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Finding the sweet spot via personalised Achilles tendon training: the future is within reach
  1. Claudio Pizzolato1,2,
  2. David G Lloyd1,2,
  3. Ming H Zheng3,
  4. Thor F Besier4,
  5. Vickie B Shim4,
  6. Steven J Obst5,
  7. Richard Newsham-West1,2,
  8. David J Saxby1,2,
  9. Rod S Barrett1,2
  1. 1 School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
  2. 2 Gold Coast Orthopaedics Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
  3. 3 Centre for Orthopaedic Translational Research, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
  4. 4 Auckland Bioengineering Institute and Department of Engineering Science, University of Auckland, Auckland, New Zealand
  5. 5 School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia
  1. Correspondence to Dr Claudio Pizzolato, School of Allied Health Sciences, Griffith University, Southport, QLD 4222, Australia; c.pizzolato{at}

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Musculoskeletal tissues, including tendon, are sensitive to their mechanical environment, with both excessive and insufficient loading resulting in reduced tissue strength. Although further research is required to elucidate the specific loading conditions (ie, magnitude, duration, frequency and rate) that maximise tendon adaptation, in vitro 1 2 and in vivo 3–6 evidence indicates tendon has an optimal range or ‘sweet spot’7 within which mechanical loading promotes positive tissue adaptation or homeostasis, with either too much or too little loading being detrimental (figure 1). In vitro bioreactor studies of rabbit Achilles tendon have shown that continuous 8 hours/day for 6 days of 6% cyclic strain at 0.25 Hz maintains1 and promotes2 tendon health, but the same duration and frequency with strain magnitude of 3% and 9% disrupted the extracellular matrix. Tendons that were load-deprived for 12 days increased their expression of collagen of inferior material properties (ie, type III) and had diminished mechanical performance. Health of these load-deprived tendons, represented by increased expression of type I collagen, was restored following the same loading regime (6 days, 8 hours/day, magnitude 6%, 0.25 Hz). In vivo studies have also systematically modulated Achilles tendon training regime by varying strain magnitude,3 6 8 duration,6 rate6 and frequency.3 6 Training at a frequency of 0.17 Hz and strain magnitude of 6.5% resulted in superior …

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  • Contributors CP, DGL, SJO, DJS, RN-W, RSB, MZ, TFB and VS contributed to conceptualise, draft, critically revise and approve the final version of the article.

  • Funding This work was supported by the Australian Research Council Linkage Project scheme (LP150100905).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.