{"id":28525,"date":"2026-08-04T22:00:31","date_gmt":"2026-08-04T20:00:31","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=research&p=28525"},"modified":"2026-08-04T19:27:00","modified_gmt":"2026-08-04T17:27:00","slug":"tendon-neuroplastic-training-for-lateral-epicondylalgia","status":"publish","type":"research","link":"https:\/\/www.physiotutors.com\/research\/tendon-neuroplastic-training-for-lateral-epicondylalgia\/","title":{"rendered":"Tendon Neuroplastic Training for Lateral Epicondylalgia: Is Neural Adaptation the Blind Spot of Exercise-Based Rehabilitation?"},"featured_media":28532,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"featured-tag":[],"tracking_tag":[2194,2204],"class_list":["post-28525","research","type-research","status-publish","has-post-thumbnail","hentry","tracking_tag-elbow","tracking_tag-exercise"],"acf":{"free_access":"unfree","app_link":"https:\/\/app.physiotutors.com\/research-reviews\/tendon-neuroplastic-training-for-lateral-epicondylalgia","sections":[{"acf_fc_layout":"page-header-small","background":{"background_image":28531,"background_image_alt_text":""},"heading":"Tendon Neuroplastic Training for Lateral Epicondylalgia: Is Neural Adaptation the Blind Spot of Exercise-Based Rehabilitation?","subheading":"Khan et al. (2025)","benefits":[{"benefit":"This double-blind randomized controlled trial investigated whether tendon neuroplastic training leads to better outcomes compared to stretching and myofascial release in lateral epicondylalgia"},{"benefit":"The study found that tendon neuroplastic training demonstrated greater outcomes in terms of pain and disability at 4 weeks"},{"benefit":"However, several study limitations limit a definite conclusion regarding tendon neuroplastic training for epicondylalgia"}]},{"acf_fc_layout":"content","background_color":"none","content_alignment":"left","content_editor":"

Introduction<\/h2>\r\nLateral epicondylalgia is a common tendinopathy affecting the common extensor tendon origin at the lateral elbow. Current evidence-based management emphasizes progressive mechanical loading, with heavy slow resistance (HSR) training widely recommended because of its favourable outcomes in several tendinopathies. However, the response to HSR appears to be less consistent in individuals with lateral epicondylalgia. As discussed in a previous Physiotutors\u2019 review<\/a><\/span>, adherence to HSR programs may be challenging in this population, as heavy loading can aggravate pain and limit exercise tolerance.<\/span>\r\n\r\nBeyond tendon pathology, lateral epicondylalgia is associated with impairments in proprioception and motor control, suggesting that rehabilitation may benefit from targeting both the tendon and the nervous system. Tendon Neuroplastic Training combines progressive tendon loading with externally paced contractions to promote neuroplastic adaptations, aiming to improve proprioception, motor control, and joint stability while simultaneously loading the affected tendon. Encouraging results have been reported for tendon neuroplastic training in patellar and rotator cuff tendinopathies.<\/span>\r\n\r\nGiven the limited evidence regarding <\/span>tendon neuroplastic training for epicondylalgia<\/span>, this study aimed to investigate its effects on pain, grip strength, and disability in individuals with lateral elbow tendinopathy.<\/span>\r\n\r\n \r\n

Methods<\/h2>\r\nThis study is a double blind randomized controlled trial and was conducted according to the CONSORT guidelines.\u00a0<\/span>\r\n\r\nSample size was calculated to account for the risk of dropout; the final number of patients was 34. The sampling method used was non-probability convenience sampling.\u00a0<\/span>\r\n\r\nParticipants were recruited using convenience sampling. Eligible participants were adults aged 25\u201345 years with clinically diagnosed lateral epicondylalgia, defined by pain and tenderness over the lateral epicondyle and at least two positive clinical tests (Maudsley's<\/a>, <\/span>Mill's<\/span><\/a>, or Cozen's<\/a> test<\/span>). Individuals with recent elbow trauma or surgery, tendon rupture, cervical radiculopathy, radial nerve entrapment, major upper limb surgery, tumors, compartment syndrome, concurrent treatment, prior treatment history, or high pain catastrophizing (PCS > 30) were excluded. The trial was double-blinded, with both participants and outcome assessors blinded.\u00a0<\/span>\r\n\r\n[caption id=\"attachment_28526\" align=\"alignnone\" width=\"1168\"]\"Tendon From: Khan et al., BMC Musculoskelet Disord (2025)[\/caption]\r\n\r\n \r\n\r\nIntervention<\/strong>\r\n\r\nBoth groups received a 10-minute hot pack before exercise sessions. The experimental group performed <\/span>tendon neuroplastic training for epicondylalgia<\/span>, consisting of paced isotonic wrist flexion and extension exercises using a dumbbell. Movement speed was synchronized with an audio-visual metronome application (20 beats\/min, 3 seconds per beat), allowing 3-second concentric and eccentric phases. Participants completed 4 sets of 8 repetitions with 2-minute rest intervals. The exercise load was progressively increased from 1 lb initially (pain \u22645\/10 during exercise), to 3 lb by the second session, and up to 5 kg between weeks 2 and 4. Tendon neuroplastic training was performed three times per week for 4 weeks.<\/span>\r\n\r\nThe active control group received wrist extensor stretching and myofascial release targeting the lateral epicondyle region. Myofascial release was applied for 5 minutes, with two repetitions per session, while stretching was performed with the elbow extended, forearm pronated, and wrist flexed with ulnar deviation. Sessions were also conducted three times weekly for 4 weeks.<\/span>\r\n\r\nOutcome measures<\/strong>\r\n\r\nOutcomes were assessed at baseline and after 1, 2, 3, and 4 weeks. Primary outcomes included:<\/span>\r\n