How to Target Tendon Loading Part 2
In our previous blog, we established how mTrigger biofeedback is critical for tendon rehabilitation. In this next blog, we will discuss specific ways to use mTrigger biofeedback to achieve that fully desired effect of exercises for tendon loading.
Role of Tendons
Let’s start by reviewing the purpose of tendons. Tendons in the body have two primary roles.1 Energy-storing tendons store large amounts of energy (4-7.5x BW) and are responsible for propulsion (i.e., Achilles tendon).1 Positional/stabilizing tendons allow for locomotion (walking) by correctly positioning and then stabilizing joints (i.e., posterior tibialis, tibialis anterior).1
Understanding the role of the tendons in the body you are targeting allows for appropriate prescription of exercise. Exercises for energy-storing tendons will need to focus on obtaining high levels of strength, increasing speed and power, and building resilience to load so that these tendons have the ability to produce large amounts of energy and propulsion. On the other hand, stabilizing tendons will need exercises more focused on strength, stability, and endurance.
Exercises for Tendon Loading
Proper tendon loading requires an exercise stimulus to promote adaptation.2 Tendons will sense the load placed on them, called mechanotransduction, and respond accordingly.1,2 This load is what allows the tendon fibrils to mature and heal after an injury.1 By loading, you are creating a more stable cellular environment for the tendon and preventing the cells from breaking down.1 A great way to do this is through eccentric exercises. Let's look at some examples of exercises for some major tendon injury sites using mTrigger biofeedback.
Rotator Cuff Tendons
Eccentric external rotation targets the infraspinatus tendon.
Prone T with external rotation targets the rotator cuff tendons and infraspinatus specifically.
Achilles Tendons
Eccentric heel raise (and low) with mTrigger biofeedback to maximize effort and load to the Achilles tendon.
Performing a decline heel raise with focus on tendon loading at end range.
Stabilizing Ankle Tendons
Shin raises will target the tibialis anterior tendon.
Hamstring Tendons
Eccentric hamstring slides are a difficult exercise that targets the hamstring tendons when done correctly and with high levels of muscle activation.
Nordics are a challenging but excellent exercise for tendon health and loading capacity.
Patellar Tendon
Eccentric lunge slides will target both the patellar tendon and quad tendon.
Adjunct to Biofeedback
A study using NMES with exercise after a tendon injury was shown to increase the force, stress, and strain placed on the target tendon during exercise.3 The increase from the neuromuscular electrical stimulation is like the increase in force you are aiming to achieve by increasing muscle activation with mTrigger biofeedback. Both aim to improve the load to the tendons during the rehab process. The authors of this study demonstrated that when we increase the load placed on pathologic tendons, there is a consequent reduction in pain and symptoms.3 Which is exactly what we want.
Summary
Exercises done with correct form and maximal muscle activation will properly load an injured tendon to its desired level. Using mTrigger biofeedback to ensure your patients are getting the correct muscle to activate and, in turn, loading the correct tendon is pivotal for a successful recovery. As medical providers we cannot underload tendons and expect superior results. Make sure to use sEMG biofeedback in your practice to increase muscle activation and tendon recovery.
Top Application of mTrigger Biofeedback
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Using Biofeedback with Older Adults
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References
- 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
- Gabbett TJ, Oetter E. From Tissue to System: What Constitutes an Appropriate Response to Loading? Sports Med. 2025;55(1):17-35. doi:10.1007/S40279-024-02126-W
- Quaglioti Durigan JL, Ito N, Katz SE, Kalish L, Cone SG, Silbernagel KG. Neuromuscular Electrical Stimulation for Patellar and Achilles Tendon Loading: A Scoping Review With Practical Recommendations. J Orthop Sports Phys Ther. 2025;55(7):482-494. doi:10.2519/JOSPT.2025.13151
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