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Tendinopathy Adaptation Principles and New Clinical Framework

Peter Malliaras explains how tendons adapt to load, what drives stiffness, and how to use the optimal strain range to build tendon capacity without overload. Read more ↓

5 Episodes 1h 5m

In this lecture you will learn how tendons adapt to load, what drives changes in stiffness, why strain thresholds are important, and how muscle–tendon unit properties influence performance and injury risk. We will cover the latest research on viscoelastic mechanisms, loading variables, and the time course of adaptation, and how these principles can be applied in clinical and performance settings. A key takeaway will be how to identify and use the optimal strain range (around 4.5–6.5 percent for Achilles) to design loading programs that build tendon capacity while minimising the risk of overload.

Learning outcomes

1. Describe the key factors that influence tendon stiffness and strain, and their implications for injury and performance.
2. Interpret current evidence on viscoelastic mechanisms and time course of tendon adaptation.
3. Apply optimal strain range principles to design safe and effective tendon loading strategies.

Episodes

Is Tendon Stiffness Good, How It Is Measured and How to Build It

Whether a stiffer tendon is always better, how Achilles tendon stiffness is measured with ultrasound and a dynamometer, and which types of loading reliably build stiffness and how quickly the tendon adapts.

Force-Velocity, Joint Position and the Minimum Effective Loading Dose

How the force velocity curve, joint position and moment arm shape tendon strain, and what research says about the minimum effective dose of isometric loading needed to stiffen a tendon without causing fatigue.

Tendon Viscoelasticity, Adaptation Mechanisms and Isometric Stages

How the viscoelastic properties of tendon, fluid movement and stress relaxation contribute to adaptation, and a staged isometric progression from yielding holds through push isometrics and slow eccentrics to outer range pushes.

Assessing and Progressing Achilles Isometrics in the Clinic

How to assess and progress Achilles isometrics in the clinic, from weighted holds in three ankle positions to seated and standing push tests on a force plate and pushes in full dorsiflexion.

A Rugby Player Case and the Mismatch Between MVIC and Tendon Strain

A professional rugby player case shows the isometric progression in practice, followed by why MVIC is an unreliable guide to tendon strain and how to match training to mismatches between muscle strength and tendon stiffness.

In this lecture you will learn how tendons adapt to load, what drives changes in stiffness, why strain thresholds are important, and how muscle–tendon unit properties influence performance and injury risk. We will cover the latest research on viscoelastic mechanisms, loading variables, and the time course of adaptation, and how these principles can be applied in clinical and performance settings. A key takeaway will be how to identify and use the optimal strain range (around 4.5–6.5 percent for Achilles) to design loading programs that build tendon capacity while minimising the risk of overload.

Learning outcomes

1. Describe the key factors that influence tendon stiffness and strain, and their implications for injury and performance.
2. Interpret current evidence on viscoelastic mechanisms and time course of tendon adaptation.
3. Apply optimal strain range principles to design safe and effective tendon loading strategies.

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Tendinopathy Adaptation Principles and New Clinical Framework

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Series info

5 Episodes

1h 5m

Oct 2, 2026