Original Article can be found here: Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review

What are the findings?
▸ Tendinopathy may be associated with changes in motor control; these changes may be bilateral and persistent despite rehabilitation.
▸ Current rehabilitation may not adequately address motor control issues as self-paced strength training (the mainstay of the treatment) does not alter corticospinal drive to the muscle—this may contribute to recalcitrance and recurrence of tendinopathy.
▸ Tendon neuroplastic training proposes a concept of strength-based loading that is an important stimulus for tendon and muscle, but with strategies known to optimise neuroplasticity of the motor cortex and drive to the muscle. It needs to be tested in a wide range of anatomical locations as it is unclear whether findings for the patellar tendon are applicable to all tendinopathies.

Abstract
Tendinopathy can be resistant to treatment and often recurs, implying that current treatment approaches are suboptimal. Rehabilitation programmes that have been successful in terms of pain reduction and return to sport outcomes usually include strength training. Muscle activation can induce analgesia, improving self-efficacy associated with reducing one’s own pain. Furthermore, strength training is beneficial for tendon matrix structure, muscle properties and limb biomechanics. However, current tendon rehabilitation may not adequately address the corticospinal control of the muscle, which may result in altered control of muscle recruitment and the consequent tendon load, and this may contribute to recalcitrance or symptom recurrence. Outcomes of interest include the effect of strength training on tendon pain, corticospinal excitability and short interval cortical inhibition. The aims of this concept paper are to: (1) review what is known about changes to the primary motor cortex and motor control in tendinopathy, (2) identify the parameters shown to induce neuroplasticity in strength training and (3) align these principles with tendon rehabilitation loading protocols to introduce a combination approach termed as tendon neuroplastic training. Strength training is a powerful modulator of the central nervous system. In particular, corticospinal inputs are essential for motor unit recruitment and activation; however, specific strength training parameters are important for neuroplasticity. Strength training that is externally paced and akin to a skilled movement task has been shown to not only reduce tendon pain, but modulate excitatory and inhibitory control of the muscle and therefore, potentially tendon load. An improved understanding of the methods that maximise the opportunity for neuroplasticity may be an important progression in how we prescribe exercise-based rehabilitation in tendinopathy for pain modulation and potentially restoration of the corticospinal control of the muscle-tendon complex.

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