Tendon neuroplastic training reduces tendon pain and muscle inhibition in-season: Changing the way we think about exercise

Introduction: Patellar tendon pain is at its highest in-season but there are no published data of successful management when athletes are playing and training. Furthermore, there are changes to the cortical control of the quadriceps in patellar tendinopathy (including excess quadriceps inhibition) that may not be ameliorated with current loading protocols. Strength training that is externally paced with either visual or auditory cues may not only have positive effects on tendon matrix and muscle properties but may exploit the processes leading to neuroplasticity and improve control of the muscle. The aim of this study was to compare two forms of strength training designed to affect cortical control, during a competitive season, for the effects on tendon pain and cortical inhibition. Methods: This was a randomised clinical trial with two intervention arms. Sub-elite and elite basketball and volleyball athletes aged over 16 years, playing and training three times per week, were recruited and randomised to either isometric or isotonic exercise. Protocols were completed four times per week for four weeks on a leg extension machine. Protocols were matched for time under load and rest between sets, isometric consisted of; 5×45s at 60 degrees and isotonic consisted of; 4×8 (three second concentric and four second eccentric phase). Strength training was externally paced using an audio recording specifically designed for the study. A subgroup of athletes completed testing of cortical control of the quadriceps. Results: Twenty-nine athletes were recruited. Median pain scores improved significantly over the 4-week intervention period in both the isometric group (pre 5.5/10, post 2/10, p = 0.012) and isotonic group (pre 5/10, post 2.5/10, p = 0.003). However, the isometric group reported significantly greater immediate pain relief following each intervention session (p