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

Patella tendinopathy often manifests as reduced quadriceps force output, driven by spinal inhibition rather than simple muscle weakness. Nociceptive input from the tendon activates inhibitory interneurons at the spinal level, which disrupts communication between the corticospinal tract and peripheral nerves. While traditional metronome-based training targets the corticospinal pathway to improve motor control, self-paced training effectively engages the reticulospinal tract, which is critical for maximal strength and power output. Dr. Patrick Vallance highlights that clinicians can optimize rehabilitation by profiling individual deficits and selecting interventions—such as high-intensity resistance training or pain-modulating adjuncts like TENS—to address specific neural pathways. Unlike patellar tendinopathy, Achilles tendinopathy often involves greater cortical inhibition and muscular endurance deficits, necessitating distinct, endurance-focused rehabilitation strategies rather than a one-size-fits-all approach to lower limb tendinopathy.