Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes

Abstract

Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.

Inertial Flywheel Resistance Training in Tendinopathy Rehabilitation: A Scoping Review

“…41 For several decades, heavy eccentric and more recently, heavy slow resistance training have been considered the conservative cornerstone of manging lower limb tendinopathies, as supported by evidence. 45 However, the preeminent HSRT protocol in patellar tendinopathy, known as the Kongsgaard protocol in reference to the authors who developed it, which has shown efficacy in several RCTs, 29,46-50 was found to be no more effective than IFRT, for improving pain, function, strength, power, and tendon properties. The RCT highlighted how several clinical and physical outcomes could be improved by IFRT at a comparable level to the gold standard HSRT protocol.…”

Blood Flow Restriction Training for Tendinopathy Rehabilitation: A Potential Alternative to Traditional Heavy-Load Resistance Training

“…As previously discussed, resistance training has the highest quality evidence of effectiveness out of all tendinopathy treatments, with heavy-load eccentric and HSRT typically recommended due to their documented beneficial effects [256][257][258][259] The long-held belief that resistance training must be applied with heavy-loads to derive positive adaptations in tendinopathy could be a potential barrier and explanation for the dearth of the application of BFRT in the literature. However, the lack of investigation of LL-BFRT in tendinopathy rehabilitation, may be counterproductive, as it could be an alternative option for those populations unable to tolerate traditional heavy-load training.…”

“…If such findings are confirmed in future research, the consequences for tendinopathy rehabilitation may be significant, with a potential paradigm shift in resistance training treatment recommendations, away from the current homogenous heavy-loading prescriptions for all patients. The availability of LL-BFRT as a proven, safe, and efficacious treatment option, would increases the viability of options for clinicians and give patients more choice in treatment selection, which may have far-reaching implications in areas such as training adherence, which has been identified as a problem area in resistance training for tendinopathy [259]. Whilst athletic individuals and those with resistance training experience may have less issues adhering to HL-RT, there may be implementation barriers to its prescription in those unaccustomed to HL-RT or resistance training in general such as elderly populations or those with significant co-existing medical issues [265,266].…”

The Effectiveness of Combined Extracorporeal Shockwave Therapy and Exercise for Plantar Heel Pain: A Systematic Review

“…14,46 Exercises other than stretching should be combined with ESWT, such as HSRT, and methods for individualising exercise interventions should be considered to improve outcomes compared to standardised interventions. 9, 47 Using standardized intervention protocols and validated outcome measures would also allow better translation of findings. Future studies should also emphasise the importance of completing and returning exercise diaries to monitor adherence.…”