Eccentric training went with less pain and better function in athletes with tendinopathy, mostly patellar in volleyball and basketball players and Achilles in runners and footballers, in a scoping review of 31 randomised and non-randomised trials; protocols varied widely, often allowed exercise into moderate discomfort, and heavy slow resistance did comparably (a mapping review with no pooled numbers)

Trybulski and colleagues mapped trials of eccentric training for tendinopathy in athletes to describe how the training was prescribed, what it achieved, how safe it was and where the evidence is thin. They searched three databases and kept randomised and non-randomised controlled trials in athletes with tendinopathy, appraising them with RoB 2 and ROBINS-I.

Thirty-one studies were included, most of them on the patellar tendon in volleyball and basketball or on the Achilles tendon in running and football. Load, frequency and progression varied a great deal between protocols. Pain monitoring was integral to the programmes, and exercise was often allowed to reach moderate discomfort.

The authors report that eccentric training consistently improved pain and function, that heavy slow resistance and add-on treatments gave comparable or additional benefit, that most athletes returned to sport and that adverse events were few, while performance, tendon structure and safety were measured unevenly.

They conclude that eccentric training reduces pain and improves function in athletes with tendinopathy, but that its effect on performance, on tendon remodelling and against other treatments is less clear, and they call for standard reporting.