Tendons with Peter Malliaras

03/08/25 • 75 min

Chapters

00:00 Introduction and Current Work 02:51 Shockwave Therapy: Efficacy and Mechanisms 06:07 Understanding Tendon Pathologies 09:00 Calcification and Adaptation in Tendons 11:55 The Role of Shockwave in Clinical Practice 15:12 Platelet-Rich Plasma (PRP) Insights 18:06 Stem Cells and Tendon Healing 20:57 Adjuncts in Tendon Rehabilitation 23:48 Heel Wedges: Evidence and Application 27:06 Loading Strategies for Tendinopathy 30:04 Compression and Tendon Mechanics 32:56 The Importance of Loading in Rehabilitation 35:51 Tendon Stiffness: Heavy Loads vs. Plyometrics 42:01 Understanding Tendon Loading Mechanisms 45:25 Isometric vs. Eccentric Loading for Tendon Adaptation 48:23 Maximal Eccentrics: Techniques and Applications 51:45 Fluid Movement and Tendon Health 55:35 The Role of Metabolism in Tendon Adaptation 01:01:10 The Complexity of Tendon Pathology 01:06:29 The Dynamics of Fluid Movement in Tendons 01:11:11 Plyometrics vs. Isometrics: Strain and Adaptation 01:14:05 Blood Flow Restriction Training and Tendon Adaptation 01:18:21 Metabolic Factors in Tendon Healing

Takeaways

Peter Malairis is a full-time professor at Monash University. Recent research shows shockwave therapy is ineffective for tendon pain. Calcification in tendons may be an adaptive response. PRP injections do not outperform placebo treatments. Stem cell therapy lacks sufficient evidence for tendon healing. Adjunct therapies should be accessible, cheap, and safe. Heel wedges have shown significant effects in treating Achilles tendinopathy. Loading strategies must be tailored to individual patient needs. Tendon stiffness is primarily improved through heavy loading. Fluid movement within tendons is essential for adaptation. Loading the tendon heavier leads to better fluid movement. Isometrics are crucial for early rehabilitation stages. Heavy maximal eccentrics are key for long-term adaptation. Fluid movement impacts stress relaxation in tendons. Tendon stiffness increases with appropriate loading. Metabolic health is essential for tendon adaptation. Pathological tendons may require different loading strategies. Fluid movement can help reduce pain and improve function. Plyometrics may not provide sufficient strain for adaptation. Blood flow restriction can be effective for tendon rehabilitation.

Website: https://www.tendinopathyrehab.com

Instagram: https://www.instagram.com/tendinopathyrehab/?hl=en

Twitter: https://x.com/DrPeteMalliaras

Email: [email protected]

Notes: https://jackedathlete.com/podcast-131-tendons-with-peter-malliaras/

Chapters

Takeaways

Website: https://www.tendinopathyrehab.com

Instagram: https://www.instagram.com/tendinopathyrehab/?hl=en

Twitter: https://x.com/DrPeteMalliaras

Email: [email protected]

Notes: https://jackedathlete.com/podcast-131-tendons-with-peter-malliaras/

Previous Episode

Tendons with Gerard McMahon

Chapters

00:00 Introduction to Tendon Research and Background 02:51 Understanding Tendon Mechanics and Strain 06:14 The Role of Tendons in Human Movement 09:07 Tendon Strain: Hierarchical Structure and Function 11:58 The Impact of Load and Speed on Tendon Behavior 15:08 Exploring Tendon Creep and Adaptation 18:05 Mechanotransduction and the Importance of Time 21:01 Pediatric Tendon Development and Muscle-Tendon Imbalance 24:00 Training Tendons: Strength vs. Plyometrics 26:46 Viscoelasticity and Tendon Behavior 30:14 Conclusion and Future Directions in Tendon Research 37:42 Understanding Tendon Behavior: Elasticity vs. Viscosity 42:04 The Sweet Spot of Tendon Strain 47:15 Blood Flow Restriction: Mechanisms and Efficacy 52:18 Tendon Compliance: Training and Adaptation 57:06 Passive Stretching: Effects on Tendon Adaptation 01:01:17 Training Age and Tendon Stiffness 01:06:29 Sex Differences in Tendon Adaptation 01:11:03 Future Directions in Tendon Research

Takeaways

Dr. McMahon's background includes a PhD in tendon mechanics. Tendons are part of a muscle-tendon-bone complex. Tendon strain is the relative change in length compared to its original length. Tendons have their own metabolism, albeit at a lower scale than muscles. The hierarchical structure of tendons serves to protect against stress. Tendon stiffness can increase with load and speed of movement. Creep occurs under constant load, affecting tendon length over time. Mechanotransduction requires time for effective cellular response. Pediatric tendon development may lead to imbalances with muscle strength. Strength training is more effective for tendon adaptation than plyometrics. Tendon behavior involves both elasticity and viscosity simultaneously. There is a sweet spot for tendon strain duration, ideally between 3 to 15 seconds. Longer isometric holds may not benefit healthy tendons. Blood flow restriction (BFR) may not have unique benefits over traditional training. Tendon compliance can be improved by reducing resistance training. Passive stretching may yield some adaptation in untrained individuals. Training age influences tendon stiffness and adaptation. Sex differences exist in tendon adaptation, with females gaining stiffness at lower force levels. The relationship between training volume and tendon adaptation is complex and requires more research. Understanding how tendons perceive strain is crucial for future studies.

Gerard on Twitter: https://x.com/gerdy_mac

Notes: https://jackedathlete.com/podcast-130-tendons-with-gerard-mcmahon/

Next Episode

Tendons with Falk Mersmann

Chapters

00:00 Introduction to Tendon Research 02:33 The Berlin Method and Tendon Adaptation 05:56 Strain and Metabolic Factors in Tendon Adaptation 09:54 Volume and Frequency in Tendon Training 12:46 High Strain Rates vs. Low Strain Rates 17:34 Individual Variability in Tendon Response 20:22 Personalized Approaches to Tendon Training 24:38 Viscoelastic Properties of Tendons 29:23 Understanding Tendon Mechanics and Loading Effects 35:51 Personalization in Tendon Rehabilitation 39:34 The Complexity of Tendinopathy and Pain Management 44:31 The Berlin Method: A New Approach to Tendon Training 52:30 Muscle-Tendon Imbalance: Insights and Implications 01:01:35 Practical Recommendations for Tendon Health

Takeaways

Dr. Falk Mersman leads a research group in tendon adaptation. The Berlin Method is based on systematic investigation of tendon factors. Tendon adaptation is primarily strain mediated. High training volume does not necessarily lead to better tendon adaptation. High strain rates can lead to localized tendon failure. Genetic factors may influence tendon adaptation responses. Personalized training approaches can help balance muscle and tendon adaptation. Viscoelastic properties of tendons affect cellular responses. Tendon creep is a consideration in training protocols. Not all elite athletes experience tendon overuse injuries. Tendons exhibit stress relaxation but not creep effects under loading. Longer contraction durations may be more effective for tendon stiffness. Personalization in rehabilitation is crucial for tendinopathy patients. Pain management in tendinopathy is complex and requires tailored approaches. The Berlin Method integrates various loading factors for tendon adaptation. Muscle-tendon imbalances can lead to overuse injuries in athletes. Plyometric training is essential for enhancing sports performance. Regular tendon training can improve structural integrity and reduce injury risk. High intensity loading may not always be necessary for tendon adaptation. Understanding individual responses to loading is key in rehabilitation.

Notes: https://jackedathlete.com/podcast-132-tendons-with-falk-mersmann/

Falk's Email: [email protected]