![]() Changes in motor output, however, are a combination of changes in the excitatory and inhibitory neural pathways. In the CNS, the primary regions involved in motor control are the primary motor cortex and corticospinal tract, which activate the motor neurone pool and control motor function. This may contribute to persistence of tendon pain through the continuation of aberrant motor patterns. Exercises that are painful to complete may change motor control and cause cortical reorganisation, as pain itself is known to alter cortical representation. The effect of exercise on the motor cortex may be modulated in the presence of pain. The pain inhibition following a local isometric contraction, demonstrated in previous studies of normal participants, is widespread 12 this indicates central nervous system (CNS) involvement and warrants investigation. Isometric muscle contractions have been shown to reduce pressure pain thresholds in normal participants, 11, 12 but have not been investigated in tendon pain. Isotonic exercise (heavy, slow, concentric and eccentric resistance training) has been shown to be as effective as eccentric only exercise in patellar tendinopathy (PT) for tendon pain and activity participation 1, 10 however, the immediate effect of isotonic exercise on pain has not been studied. Therefore, alternative muscle contraction types, other than eccentric exercises, warrant investigation. Third, exercises that reduce pain are likely to have greater adherence. Second, exercise is non-invasive and without potential pharmacological side effects or sequelae of long-term use that are associated with some interventions. First, athletes may be able to manage their pain with exercises either immediately prior to or following activity. 8 Athletes are reluctant to cease sporting activity to complete eccentric exercise programmes 9 and they may be more compliant with exercise strategies that reduce pain to enable ongoing sports participation.Įxercise-induced pain relief would have several clinical benefits. 6 Where eccentric exercise has been completed in the competitive season, there has been poor adherence due to increased pain, and either no benefit 7 or worse outcomes. ![]() 5 Tendinopathy is especially problematic in the competitive season, when there are constant time and performance pressures. Eccentric exercise, which is the most commonly prescribed exercise for the treatment of tendinopathy, 1–4 is often painful to complete. Tendinopathy (tendon pain and dysfunction) in athletes is difficult to manage. Box 527, Frankston, Melbourne, VIC 3199, Australia
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