Tendon neuroplastic training and motor cortex excitability in patellar tendinopathy: a literature review

Abstract

Patellar tendinopathy (PT) is a common overuse condition, particularly among athletes involved in jumping and running activities. Although traditionally considered a local tendon disorder, increasing evidence suggests that changes in motor control and corticospinal excitability may contribute to persistent symptoms and impaired function. Tendon neuroplastic training (TNT) combines progressive tendon loading with externally paced exercise or timing cues intended to influence motor-system adaptation. Objectives were to review evidence regarding TNT, exercise-based rehabilitation, and neurophysiological changes associated with PT, with emphasis on the potential relationship between TNT and motor cortex excitability. A literature review was conducted using PubMed, Google Scholar, and ResearchGate. Studies related to PT, TNT, corticospinal excitability, motor cortex excitability, and exercise-based rehabilitation were considered. English-language studies published between 2004 and 2026 were included. Studies unrelated to PT, TNT, motor cortex excitability, or tendon rehabilitation were excluded. The literature was organized into three groups: studies directly investigating TNT, exercise-based rehabilitation studies in PT, and studies investigating motor cortex or corticospinal excitability in PT. Direct TNT studies were predominantly conducted in lateral elbow tendinopathy and reported improvements in pain and function. Studies in PT demonstrated beneficial effects of progressive tendon loading, including eccentric, heavy slow resistance, and isometric exercise. Neurophysiological studies demonstrated alterations in corticospinal and cortical excitability in individuals with PT. TNT represents a promising neurophysiologically informed approach that may complement progressive tendon-loading rehabilitation. However, direct evidence demonstrating that TNT modifies motor cortex excitability or is superior to conventional rehabilitation in PT remains insufficient.