Heavy slow resistance training is a compliance-favorable, evidence-equal alternative to eccentric loading for Achilles tendinopathy — and recreational runners carry real lifetime exposure to it
Interpretation
Beyer et al.'s RCT found no significant difference in clinical/structural outcomes between heavy slow resistance (HSR) and eccentric training, but meaningfully higher compliance (92% vs 78%) and satisfaction (100% vs 80%) with HSR. Lagas et al.'s cohort shows this isn't a niche concern: 5.2% of recreational runners developed Achilles tendinopathy over the study period, rising to 7.4% among marathon-registered runners.
Practical implication
Default to HSR over eccentric-only protocols for Achilles tendinopathy management where both are viable, specifically because higher compliance (not superior efficacy) is the real differentiator — and treat progressive tendon loading as baseline prevention content, not a niche injury topic, given the incidence rate.
Sources
2 sources, independently verified.
No significant difference in clinical/structural outcomes between heavy slow resistance (HSR) and eccentric training at 12 or 52 weeks, but HSR had notably higher compliance (92% vs 78%) and satisfaction (100% vs 80%) — a practical, not efficacy, argument for HSR as the default protocol.
5.2% developed Achilles tendinopathy over the follow-up period; marathon-registered runners had the highest incidence at 7.4%. Prior AT in the preceding 12 months was the strongest risk factor (OR 6.3), ahead of training-schedule use and compression-sock use.