title: Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review.
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.
authors.affiliation: Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Victoria, Australia The Australian Centre for Research into Injury in Sport and its Prevention, Ballarat Federation University, Victoria, Australia.
authors.forename: Ebonie
authors.initials: E
authors.lastname: Rio
authors.affiliation: Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Dawson
authors.initials: D
authors.lastname: Kidgell
authors.affiliation: Sansom Institute for Health Research, University of South Australia & Pain, Adelaide, South Australia, Australia.
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
authors.affiliation: Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Victoria, Australia Department of Physiotherapy, University of Canberra, Bruce, Australian Capital Territory, Australia University of Canberra Research Institute for Sport and Exercise, Australia.
authors.forename: Jamie
authors.identifier: http://orcid.org/0000-0002-4504-9188
authors.initials: J
authors.lastname: Gaida
authors.affiliation: Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Victoria, Australia The Australian Centre for Research into Injury in Sport and its Prevention, Ballarat Federation University, Victoria, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Docking
authors.affiliation: Department of Physical Therapies, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Purdam
authors.affiliation: Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Victoria, Australia The Australian Centre for Research into Injury in Sport and its Prevention, Ballarat Federation University, Victoria, Australia.
authors.forename: Jill
authors.initials: J
authors.lastname: Cook
mesh_terms: D000125:Achilles Tendon / Q000293:injuries; D001265:Athletic Injuries / Q000503:physiopathology / Q000534:rehabilitation; D001696:Biomechanical Phenomena / Q000502:physiology; D006801:Humans; D009044:Motor Cortex / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology; D052097:Quadriceps Muscle / Q000502:physiology; D055070:Resistance Training / Q000379:methods*; D052256:Tendinopathy / Q000503:physiopathology / Q000534:rehabilitation*
keywords: Brain; Exercises; Quadriceps; Tendinopathy; Tendon