Hi.

Firstly, in defence of 21st Century Physio, Alfredson and his researchers have found the presence of increased new blood vessels in cases of mid tendon tendinopathy. They (I think) have also found that glutamate and not prostaglandin E2 is predominate in tendinopathies. Glutamate is a central sensitiser.

The thought behind eccentric exercise is that perhaps it stretches these new blood vessels and their accompanying neural supply - they found less vascularity after a programme of eccentric exercises in the Achilles Tendon.

Secondly, stretching changes the mechanical properties of both the tendon and muscle and in a muscle like the gastrocs, the length changes can be x4-10 more than the length change in the muscle (see Kubo et al various studies). So it is possible that the stretching effect of eccentric exercises via the various soft tissues changes the tendon.

In response to 21stCPhysio's question about using ice, i do use ice but not to assist the tendinopathy - more for the other muscles and tissues that are strained during the exercises and for pain relief!

That's my 2 cents worth, I hope it helps