Tendinopathy & Neuroscience with Dr. Patrick Vallance

Tendinopathy management requires a shift from traditional metronome-based neuroplastic training toward interventions that address specific spinal-level motor deficits. Dr. Patrick Vallance, a physiotherapist and researcher at Monash University, challenges the conventional focus on cortical inhibition in patellar tendinopathy, identifying spinal-level inhibition—a "kink in the hose"—as the primary driver of maximal force deficits. This inhibition, potentially linked to pain signaling similar to Arthrogenic Muscle Inhibition, suggests that self-paced training may more effectively engage the reticulospinal pathway to restore function. Furthermore, the widely accepted practice of using isometrics for immediate pain relief is highly variable and lacks consistent clinical support, indicating that rehabilitation should move toward precision-based strategies that account for individual pain profiles and specific motor pathway alterations rather than relying on standardized, one-size-fits-all protocols.