An eccentric training protocol for the treatment of Achilles tendinopathy is demonstrated. (A) The patient starts in a single-leg standing position with the weight on the forefoot and the ankle in full plantar flexion. (B) The Achilles is then eccentrically loaded by slowly lowering the heel to a dorsiflexed position. (C) The patient then returns to the starting position using the arms or contralateral leg for assistance to avoid concentric loading of the involved Achilles tendon.
Eccentric strengthening protocols have also been successful in the treatment of lateral epicondylitis [41]. In a well-designed study, 92 patients with lateral epicondylitis were randomized to a standard physical therapy protocol with and without an eccentric strengthening program [41]. The group with the eccentric strengthening showed a considerable improvement in pain, strength, and function compared with the control group. A similar study showed no difference among patients assigned to stretching and icing alone, stretching and icing with eccentric strengthening, or stretching and icing with concentric strengthening [104]. A systematic review of the literature on eccentric strength training for the treatment of tendinopathy has been published [197]. Based on the variable results of the current studies, this review concluded there is only limited evidence to support the use of eccentric exercise over other treatments such as concentric exercise, stretching, splinting, massage, and ultrasound.
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Variable results have been demonstrated with the use of ESWT in the treatment of lateral epicondylitis. There have been reports of improved pain and function compared to control groups using ESWT in the treatment of lateral epicondylitis [135, 142]. However, the majority of studies evaluating ESWT for the treatment of lateral epicondylitis report no improvement using this modality compared to controls [35, 68, 91, 165]. Two systematic reviews have investigated this issue and have concluded ESWT provides little or no benefit in the treatment of lateral epicondylitis [22, 29]. Similar, contradictory findings are seen with the use of ESWT in the treatment of Achilles tendinopathy. One study reported ESWT comparable to eccentric training and superior to a wait-and-see policy for the treatment of Achilles tendinopathy in a randomized clinical trial [143]. In contrast, another randomized, double-blind clinical trial reported no difference between patients treated with ESWT and sham ESWT in the treatment of Achilles tendinopathy [40]. Of note, this study also reported two episodes of Achilles tendon rupture in the ESWT group and questioned the safety of this treatment modality for the Achilles tendon in older patients.
a, Locations and representative histology section of six cardiac regions sampled, including right and left atrium, right and left ventricular free wall and left ventricular apex and interventricular septum. H&E, magnification 10; scale bars, 500 μm. b, Spatial visualization of positive and negative RNAscope control probes. Scale bars, 5 μm. For statistics and reproducibility, see Methods. c, Heat map of top five significantly enriched Gene Ontology Biological Processes term for each of the vascular subpopulations from Fig. 3a. Data are available in Supplementary Table 25. d, SCCAF scores for each batch aligned manifold. For each population, we plotted the true positive (TPR) versus false positive (FPR) learning ratios from the subpopulation in each manifold. Next, we plotted how accurately the manifold represents each learned subpopulation based on the test training set and the CV cross-validation set. The closer the CV value to the test value, the better the manifold is at representing the subpopulations.
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5.28 Most adults with type 1 C and type 2 B diabetes should engage in 150 minutes or more of moderate- to vigorous-intensity aerobic activity per week, spread over at least 3 days/week, with no more than 2 consecutive days without activity. Shorter durations (minimum 75 minutes/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals. 2ff7e9595c
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