Functional approaches in tendinopathy rehabilitation: exploring the role of tendon neuroplastic training

Background: Achilles and patellar tendinopathies pose significant challenges due to their high prevalence and persistent symptoms, impacting athletes and active individuals alike. Traditional rehabilitation methods, primarily eccentric exercises, have shown limited efficacy, prompting reevaluation of treatment strategies. Emerging evidence suggests that central nervous system sensitization contributes to chronic tendon pain, necessitating interventions that address both tissue pathology and neurophysiological factors. Tendon neuroplastic training (TNT), incorporating heavy slow resistance training (HSR), offers a promising approach by targeting both aspects of tendinopathy. Methods: A scoping review following the JBI methodology and PRISMA-ScR guidelines was conducted. Eligible studies focused on adults with chronic Achilles or patellar tendinopathy, comparing TNT with traditional load-based rehabilitation methods. Outcome measures included pain reduction, functional improvement, and neuroplasticity markers. Data were extracted and synthesized to assess the effectiveness of TNT in modifying central sensitization and improving clinical outcomes. Results: Five studies met the inclusion criteria, comprising a randomized controlled trial (RCT), systematic reviews, and a cross-sectional study. RCT findings indicated comparable outcomes between HSR and eccentric exercises for Achilles tendinopathy, with higher patient satisfaction with HSR. Systematic reviews highlighted gaps in direct comparisons and emphasized the need for more studies on HSR. Studies also demonstrated the presence of central sensitization in tendinopathies, complicating treatment and recovery. Conclusion: This review supports a comprehensive approach to tendinopathy treatment, integrating strategies addressing both tissue pathology and central sensitization. While HSR within TNT shows promise, further research with standardized protocols and direct comparisons is needed to optimize clinical outcomes.