Controlled heel lowering can build calf and Achilles load tolerance.

Eccentric strengthening loads a muscle while it lengthens. Examples include lowering a heel from a step, controlling the downward phase of a squat or slowly lowering a weight. Physiotherapists may use eccentric exercise to improve muscle strength, tendon capacity and control during lowering, landing and deceleration.

Eccentric exercise is one loading option, not a universal solution. The most suitable program depends on the condition, current capacity, symptoms and activity goals. It may sit alongside concentric, isometric, heavy-slow resistance and sport-specific exercise within a structured physiotherapy exercise program.

What Is Eccentric Strengthening?

Eccentric strengthening is resistance exercise in which a muscle remains active while its fibres lengthen. During a calf raise, for example, the calf muscles work concentrically as the heel rises and eccentrically as the heel lowers under control.

Eccentric control helps the body absorb force. Walking downstairs, lowering into a chair, landing from a jump and changing direction all rely on muscles controlling movement while lengthening.

A rehabilitation program often combines all three contraction types. The balance changes as symptoms settle and strength, speed and activity demands increase.

What Are the Benefits of Eccentric Exercise?

Eccentric exercise can improve strength, force absorption and control when the load is appropriate and progressed consistently. Its value depends on how well the exercise matches the person and the task they need to regain.

• Build tissue capacity

  Progressive resistance can help muscles and tendons tolerate higher loads over time.

• Improve lowering control

  Training can improve control during stairs, squats, landings and deceleration.

• Develop strength

  Eccentric training can produce high force and contribute to strength and muscle development.

• Prepare for activity

  Later progressions can support running, jumping, lifting, gym training and sport.

Which Conditions May Use Eccentric Strengthening?

Physiotherapists commonly use eccentric exercise when a muscle or tendon needs greater load tolerance. The exercise and timing vary between conditions.

• Tendinopathy, including Achilles tendinopathy and patellar tendinopathy
• Calf strain or tear rehabilitation
• Hamstring strain rehabilitation and return-to-running preparation
• Some shoulder, elbow, hip and knee tendon conditions
• Weakness or reduced control during stairs, landing, lifting or sport

Eccentric loading may not be the first step in an irritable injury. Some people begin with activity modification, isometric exercise or lighter resistance before progressing to a larger range or heavier load.

What Are Examples of Eccentric Exercises?

An eccentric exercise usually emphasises the controlled lowering phase. The return phase may use both limbs, assistance or a normal lifting speed, depending on the goal.

1. Calf heel lower

   Rise using both legs if required, transfer weight and lower the heel under control on the working side.

2. Slow squat or step-down

   Control the descent through a suitable range, then return at a comfortable speed.

3. Hamstring slider

   From a bridge position, slowly slide the heels away while controlling the hips and trunk.

4. Assisted weight lowering

   Use both arms or legs to lift the weight, then lower it with the target side when appropriate.

These are examples rather than a personal program. Technique, range, tempo, sets, repetitions and external load should reflect the tissue being trained and the response after exercise.

Tempo, range and resistance can all change the training dose.

How Do Physiotherapists Prescribe Eccentric Exercise?

A physiotherapist first identifies the capacity that needs improvement, then selects a loading strategy that fits the diagnosis and goal. The process should include clear symptom guidance and measurable progression.

1. Assess

   Review pain behaviour, strength, movement, function, training load, work demands and recovery factors.

2. Select

   Choose an exercise, range and starting resistance that target the relevant muscle-tendon unit.

3. Coach

   Teach the required technique and explain what level of discomfort or post-exercise response is acceptable.

4. Progress

   Adjust load, volume, range, speed or complexity as strength and activity tolerance improve.

How Should Eccentric Load Progress?

Progress one or two variables at a time and judge the dose by both the exercise response and the following day. A slow tempo can help technique early, but rehabilitation should eventually reflect the speed and force demands of the intended activity.

A sudden spike in training volume, hills, jumping, gym load or work demand can exceed current capacity. Planned progression and recovery are therefore as important as exercise choice.

How Much Pain Is Acceptable?

Some discomfort can be acceptable in certain rehabilitation programs, but pain rules must suit the diagnosis and individual. A mild, stable response that settles after exercise may be manageable. Sharp pain, increasing swelling, altered walking or a substantial next-day flare suggests that the dose needs review.

Delayed-onset muscle soreness may occur after unfamiliar eccentric training. This differs from an injury flare. Learn more about delayed-onset muscle soreness.

Is Eccentric Strengthening Safe?

Eccentric strengthening is generally safe when the exercise and dose match your current capacity. Start conservatively after an injury, surgery or long break from training. Allow enough recovery and avoid increasing several training variables at once.

Seek individual advice before heavier exercise if you have had recent surgery or a fracture, or if osteoporosis, a significant heart condition, poorly controlled diabetes or another medical issue affects exercise safety.

When Should You Book an Assessment?

Consider a physiotherapy assessment if pain persists, keeps returning or limits work, sport, walking, stairs or gym training. Assessment is also useful when you are unsure about the diagnosis, exercise technique, acceptable symptoms or how quickly to progress.

Related Strength and Rehabilitation Topics

• Physiotherapy Exercise Programs: structured exercise selection and progression
• Tendinopathy: tendon pain, load tolerance and rehabilitation
• Achilles Tendinopathy: calf and Achilles loading options
• Patellar Tendinopathy: managing jumping and landing loads
• Calf Strain and Tear: progressive calf rehabilitation
• Hamstring Strain: strength and return-to-running rehabilitation

Common Questions About Eccentric Strengthening

What to Do Next

If tendon or muscle pain is limiting your activity, a physiotherapist can assess the problem and determine whether eccentric strengthening belongs in your program. PhysioWorks provides physiotherapy and exercise rehabilitation across Brisbane and Logan clinics.

References

1. Hody S, Croisier JL, Bury T, Rogister B, Leprince P. Eccentric muscle contractions: risks and benefits. Front Physiol. 2019;10:536. doi:10.3389/fphys.2019.00536.
2. Bright TE, Nunns M, Buckley JD, et al. Effects of eccentric resistance training on measures of physical performance: a systematic review and meta-analysis. Sports Med Open. 2023;9:36. doi:10.1186/s40798-023-00563-z.
3. Prudêncio DA, Maffulli N, Migliorini F, et al. Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis. BMC Sports Sci Med Rehabil. 2023;15:9. doi:10.1186/s13102-023-00618-2.
4. Challoumas D, Clifford C, Kirwan P, Millar NL. Effectiveness of exercise treatments with or without adjuncts for mid-portion Achilles tendinopathy: a systematic review and meta-analysis. Sports Med Open. 2023;9:53. doi:10.1186/s40798-023-00616-1.
5. Bai Z, Li J, Zhang Y, et al. Neuromuscular adaptations to eccentric training with different durations, intensities and frequencies: a systematic review and meta-analysis. Sports Med Open. 2025;11:14.