Tendon Neuroplastic Training (TNT) introduces the concept of pacing through rhythmic external stimuli, like metronomes, to optimise recovery. But why is this seemingly simple addition so effective?
The answer lies in how our brain coordinates movement. When we experience tendon pain, such as in Achilles tendinopathy, our motor control—the brain’s ability to efficiently guide muscles—becomes disrupted. This not only leads to pain but can also impact our ability to perform everyday movements. TNT addresses these motor control issues by helping to “retrain” the brain using external pacing.
Why Rhythm Matters: The Science Behind Pacing
At the heart of Tendon Neuroplastic Training is the idea that the brain’s plasticity can be harnessed to aid in tendon recovery. Neuroplasticity is the brain’s ability to adapt, reorganise, and form new neural connections. By incorporating rhythmic external stimuli, such as the sound of a metronome or music, we can restore the brain’s ability to regulate motor output. Essentially, rhythm serves as a cue for the brain, guiding it to regain its control over the muscles affected by tendinopathy.
The metronome is used to guide patients through tendon loading exercises. Each beat ensures the patient performs the movement with a consistent tempo, which in turn helps maintain motor control. Over time, this retrains the brain to send proper signals to the muscles, preventing further injury or re-aggravation of the tendon.
The Practical Benefits of Pacing
- Consistency in Movement: Tendinopathy often causes patients to avoid certain movements or perform them irregularly due to pain. The metronome enforces a regular rhythm, helping to avoid compensatory patterns.
- Engagement: The sound of the metronome adds a layer of focus for patients, keeping them engaged with the exercise and aware of their movement patterns.
- Improved Load Management: TNT utilises progressive tendon loading, and the pacing helps ensure that patients are loading tendons in a controlled, safe manner, preventing overloading.
- Brain-Body Connection: The brain, which may have formed maladaptive responses due to injury, gradually learns to work with the tendon again. This reconditioning is crucial for long-term recovery.
From Clinic to Daily Life
The beauty of pacing techniques lies in their simplicity and ease of application. A metronome or rhythmic guide can be integrated into various exercises, from simple calf raises to more complex plyometric movements. As the patient progresses, they can adjust the tempo, increasing or decreasing it based on their level of comfort and control.
Interestingly, the use of pacing extends beyond tendon rehab. It can also be applied to sports performance, where athletes use rhythm to refine their movements and enhance muscle memory. Musicians, for example, rely on metronomes to fine-tune their timing. Similarly, TNT can be likened to “fine-tuning” the brain-muscle connection, helping patients regain full, pain-free function.
Conclusion: Pacing for a Pain-Free Future
Tendon Neuroplastic Training and the use of external pacing offer an exciting, brain-centred approach to tendon rehabilitation. The use of rhythmic stimuli is proving to be a game-changer in tendon rehab, helping patients regain motor control, consistency, and strength. By “moving to the beat,” patients are able to engage more fully in their recovery and pave the way for long-term tendon health.
References
Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2016). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British journal of sports medicine, 50(4), 209–215. https://doi.org/10.1136/bjsports-2015-095215