Comparison of the effectiveness of eccentric and concentric exercises in orthopedic rehabilitation following tendinopathy, total knee and total hip arthroplasty. A literature review

Introduction. Eccentric and concentric exercises are fundamental components of resistance training in orthopedic rehabilitation. Differences in contraction mechanics influence their clinical application – eccentric contractions generate greater force at a lower metabolic cost, whereas concentric exercises are better tolerated during the early stages of therapy. This review aimed to compare the effectiveness of eccentric and concentric exercises in orthopedic rehabilitation and to formulate practical therapeutic recommendations for use in this context. Methods. A total of 40 publications from 1998 to 2024 were analyzed, covering tendinopathies, rehabilitation following total knee arthroplasty (TKA) and total hip arthroplasty (THA), older adult populations, and data on muscular adaptations and safety. Outcomes included pain reduction, strength gains, functional improvements, and exercise tolerance. Results. Eccentric exercises demonstrated superior efficacy in reducing pain and improving function in chronic tendinopathies (Achilles, patellar, rotator cuff, and lateral epicondyle). In post-TKA and THA rehabilitation, eccentric training was more effective in restoring muscle strength and dynamic function compared to concentric protocols. Among older adults, eccentric exercise improved muscle strength and balance with good tolerance. Electromyographic analyses confirmed the greater neuromuscular efficiency of eccentric training, and its safety has been well-documented in multiple clinical trials. Conclusions. Eccentric exercises show greater clinical effectiveness than concentric exercises in the treatment of tendinopathies and post-operative rehabilitation following TKA and THA – particularly in terms of strength restoration, functional recovery, and pain reduction. In older populations, eccentric training enhances balance and physical performance with lower metabolic demands. When appropriately dosed, eccentric training is both safe and effective. A progressive strategy that integrates both contraction types, tailored to the rehabilitation phase and patient capabilities, yields the most favorable outcomes.