Physio Edge podcast with David Pope8 Loka

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, 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.

Links associated with this episode

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