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

Your patellar tendinopathy patients are performing a solid, progressive loading program, but their quadriceps still test weaker, with lower maximal force output. Are their quads actually weak, or is muscle inhibition limiting the strength they can access? And how does this change your rehab?

In this episode, Dr Patrick Vallance (Ph.D, Physiotherapist, Tendinopathy neuroscientist, Lecturer in Physiotherapy at Monash University) and David Pope explore why force output can be reduced in tendinopathy, and how understanding the mechanisms involved can help you tailor your treatment.

You'll also discover:

Clinical clues that inhibition may be contributing to your patient's reduced force output How inhibition at the brain and spinal cord differs, and why this matters for rehab The reticulospinal pathway and its role in producing strength and power How metronome-paced and self-paced exercises may target different neural pathways, and what this could mean for your exercise choices Why Achilles and patellar tendinopathy may need different treatment approaches, including when to target muscular endurance How assessing strength, power and endurance helps you identify what each patient's rehab needs to address Why researchers are reconsidering TENS and ice as possible adjuncts to exercise for patellar tendinopathy Where isometrics fit when they don't relieve pain, and how their role in tendon stiffness could influence your exercise prescription Throughout the episode, Patrick uses simple analogies and practical exercise examples to make the science easier to understand and apply. He explores what the research can currently tell us, which treatment ideas are still being tested, and how to use this understanding to tailor your rehab to your patients' needs and goals.

Chapters

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,