Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives Paula R Camargo, Francisco Alburquerque-Sendín, Tania F Salvini Paula R Camargo, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP 13565-905, Brazil Francisco Alburquerque-Sendín, Department of Physical Ther- apy, University of Salamanca, 37008 Salamanca, Spain Tania F Salvini, Department of Physical Therapy, Federal Uni- versity of São Carlos, São Carlos, SP 13565-905, Brazil Author contributions: All authors contributed to this work. Correspondence to: Paula R Camargo, PT, PhD, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP 13565-905, Brazil. prcamargo@ufscar.br Telephone: +55-16-33066696 Fax: +55-16-33512081 Received: January 24, 2014 Revised: April 29, 2014 Accepted: July 17, 2014 Published online: November 18, 2014 Abstract Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an ad- equate dose of mechanical load might explain the ben- eicial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric train- ing also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, compre- hension and motivation of the patients, and the estab- lishment of speciic goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aim- ing improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose- response and to determine long-term follow-up effects. © 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Cellular; Mechanotransduction; Rehabilita- tion; Shoulder Impingement; Supraspinatus; Tendon injuries Core tip: Eccentric training can be considered a new and ambitious treatment approach for several tendi- nopathies. The paper establishes the basic principles for explaining the effects on the tendon of an intense mechanical load, as the eccentric training. Further, the authors bring other possible explanations of the suc- cess of this training for tendinopathies, as the individu- alization of the exercise programs and the motivation of the patients who reach speciic goals. Negative and side effects are also identified. Finally, the main evi- dence afforded by original articles is commented and future research purposes are deined. Camargo PR, Alburquerque-Sendín F, Salvini TF. Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World J Orthop 2014; 5(5): 634-644 Available from: URL: http://www.wjgnet.com/2218-5836/full/v5/i5/634. htm DOI: http://dx.doi.org/10.5312/wjo.v5.i5.634 INTRODUCTION Tendon injuries in the shoulder account for overuse in- juries in sports as well as in jobs that require repetitive activity [1-4] . Excessive mechanical loading is considered the major causation factor. Although tendon problems are very frequent, they are not always easy to manage. TOPIC HIGHLIGHT Online Submissions: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.5312/wjo.v5.i5.634 634 November 18, 2014|Volume 5|Issue 5| WJO|www.wjgnet.com World J Orthop 2014 November 18; 5(5): 634-644 ISSN 2218-5836 (online) © 2014 Baishideng Publishing Group Inc. All rights reserved. WJO 5 th Anniversary Special Issues (7): Shoulder