Intended for healthcare professionals

Rapid response to:


Time to abandon the “tendinitis” myth

BMJ 2002; 324 doi: (Published 16 March 2002) Cite this as: BMJ 2002;324:626

Rapid Response:

Treatment/management for Tendinopathy

Dear Editor--We agree with the recommendation of Khan et al. (2002)
article that the term tendinopathy is the ideal term for clinical
diagnosis in overuse tendon disorders. We also agree with the rapid
response of this article (treatment for tendinopathy-Khan et al. 2002)
that the most effective treatment for tendinopathy is a well-designed
exercise programme consisting of eccentric strengthening exercises of the
“injured” tendon, so long as the load of eccentric exercises to be
increased according to the patients’ symptoms, because the opposite has
shown poor results1. In addition, static stretching exercises of the
“injured” tendon have to be part of a well-planned eccentric strengthening
exercise programme, because the opposite has shown poor results2. However,
in all conducted studies the exercise programme was performed in home,
daily, once or twice, for about three months 3-8. Our experience has
showed that patients rarely performed an exercise programme in home not
only for tendinopathies, but also for any musculoskeletal injury. Thus, we
are wondering if such an exercise programme, consisting of eccentric
exercises and static stretching exercises of the “injured” performing in
clinic under the supervision of a physical therapist can give better
results in a shorter treatment period. Two studies to support this opinion
there are in literature 9-10, but further research to provide evidence of
such an exercise programme is required.

Dimitrios Stasinopoulos Physiotherapist, M.Sc, research student,
Cert. Clin Ed., PGCRM, Cert Orth Med (Cyriax) /Rheumatology and
Rehabilitation Centre, Athens Greece/ School of Health and Human Sciences,
Leeds Metropolitan University, Leeds, U.K.

Prof. Mark I. Johnson B.Sc, PhD, PGCHE, Principal Lecturer in
Learning, Teaching and Assessment (Human Physiology), School of Health and
Human Sciences, Leeds Metropolitan University, Leeds, U.K.


1. Cannell L, Taunton J, Clement D, Smith C, Khan K. (2001). A
randomized clinical trial of the efficacy of drop squats or leg
extension/leg curls to treat clinically diagnosed jumper’s knee in
athletes: a pilot study. British Journal of Sports Medicine, 35 60-64.

2. Jensen K, Di Fabio R. (1989). Evaluation of eccentric exercise in
treatment of patellar tendinitis. Physical Therapy, 69 211-216.

3. Mafi N, Lorentzon R, Alfredson H. (2001). Superior short-term
results with eccentric calf muscle training compared to concentric
training in a randomized prospective multicenter study on patients with
chronic Achilles tendinosis. Knee Surgery Sports Traumatology Arthroscopy,
9 42-47.

4. Niesen-Vertommen SL, Taunton JE, Clement DB, Mosher RE. (1992).
The effect of eccentric versus concentric exercise in the management of
Achilles tendonitis. Clinical Journal of Sports Medicine, 2 109-113.

5. Alfredson H, Pietila T, Johnson P, Lorentzon, R. (1998). Heavy-
Load eccentric calf muscle training for the treatment of chronic Achilles
tendinosis. American Journal of Sports Medicine, 26 360-366.

6. Ohberg L, Lorentzon R, Alfredson H. (2004). Eccentric training in
patients with Achilles tendinosis: normalized tendon structure and
decreased thickness at follow up. British Journal of Sports Medicine, 38 8

7. Purdam CR, Johnsson P, Alfredson H, Lorentzon R, Cook J L, Khan K
M. (2004). A pilot study of the eccentric decline squat in the management
of painful chronic patellar tendinopathy. British Journal of Sports
Medicine, 38 395-397.

8. Shalabi A, Kristoffersen-Wilberg M, Svensson L, Aspelin P, Movin
T. (2004). Eccentric Training of the Gastrocnemius-Soleus Complex in
Chronic Achilles Tendinopathy Results in Decreased Tendon Volume and
Intratendinous Signal as Evaluated by MRI. American Journal of Sports
Medicine, 32 1286-1296.

9. Stasinopoulos D, Stasinopoulos I. (2004). Comparison of effects of
exercise programme, pulsed ultrasound and transverse friction in the
treatment of chronic patellar tendinopathy. Clinical Rehabilitation, 18

10. Stasinopoulos D, Johnson MI. Comparison of effects of Cyriax
physiotherapy, exercise programme and polarised polychromatic non-coherent
light (Bioptron light) in the treatment of Tennis elbow/Lateral
epicondylitis. Unpublished data

Competing interests:
None declared

Competing interests: No competing interests

22 September 2004
Dimitrios I. Stasinopoulos
PhD student
Prof. Mark I. Johnson
School of Health and Human Sciences, Leeds Metropolitan University