Clinical Edge - 181. Tendinopathy: Is it weakness or inhibition? with Dr Patrick Vallance

Your patellar tendinopathy patients work through a solid, progressive loading program, yet their quads still test weaker on the painful side. It's frustrating for an athlete who is ticking every box in the gym, and for you when their strength and power won't return. Are their quads actually weak, or is muscle inhibition limiting the strength they can access? And how does that change your rehab?

In this episode, Dr Patrick Vallance (PhD, Physiotherapist, tendinopathy neuroscientist and Lecturer in Physiotherapy at Monash University) and David Pope break down why force output is reduced in tendinopathy, and what you can do about it in your treatment. You'll also discover:

Clinical clues that inhibition, not just weakness, is limiting your patient's strength
A simple knee extension strength benchmark to compare your patellar tendinopathy patients against healthy athletes
The "garden hose" analogy that explains inhibition at the brain and the spinal cord, and where the block sits in patellar tendinopathy
Why the often-overlooked "reticulospinal pathway" is so important for maximal strength and power
Metronome-paced vs self-paced strength training: which pathway each one targets, and when to use each
How to use lower reps, higher intensity and "intent to move fast" to target the reticulospinal pathway
Why TENS and ice are being reconsidered as adjuncts to exercise in patellar tendinopathy
Why Achilles tendinopathy needs a different approach, and the calf endurance target to aim for
Where isometrics fit when they don't relieve pain, and how shorter holds may help tendon stiffness

So you can easily apply the podcast with your patients, Pat breaks down the neuroscience with simple analogies and practical exercise examples, and is clear about what the research supports now and which ideas are still being tested.

For more on tendinopathy rehab, listen to podcast 175. Tendinopathy treatment: Your guide to isometrics, isotonics & plyometrics with Dr Ebonie Rio.

Timeline:

0:00 - Introduction
2:28 - Tendinopathy, inhibition and force output
3:10 - Measuring inhibition
8:47 - Why look beyond the tendon?
10:24 - Corticospinal vs reticulospinal pathways
16:01 - Pain and spinal inhibition
22:09 - Power vs control
26:20 - Metronome-paced vs self-paced training
30:50 - What is self-paced training?
36:08 - How to reduce nociceptive drive
39:26 - How to target the reticulospinal pathway
41:16 - How to target the corticospinal pathway
43:19 - Achilles vs patellar tendinopathy
46:08 - Endurance targets
47:36 - Isometrics and tendon stiffness
50:05 - Where the research is heading

Free resources

Podcast handout: your key takeaways from the podcast, plus the full transcript, so you can remember it and apply it with your patients.
Clinical Edge membership: improve your assessment and treatment results, including the new taping video series with Zoe Russell (Specialist Sports Physiotherapist).
Free running injury resources: for the runners and running injuries you treat.

181. Tendinopathy: Is it weakness or inhibition? with Dr Patrick Vallance

Free resources

Links associated with this episode