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.