& REHAB
TRAIN THE BRAIN TO
BEAT TENDON PAIN
An innovative approach to treating tendinopathy targets
the brain as well as the body to get clients back on track with
their training sooner.
WORDS: THUY BRIDGES
endon pain can be persistent and tricky to manage. Any
therapist or trainer who has been in the business for a
while will know that once symptomatic, tendons can be
slow to improve and easy to aggravate. Recurrence rates can be
high, and some tendons remain unresponsive to conservative
management, which affects compliance and adherence to training.
Until fairly recently, the mainstay of tendon rehabilitation had been an
eccentric training approach. Isometric exercises were introduced to
reduce pain and aggravation, and heavy slow resistance protocols
allowed a more safe production of strength and load capacity.
More recently a new tendon management approach has been
introduced by the Monash University Tendon Research Group
coined TNT (tendon neuroplastic training).
T
The change is the brain
So what’s changed? The key difference with the new technique is
that it is not movement-based (which may increase tendon pain and
can therefore be harder for people to comply with). Rather than just
focusing on strength and building up the load capacity of a muscletendon unit, TNT also addresses the deficits of motor control.
The implication here is that with chronic and recurring pain conditions
there is an altered pattern of corticospinal control and recruitment of
muscles which may lead to recalcitrance and symptomatic recurrence.
This may help to explain why the research team reported that more than
50 per cent of people who stop sport because of tendon pain still suffer
from that tendon pain 15 years later. This new approach proposes that
a painful experience is not necessarily indicative of structural damage
occurring at the site of the tendon pain!
The change in focus to include brain training rather than just
strength training is consistent with current advances in the area of
pain research; the persistence of pain can be more about the brain
and its response to perceived threat than it is about the local site of
structural pathology.
TNT involves strength training which is known to be good for
tendons and muscles. In addition to this, it includes stimulation of the
brain externally while the exercise is performed. Rather than simply
holding a muscle contraction or moving through a range, a pose is
held while the client is concurrently stimulated with a metronome or
voice recording providing an external pacing. External pacing has
been shown to be superior to self-pacing for improving excitability
and releasing inhibition.
How effective is it?
Isometric exercise used in the protocol can induce an immediate
analgesic effect that can last up to 45 minutes. That’s right, a
painkiller that is all natural and works immediately.
This can be an extremely useful tool to have a client execute
immediately before a training session. Doing so would reduce their
NETWORK SUMMER 2016 | 43