How to Target Tendon Loading Part 1
The prevalence of tendon ruptures in collegiate and professional sports has been gaining legitimate concern over recent years. With the media’s attention focusing on stars like Jayson Tatum, Aaron Rodgers, and Tiger Woods all going down with tendon tears, awareness is quickly increasing along with the need to do something about it.
Researchers across a variety of fields, such as cell biologists, physical therapists, physiologists, and biomechanists, have dedicated their lives to tendon research. Needless to say, it is not an easy or straightforward problem to fix. As awareness increases, so does the demand and reach of research. With that, one thing has become very clear in the literature -> tendons need appropriate LOAD.
Within 24-48 hours, tendon cells start to change composition.1 That is to say, what makes up a strong, robust, resilient tendon cell changes with 1-2 days of not being loaded.1 Think about that for a minute; some of us have sat around on the weekend or on an airplane for longer. Athletes are frequently immobilized longer than that as standard treatment for fractures, surgeries, or high-grade sprains. While this is a necessary treatment in most cases, when appropriate, research has also demonstrated a STRONG argument that loading a tendon is best practice for healing.
Why is tendon loading important?
Healthy tendons exhibit bundles of ordered fibers, cross-linked and arranged in parallel to the direction of load.2 In aging and injured tendons, these fibers become smaller, display less crosslinking, and are disorganized.2 Meaning their ability to handle forces of tension, compression, and shear (depending on their specific role in the body) decreases.2 In addition, adult tendons have limited capacity to heal and regenerate, making the role of tendon loading even more critical. 2
Tendon cells and the properties of the tendon develop in response to the mechanical demands placed on the tendon.2 For example, if you do a lot of sprinting and hurdling, your tendon will adapt to better handle that quick, springy load. If you do a lot of slow jogging, your tendon will adapt to handle low-load, long-duration impact. Consequently, if you do a lot of sitting, your tendons will adapt to that stress (or lack thereof) as well. Because tendons adapt to the load placed on them, in rehab, it is critical that we are truly placing the load on the desired tendon.
Where does mTrigger biofeedback come in?
Since muscles are directly connected to tendons, we can infer that to get a load on a tendon, there has to be some sort of muscle activation. This is where sEMG comes in. If we are trying to load the Achilles tendon, by assessing and measuring muscle activity of the gastroc/soleus, we can begin to understand the degree (or lack thereof) to which the desired tendon is being loaded.
Common tendons for loading include the Achilles tendon, posterior tibialis/peroneal tendons, patellar tendon, and rotator cuff tendons. Unfortunately, most all these tendons have other muscles that can achieve similar movements without tremendous activation of the desired muscle/tendon unit. Cue unfavorable compensation patterns. This is why it is essential to guarantee proper muscle activation during exercises that are designed for tendon loading. Using mTrigger sEMG biofeedback can be a great way to improve muscle activation and tendon loading.
Here are a few basic exercise examples to demonstrate the use of mTrigger biofeedback to load tendons.
An eccentric single-leg heel raise, when performed correctly, is an excellent way to maximize load to the Achilles tendon.
A stiff-leg deadlift is a great example of proximal hamstring tendon loading when performed correctly. However, this can be a more challenging exercise; therefore, using mTrigger biofeedback to demonstrate and enhance muscle activation is an excellent idea.
Summary
The research is clear: loading an injured tendon is best clinical practice. Using mTrigger sEMG biofeedback to ensure proper muscle activation and thus tendon loading is the perfect adjunct to your tendon loading exercise programs.
Part 2 of this blog series will focus on specific ways to use mTrigger biofeedback to achieve a variety of tendon loading goals with exercise rehabilitation.
References
- Magnusson SP, Kjaer M. The impact of loading, unloading, ageing and injury on the human tendon. J Physiol. 2018;597(5):1283. doi:10.1113/JP275450
- Tam KT, Baar K. Using load to improve tendon/ligament tissue engineering and develop novel treatments for tendinopathy. Matrix Biology. 2025;135:39-54. doi:10.1016/j.matbio.2024.12.001
- https://inlinephysio.com.au/10-facts-about-tendons/ (image)
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