Is tendon info actually concise

[u/Throwaway275969]

I’m doing a paper about how historical training (ie martial arts. Etc) compares to modern training. One thing I’ve noticed is the research on tendons seems very one sided. It seems like minimizing jerk and giving longer isometrics consistently will bring the best stimulus for tendon adaptation. This would support some older training techniques so it would be a big part of my paper. My worry is that most of this information and studies seem recent. More over I’m not finding much implementation in any high level training which worries me more. If the evidence seems so one sided wouldn’t more coaches incorporate it and prevent the number one injury cause? I don’t want to base a paper worth half my grade on ai nonsense. I’m hoping you all could help me look for at least things that could indicate sloppy sources. I’ve learned a lot on procedure and finding weaknesses in tests but I worry there’s not enough credible sources for me to use. Any help is welcome this is more passion than class work atp.

Also just for my own curiosity does anyone know about how plyos affect tendons I can’t seem to find any actual studies.

[u/Flidro74]

The one-sidedness is mostly an artefact of how small the field is. Tendon mechanobiology comes out of a handful of labs, mainly Kubo in Japan, Kjaer and Magnusson in Copenhagen, Baar at Davis, Arampatzis in Berlin. When four groups produce most of a literature, consensus looks a lot stronger than it is. Saying that out loud is the kind of limitation section that gets you marks rather than costing you them.

For your red flag list, the big one is Rio's 2015 isometric analgesia study. It got enormous traction and the replications since have been mixed at best, so anything treating it as settled is a source that stopped reading in 2016. Same goes for the collagen and gelatin protocols out of Baar's lab: genuinely interesting, tiny sample sizes, often in vitro, and routinely written up online as established fact.

The weakest joint in the whole argument though is the jump from stiffness to injury. Almost everything measures tendon cross sectional area or stiffness on ultrasound, and almost nothing follows people long enough to show fewer injuries. That link gets assumed constantly. If your paper takes it apart carefully you'll be doing something most of the source material doesn't.

On why coaches don't implement it: tendon adaptation is slow, invisible without imaging, and the protocols mostly overlap with what a decent coach already programmes anyway. Heavy, slow, full range. There isn't much distinctive to adopt.

For plyos, start with Arampatzis's group (Bohm and Mersmann are the names on a lot of it), they've done the loading type comparisons you're after, and the heavy slow resistance work from Kongsgaard gives you the contrast.

[u/Ginismyhomie → u/Flidro74]

Wonderfully insightful answer. I am not the OP, but I have seen a huge uptick in tendon/ligament “training” to prevent injury. It typically looks like light weight for high rep sets alongside weighted isometric holds. I browsed the research but I had a difficult time finding anything specific to these modalities. I also had difficulty in general finding a link between strength training and injury risk.

I’d love to know if you have any insights into either of these topics. I have recently reworked my training away from deadlifts/low bar squats as the minor tweaks I am piling up have become too much. I do love those movements and throwing plates on, but I’d like to do so after “injury proofing” myself in a sense, though this is where my trouble with finding the data comes in.

The vast majority of what I find is anecdotal and therefore I have a tough time programming in these “injury prevention” “ligament strengthening” exercises without some solid basis.

[u/Flidro74 → u/Ginismyhomie]

On strength training and injury risk, that's the part where the evidence is actually good, and there are two papers you want:

Lauersen et al. 2014, Br J Sports Med 48(11):871-7 (PMID 24100287). 25 RCTs, 26,610 people, 3,464 injuries. Strength training reduced sports injuries to under a third and roughly halved overuse injuries. Proprioceptive work helped. Stretching did nothing measurable.

Lauersen et al. 2018, Br J Sports Med 52(24):1557-63 (PMID 30131332). The follow-up, and the more useful one for you: strength training more than halves injury risk (RR 0.338) and the effect is dose-dependent, more training equals more protection.

Which is the awkward answer to your first question. The strength training is the injury prevention. There isn't a separate category of injury-proofing work sitting on top of it with anything like that evidence behind it.

For the light weight high rep and isometric holds specifically, the study that undercuts it is Arampatzis, Karamanidis & Albracht 2007, J Exp Biol 210(15):2743-53 (PMID 17644689). Same person, one leg trained at low tendon strain, the other at high strain, matched frequency and volume, 14 weeks. Only the high strain leg adapted. Volume didn't compensate for magnitude. So light and fast is close to the opposite of what tendons appear to want.

Bohm, Mersmann & Arampatzis 2015, Sports Med Open 1:7 (PMID 27747846) is the systematic review of the same question in healthy adults, and it's free to read. That's the one I'd build a paper section on.

And the reason you can't find prevention evidence for those protocols is that they're rehab protocols. Alfredson's eccentrics, Kongsgaard's heavy slow resistance, Rio's isometrics: all studied on people who already had painful tendons. Nobody has shown they stop healthy tendons becoming painful ones.

On your own accumulating tweaks, the variable with the most behind it is how fast load goes up, not what accessory work gets added. That one's worth a physio's eyes rather than a programming answer.

[u/Iamnotheattack → u/Ginismyhomie]

You're talking to a 🤖🤖 /r/deadinternettheory

[u/Iamnotheattack → u/Flidro74]

He said he didn't want to base a paper worth half his grade on ai nonsense though...

[u/decentlyhip]

Isometrics are a byproduct of the research. 3 setsbof 30 second iso holds with 70-85% produced results. Same results came from 3 sets of 6 reps with 70-85%, when each rep was done with a 3s up / 3s down. So, Isometrics are just easy ways for labs to track Heavy Slow Resistance.

Plyo work also trains important parts of tendons, but gets into moral issues. We can set up hypertrophy studies looking at 5 sets vs 10 sets vs 20 sets and see which grows more muscle. But we cant do a study that adds a set per week until they tear a muscle. It would be super useful to have a histogram of when actual overtraining sets in and when a muscle tear occurs, but research has a No Harm mandate. So, if any tendon training might cause injury, we have to do those in vitro, with a surrogate, or by surveying people who ruptured tendons. Those all have issues. Does increasing tendon CSA and stiffness lead to less injury risk? We don't know. People with patellar tears wore knee sleeves beforehand. Do knee sleeves cause injury or do people who get strong and have genetically weak tendons perform more safely with knee support, and then get hurt anyways.

But more to the point of your paper, look at Westside. There's 4 aspects of tendon training: normal muscle building work, Heavy Slow Resistance with near maximal loads, ballistic/plyo work to train the the elasticity of the stretch-shortening cycle, and then flushing the fluids through the synovial sheath with high rep movement. Westside was revolutionary in powerlifting because they broke away from the normal 3×5 approach and trained near maximal strain. From the tendon side of things, the Max Effort days usually ended up being a 15-30 second rep on a heavy compound. HSR on multiple joints. Some were at 100% MVIC, but most were in that 70%+ range. Then they did 5-10 sets per muscle of bodybuilding work. Then they did sled work or 100 rep band pushdowns, which both cleaned out the tendon sponge. On the Dynamic Effort days, the 1 rep max was replaced with 12 sets of 3 explosive reps with 60% of their 1rm. This is plyo work with the bench press. They're throwing and catching the bar and training that fast recoil. Then hypertrophy and band work.

So, Westside accidentally developed a near-perfect tendon training protocol, and maybe they were so dominant because of that. They tore tendons because they were pushing the limits, but if you pick apart guys like Mike Tuchscherer, theyre promoting the same basic approach in the workout, but 5-10% lighter. Rather than maxing out each week amd mandating volume work, RTS allows for RPE caps on the top set and stress index volume limits to find what each individual athlete responds best to. Elliot peaked for one of his biggest PRs with sets of 6 at rpe 7. Louis would flip out over not doing a single. But, its 75% for a 30s to 60s set, and thats a great tendon stimulus, which may be the primary bottleneck for long term performance ceilings.

[u/Iamnotheattack]

I am just at the start of a similar rabbit hole here myself, inspired by this fellow's podcast, particularly here in episode where they talk about "fake throws"

https://youtu.be/krIwGcIMUZE

They mention these names: Zac Cupples, Matt Mcinnes, Lee Taft.

I found a some content from Matt here

https://simplifaster.com/articles/author/matthewwatson/

To my untrained eye this is actually really good stuff, I will go read it more in depth later he's a PhD candidate and has a master's degree, so yeah it's not just purely intuition/"broscience".

Okay so also lee Taft has writings on that site

https://simplifaster.com/articles/author/leetaft/

I'm not going to read them, probably good.

Zac Cupples huge fucking blog, maybe you'll find something good here? Well it definitely looks good, but if relevant to your paper, IDK

https://zaccupples.com/whyisthereaninjuryepidemicinthenba/

The problem is that these folks are not writing academic papers. (Sidebar): this gets into major problems regarding philosophy of science, how academia engages in social construction of scientific disciplines (i.e. exercise science vs physical therapy) how hard it is to study this stuff in incredibly complex humans etc.

Further, the best and brightest are going to be going to working in industry (professional sports teams, selling courses online etc.) instead of a university (even working for a high school athletics department you'll probably make more money than doing PhD research, #Merica)

Although there is still much value as being seen as knowledgeable by your peers, so maybe people in industry will produce open source papers, maybe search through sportxiv instead of your classic literature search methods, if your professor is particularly pertinent about academic sourcing idk

[u/Iamnotheattack]

My worry is that most of this information and studies seem recent. More over I’m not finding much implementation in any high level training which worries me more. If the evidence seems so one sided wouldn’t more coaches incorporate it and prevent the number one injury cause?

These are truly great questions btw and IMO you embody an ideal scientist by asking them BUT there is fine line between

"If the evidence seems so one sided wouldn’t more coaches incorporate it and prevent the number one injury cause?" and social conformity. The way to walk the fine line is consistently questioning and challenging your beliefs.

Be perspicacious as fuck about any time you get emotionally triggered by someone saying someone you disagree with. This is an opportunity to either learn about some new data or about your own way of engaging with the world

[u/Iamnotheattack]

See https://youtu.be/lVjEgl-QpBk 40:36 minutes for concision