. Therefore, focusing on eccentric exercises provides the best approach to facilitate healing and improve tendon function.