Tendonitis affects upper- and lower-limb tendons — tennis elbow, golfer’s elbow, patellar tendonitis, Achilles tendonitis, and high hamstring tendonitis, among them. Exercise therapy is the most effective treatment for tendon pain, yet many people still struggle to return to sport. Recently, an exciting rehab approach — tendon neuroplastic training — has shown promising signs of improving exercise outcomes for tendonitis. So what is tendon neuroplastic training, and how do you add it to your current programme?
Tendon neuroplastic training is one of several ways to get more from tendon rehabilitation, alongside shockwave, GTN patches, and collagen supplements.
How do we currently treat tendonitis?
Tendonitis treatment usually combines three things: reducing or stopping the offending activity (running or sport), exercise therapy to strengthen the tendon and surrounding muscles (such as calf raises or quadriceps work), and pain-reducing treatments such as tablets, shockwave, and tendon injections. Most people improve — but a sizeable minority still struggle to return to their sport or activity. That’s the gap tendon neuroplastic training aims to fill.
Why add tendon neuroplastic training?
Tendon neuroplastic training is a novel concept: it changes how you perform your strengthening exercises. Rather than targeting only the tendon or muscle, it targets the nervous system that controls them.
What is neuroplasticity?
Neuroplasticity describes the way the brain and spinal cord change their connections in response to a stimulus, such as exercise. The brain grows new connections and rewires old ones. This happens after an injury or in response to physical or mental stimulation, such as learning a new skill.
What is motor control?
Motor control is the ability to contract a muscle smoothly and precisely. When you perform a squat, your brain sends finely-timed signals telling the quadriceps to contract in a controlled way. Recent research suggests this control is disrupted in chronic tendonitis. Think of a driver lurching from first gear straight to fourth, jerking the car forward — in chronic tendonitis, the smooth control of muscle contraction is similarly disrupted, so the muscle responds less cleanly to signals from the brain.
So improving tendonitis isn’t only about making the muscle stronger — it’s also about restoring smooth, jerk-free muscle contraction.
How do we improve motor control?
Externally-paced strength training appears to improve motor control — making muscle contraction smoother. To set the pace, we usually use a metronome. When you perform a weighted squat, the metronome tells you how quickly to rise and lower. We typically set it to beep every three seconds, so you take three seconds to lower and three seconds to rise. The key is letting the metronome set the pace, which trains your brain to control the muscle more smoothly.
Metronome training has another benefit: it keeps you engaged, stops your mind wandering, and keeps your attention on the movement. And metronomes are built into free phone apps you can use in any gym or weight room.
Tendon neuroplastic training: practical examples
There are many ways to set the metronome, but a simple favourite is a beep every three seconds, where each beep signals a change of direction. For calf raises, the first beep tells you to start rising; you keep going until the next beep at three seconds, then lower back down to the following beep — repeating up and down in time with the metronome.
In advanced Achilles, patellar, or hamstring rehab, you can also use the metronome when reintroducing running on stairs or the road. Start at around 80 beats per minute, then increase to 100 as your pace quickens.
Which tendons suit tendon neuroplastic training?
Most lower-limb tendons suit it — the Achilles, patellar, and hamstring origin tendons in particular. It can also help upper-limb tendons, such as tennis or golfer’s elbow. Speak to your physiotherapist or sports doctor about adding metronome training to your programme.
Frequently asked questions about tendon neuroplastic training
Could adding tendon neuroplastic training shorten tendonitis rehab?
Possibly. Rehab isn’t only about getting as strong as possible — it’s also about motor control, the ability to contract the muscle smoothly. By training that control, neuroplastic training may help some people who’ve plateaued with strength work alone progress and return to sport.
What is the science behind metronome (externally-paced) training?
Chronic tendonitis appears to disrupt the brain’s control of muscle contraction. Externally-paced exercise — moving in time with a metronome — is thought to retrain that control through neuroplasticity, the brain’s ability to rewire its connections in response to a stimulus.
How do I start metronome training at home?
Download a free metronome app, set it to a beep every 3 seconds, and apply it to your existing rehab exercises (such as calf raises or squats) — 3 seconds up, 3 seconds down. Build it into the programme your physiotherapist has set, rather than replacing that programme.
Is tendon neuroplastic training a replacement for normal strengthening?
No — it’s an enhancement. You still do progressive strengthening; neuroplastic training changes how you do it (paced, controlled) to improve motor control alongside strength. It also works best alongside the other tendon treatments where needed — shockwave, GTN patches, and injections.
Does it work for upper-limb tendons, such as tennis elbow?
Yes. Although most studied in lower-limb tendons, the same paced-contraction principle applies to upper-limb tendons, such as those affected by tennis elbow and golfer’s elbow.
Final word from Sport Doctor London about tendon neuroplastic training
There’s more to tendon rehab than building strength. Motor control — the ability to contract a muscle smoothly — matters too. Externally paced strengthening with a metronome is a simple, accessible way to improve motor control and get more out of your tendonitis rehab.
To discuss a tendon rehab plan with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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