Rather than just focusing on strength and building up the
load capacity of a muscle-tendon unit, the new technique also
addresses the deficits of motor control.
symptoms enough for them to be able to
maximise their involvement in the session.
This means that tendon pain no longer
needs to restrict athletes and clients from
participating in their chosen sport or activity!
It also adds to the client’s experience
by enabling them to exercise the area
and potentially introduce more movement
variability options to the affected muscletendon complex. This is a great benefit,
because a lack of movement variability
seems to be an important factor in the
development of chronic pain. The more painfree movement options that the body is able
to access, the less likely it is to travel down the
one painful path, thereby reducing the risk of
recurrence. For the client, it also engenders
the simple yet powerful appreciation that they
can continue to exercise.
For the trainer, it is exciting to note that
research on the quadriceps muscle found
that there was also a 19 per cent increase
in muscle strength over a four-week period.
So, how effective is TNT? As ACDC sang,
it’s dynamite.
Using TNT with your clients
When applying the TNT approach with
clients suffering tendinopathy pain, a high
load is required so that sufficient activity is
generated in the muscle tendon complex.
Light resistance is not effective. However,
the effort exerted should not be so high
that it induces pain. Keep in mind that the
exercise is supposed to create an analgesic
effect, so experiencing pain while it’s done is
not appropriate.
• Direct the client to perform the
appropriate isometric exercise.
• Ask them to tune in to a metronome
during the exercise, counting with the
beat if they wish. Alternatively, you can
provide an external verbal pacing.
• Advise the client to aim to hold the
contraction with maximal pain-free effort
for 30 to 60 seconds. If the client cannot
do so without experiencing pain, then
this is not the appropriate exercise for
them at this stage.
• Allow for a 1-minute recovery between
each isometric contraction. Repeat
isometric contractions, interspersed with
rest breaks, for as long as there is no
pain or discomfort.
• If the client becomes aware of, or
distracted by, discomfort that could be
44 | NETWORK SUMMER 2016
leading to pain, they should stop the
exercise. Practitioners should avoid
sensitising the nervous system with
repeated aggravating tasks.
Other TNT tips
• Remember that the intent of training is to
regain neural control, so it’s not
appropriate for the limb to shake with
effort!
• This is not a training program for
balance, so clients may hold onto
furniture for assistance if needed.
• If the exercise causes pain before 30
seconds is up, then the training load is
too high; make the exercise easier by
decreasing resistance. If the contraction
can be held easily for more than 60
seconds, the training load is too low.
• TNT can be utilised throughout the
whole body. Be sure to consult a
physiotherapist or health professional for
additional assistance.
• Extend the knee against the resistance
of the band in standing, and hold the
contraction isometrically. A slow
build-up and hold of heavy resistance
engages muscle activity and minimises
the risk of tendon pain exacerbation.
• Count with a metronome (backwards for
a mental challenge) for 30 to 60 seconds.
An externally paced hold of the
contraction, particularly with mental
distraction (counting), creates an
alternative program for cortical control of
muscles involved in the contraction. Once
the contraction is made, there is no need
for the client to think about the muscle or
tendon in particular, but rather, to just
hold the position under heavy load. This
type of training begins the process of
muscle activation that is automatic rather
than a conscious contraction.
• There should be effort with the contraction
but no pain. At the end of the contraction,
the client should notice that the affected
muscle tendon complex feels less irritable,
more strong, more stable or easier to
control. With symptoms more under
control, the client will be better able to
participate in, and enjoy, training.
TNT for patella tendon pain
In the case of training clients with patella
tendon pain, the following approach is
appropriate:
• Tie a heavy therapy band or tubing to a
stable upright.
• Place the band around the knee and
step back away from the upright until
sufficient tension is generated on the
band.
The 30-second article
• Tendon pain can be slow to treat and
easily aggravated, and recurrence
rates can be high, preventing clients
from maintaining their fitness regime
• A new tendon management approach
called TNT (tendon neuroplastic
training) stimulates the client's brain
at the same time that they perform
isometric strength training exercises
• This approach can induce immediate,
and natural, pain relief that can last
up to 45 minutes
• By enabling greater movement
variability, the body is less likely to
experience injury recurrence.
Extend the knee against the resistance of the band
in standing, hold the contraction isometrically
TNT offers a new dimension to training
clients with tendon pain and builds on the
foundation of previous research. It can be
used as a tool to enhance compliance with
training or as part of a self-directed and
active self-management program.
Stay tuned: with continuing research
into the mechanisms responsible for tendon
rehabilitation, more advances in this area
could be on the horizon.
Thuy Bridges, BAppSc (Physio) is the Director
of PhysioWISE physiotherapy and Pilates clinics in
Sydney, author of Length, Strength and Kinesio Tape
and an educator of dynamic presentations to health,
movement and fitness professionals worldwide.
physiowise.com.au
28-30 APRIL 2017 / ICC SYDNEY
Thuy is presenting at FILEX 2017 – find her
sessions at filex.com.au or in the brochure
accompanying this magazine