Notes
https://podcasts.apple.com/us/podcast/jacked-athlete-podcast/id1462537296?i=1000699042161
“So basically all of tendon adaptation is strain mediated. That is the most important mechanical factor.”
“Metabolic factors, they may play a role, of course, at a given amount of mechanical loading. But in comparison to mechanical loading, not as important. So it’s a minor factor.”
“When the stimulus for the tendon is more or less saturated in terms of the overall volume of mechanical loading which is necessary to stimulate the tendon metabolism, that basically additional mechanical loading may just lead to, let’s say, more wear of the tissue and increase the catabolic side of the response.”
“So any loading increases both anabolic and catabolic responses but if the anabolic responses start to level off at a certain point, then just adding mechanical loading may in the end either reduce the effectiveness or let’s think about really elite athletes which train 11 times a week or something like that. It may be actually too much for the capacity of the tendon to repair the microdamage that is associated with mechanical loading.”
“Tendon cells, which are actually stimulated due to a loading cycle, reduces with high strain rates. So in our view, physiological stimulus for the tendon, high loading is good, but at rather lower strain rates and longer strain durations.”
“Usually if you have a high strain rate, you also have a short loading duration in terms of sprinting, jumping, change of direction, something like that. So this usually comes in combination and we see as I said that many tendon cells are not receiving the stimulus because maybe the distribution of strain within the tendon tissue is not as homogeneous as when the strain is applied more slowly.”
“If you strain the tendon until failure, at very high strain rates, you cause more localized failure and at very low strain rates you cause more global or more distributed indications of failure, which if we go to the physiological level, suggests the idea that the strain distribution is more homogeneous if the strain is applied rather slowly.”
“With isometrics or heavy-slow resistance training, we consistently see increases in stiffness when the load magnitude is high enough. And then we have these studies on plyometric loading, and there the responses are very inhomogeneous.”
Falk (17:34)
The average increase or the average change in stiffness in response to climatic loading was actually not too bad in our study, but it was very homogeneous. So it’s really hard to predict how stem, how the tendon responds to these high strain rates.
Jake (17:42)
Absolutely.
Did you, do you have any speculation why it was so inhomogeneous with why were some people getting stiffness from plyometrics and some were not? Were there a variety of different, was there any commonality between those groups of people or was it just completely random?
Falk (18:13)
Basically, think with the methods that we are able to apply in vivo, we are very limited to identify these factors. So I’m quite sure that there is a genetic component which is also involved in how the mechanical load is converted into a cellular signal. There is research showing that
There are some genes that determine how these mechanosensors in tendons work, but we have no possibility to control for that in our labs. And also, aside from that, we of course documented habitual physical activity, the sports background, and so on, of the participants who took part in our experiment, but we were not able to establish clear…
Jake (19:07)
I have lots of business, I’ve been here a lot of times. But never
as a day adult. It’s one of the rarest things in the world.
Falk (19:11)
relationships there. it’s great questions why if
you give to on first view quite similar homogenous population to apply your medicine in terms of our tendon training and still the response is rather inhumane. So for most I would say we are still
wandering in the dark.
Jake (19:44)
Yeah, this I think because I talked to Gerard McMahon recently and he and there’s no straight no game paper he had he had a graph two types of people one was a very stiff tendon and in order for them to get a stiffer tendon they would have to train at a like a 90 % MVC to get it stiffer but someone who had a really compliant tendon they could train with really not as heavy means or not as specific means and still gain stiffness in their tendon.
Do you think you see any of this with someone coming in with a stiffer tendon versus a more compliant tendon? Does that exist with all these people you’ve looked at?
Falk (20:22)
Well, yeah, absolutely.
That is, thank you for that question, because that is actually maybe the, maybe not the only one, but a very key factor that we are able to control. And we started to control for that quite recently, that this prescription of loading, that we think we want to use rather high loads.
80 % or 90 % of an isometric MVC for example or 90 % of a repetition maximum. That is actually, as you said, for a person who already has more or less an imbalance of muscle strength and tendon stiffness or deficit in tendon stiffness, this loading would actually lead to very high strains, higher than necessary to…
to provide a good stimulus for tendon adaptation and also maybe putting in a predisposition to develop overuse injury. So that is something that we actually can do. It’s not easy, it’s not trivial to determine tendon strain in vivo, but it’s possible and we just finished three longitudinal intervention studies where we did exactly that.
Jake (21:37)
He’s the first man to go back to the United States.
Falk (21:42)
So the athletes came to our lab, we investigated muscle strength, investigated tendon stiffness, and then identified if there are more or less balanced muscle tendon units. These participants trained at unabated intensities, which are known to stimulate muscle strength, and in these cases also leads to tendon strain in the order of 5 to 6 percent, which is…
Jake (21:58)
I agree.
You know that.
Falk (22:10)
very good to promote handle adaptation. Then we had some athletes which had a deficit in muscle strength. This is rather rare, but it exists. That means that tendon strain during the maximum contraction is actually not too high. And since the compliance and elasticity of tendons is actually also helping us to perform well, it’s a good thing for physical performance.
There we said we try to find a mode of loading that is known to increase muscle mass and strength, but not so much provides stimulus for tendon adaptation. And so we chose medium loading, dynamic training, until muscular fatigue. So this metabolic stress, as we start to begin to understand, is not really a good…
driver for tendon adaptation and in these individuals at moderate loads the strain of the tendon was also not too high so what we actually achieved in this few individuals is that muscle strength increased more than tendon stiffness so restoring the balance. And the last subset of people which is actually quite a substantial amount so between depending on the cohorts 25 to maybe 40 percent of the athletes.
who have a deficit in tendon stiffness. And that means they do not need to train at very high levels of muscle force generation, quite individually between, let’s say, 50 and 75 % of their MBC. And since the overall loading volume that we subscribe is rather low, the muscle adaptation is not promoted to a great extent.
Jake (23:44)
you
Falk (24:10)
but more tendon stiffness. So basically also there we were able to restore a more balanced adaptation of muscle and tendon. And the benefits for the performance and for the reduction of tendon overuse injury, this is something that we need to gather more data because pain, example, tendon overuse, since there are so many factors and…
Jake (24:32)
you
Falk (24:38)
also individual factors, we actually need some larger sample sizes to statistically be able to show that this personalized approach is actually worth the additional effort. Because the additional effort is actually a lot, still we believe it’s good, particularly for patients with tendinopathy. This is what we are currently doing at this.
Jake (24:56)
Yeah.
Falk (25:07)
very weeks. are extensively in the lab and preparing to recruit participants with telegraphy to apply this personalized approach.
Jake (25:19)
Okay, I have a lot of questions on that, I might… But I wanted to go back to… Yeah, I have a few on that. I’ll come back to those. you… The homogeneous strain when you have a low strain rate versus the high strain rate, it’s inhomogeneous. It makes me think of… I did a show with Hazel Screen, and she has all that work on the intervascular matrix. Is this more of like a viscosity component, you think?
Falk (25:35)
Hmm? Hmm?
Jake (25:48)
why things can kind of shuffle around and then you can get load in certain areas that are not going to be loaded when you’re doing something that’s a high strain rate. Is that what you think is happening? Is things can kind of shuffle around and you can get load sharing in all the different regions? Or what do you think is happening? Okay.
Falk (26:03)
Exactly. Exactly.
Exactly. mean, that is also not our field of research, right? It’s our field of research, not our expertise here. We are looking at only global tendon strain in vivo. And for example, the group of hazel spleen, are very, very excellent work looking more into what actually happens within the tendon tissue. exactly that’s so on
Jake (26:07)
you
Falk (26:36)
the global level, these viscoelastic properties of tendons do not really show to a great extent, almost nonexistent. But we believe that within the tendon, these viscoelastic properties actually greatly affect, for example, how tenocytes are stimulated, how single fascicles are mechanically loaded, and also the loading gradients within the…
Jake (26:54)
Nice seat.
Falk (27:04)
the tissue may be very much affected by the extracellular matrix of the tendon and the low transduction between fibers and clasticles.
Jake (27:22)
So you can’t see the viscoelasticity if you look at the whole thing. Because all it does is it strains or it doesn’t strain, right?
Falk (27:30)
Yes, at physiological loading rates for example, we see that there is a preconditioning, so a totally unloaded tendon, if you start to form warm-up for example, there you will see over about 5 to 10 loading cycles, you will actually see a change in the mechanical behavior, but after that we do not see it anymore.
And what is done in cadaveric studies, you usually have this phenomenon that with a given load, tendon strain rather quickly increases. Then there is plateau coming for a lot of loading cycles. And then when there is material fatigue, the strain at a given force again increases under the tendon ruptures, for example.
And this is what we do not see in vivo because usually the muscle would fatigue prior to the actual failure of the tendon. At least if we talk about acute loading, right? Of course there is something like tendon rupture, no doubt about that, but that doesn’t develop within one loading session, right? This is a development that is progressing prior to that incident.
Jake (28:39)
you
The yeah, so I’ve thought that you guys have the three second isometrics that I when I first got into them there were there were 30 seconds like the Keith Barr prescription of 30 seconds and he was His I think his idea was tendon creep that you start holding and it gets longer and longer over the set But I’ve always been like isn’t the muscle fatiguing first so it can’t it can’t keep pulling as hard on the tendon So how could it creep? Do you do you think something like that is?
similar or do you actually get this slow elongation of the tendon even if the muscle is fatiguing?
Falk (29:30)
Yeah. So my supervisor did some experiments in 2006, 2007 addressing that issue. they both with dynamic loading and so dynamic cyclic loading and constant isometric loading. They were not able to show basically this
creep effect in tendons. So initially, so this preconditioning effect, this is actually observable, basically then indications for failure, let’s say, we do not see it in people. We don’t, no. yeah, nevertheless, basically what the ideas we are sharing with, for example, Keith Barr here is that
Jake (30:17)
Mm-hmm.
Falk (30:28)
there is stress relaxation within the tendon. We believe it’s not an important phenomenon on global tendon strain that really has an effect on, for example, performance or something like that. So that the deformation, the compliance of the tendon really substantially changes so much during the competition that it actually affects performance so much. But yeah.
that, where was I going now? Within the tendon, there are these effects that determine how strain is distributed to tendon cells and that this is one factor why we also promote slow types of loading with longer contraction durations. we also have a longitudinal study where we applied
single contractions of 12 second duration and we found that we were surprised that five sets with only one repetition over 12 seconds is actually increasing tendence stiffness. That was a big surprise for us. But still, doing not one cycle of 12 seconds but four cycles of three seconds was the more effective approach.
And we don’t know if six seconds may be better than three. We are not able to change our protocols so slightly. Now we look for the contrast there. And of course we are not talking about, you mentioned like one second in another study, we had one second loading. There was actually some changes in the tendon, but three seconds was more effective.
There’s not a fixed threshold that you need to go over, it’s more a range. the multi-second range, that is probably a very good trick. And after a certain time, under strain, probably you do not benefit that much. And it’s better to release and to contract again.
from my point of view, 30 seconds contractions in terms of changing tendon mechanical properties, it’s unnecessarily long. I would reduce it. you also one thing, things are unfortunately, or maybe for scientists, it’s also a good thing that they are complicated and that there are many facets to it. I’m only talking about changes in mechanical properties. If let’s say a physiotherapist tells me,
And there is work by Ebonurio, probably already know that they were focusing this pain aspect. And why we say the contraction type, isometric, concentric, the tendon has no sensors that, you know, translate this. And there is, I think, date, exclusively evidence supporting the idea that force and strain
strain is the dominant factor and not the contraction type. But in terms of pain release, there is at least some work suggesting that isometric have kind of a special effect. And could be. On the sensory aspect, this could be a different story. But focusing on the tendon mechanical properties, I would argue that the type of loading
the contracture type doesn’t matter too much and it’s better to use a little bit more loading cycles than extensively long contracture.
Jake (34:31)
This, yeah, this makes me think of, so when there is the tendinopathy, because you guys have some work in tendinopathy, right? And younger kids with tendinopathy, patellar tendinopathy. But it makes me think of, you were talking about this four point, I think it was 4.5 to 6.5 strain was kind of the area you want to get get signaling. But then our kind of discussion on the individualization, you know, like some tendons are stiffer, some are more compliant. And I’m thinking of the tendinopathy case.
And to me, it seems like those tendons are more compliant. Like they showed it in the Achilles and the patellar, they did shear wave elastography and they didn’t. So it wasn’t really a good comparison because they should have probably done ultrasound or something. But I’m thinking it’s so easy to set off those tendinopathic tendons with like a three second super heavy isometric is probably more likely to set off a pain cascade versus maybe a 30 second one.
I don’t know if this is anything you’ve speculated on of people with tendinopathy. Is this why you think they might respond better to longer duration lower load? Or do you think it’s something else? I’m looking at it I’m just thinking it has to just be less strain on the tendon. So it’s probably just better for the tendon if it’s really sensitive.
Falk (35:49)
So, certainly with regard to this personalization aspect, tendinopathy is, or patients with tendinopathy are extremely interesting cohort because as we said, it’s not consistent finding that the mechanical properties are.
So the stiffness is decreased in these pendants, but for the Achilles, I think the meta-analysis has been demonstrating that we can assume that this is rather consistent in chronic cases. And that means that with our recommendations of rather high intensities of contractions, it may actually be that the loading is unnecessarily high.
We did one study with tendinopathy patients with achilles tendinopathy. So our work in adolescent athletes, they were usually mixed and severe case of tendinopathy usually didn’t take part in the experiment. So, but there’s one study that addressed actually the patient population. And there we did not do personalized loading, but basically our generic recommendations.
Jake (37:12)
you
Falk (37:12)
90 % of an embassy. And the reduction in pain was similar to, for example, efforts on eccentric loading and basically a physical therapy group. But the loading program was the only one that was able to increase tendon mechanical properties. And the time spent in achieving these outcomes
particularly in regards or in comparison to alpha-zone eccentric loading, which is suggested that you need to train twice every day, we have a way higher efficiency. So what does it mean? I think in terms of pain, pain is…
basically even less or way less understood than tendon mechanical properties and how it responds to loading. I think with regard to pain you need to take personalized approaches. We also did so that if heavy or high intensity loading was too painful for the participant, we needed to decrease the load.
I totally believe this is necessary. I’m not sure if there’s already enough evidence to suggest that low intensity, long duration isometrics are more effective than, for example, high intensity, short duration isometrics. Not sure, maybe, I don’t know. Studies have showed that. Yeah, but for me this…
Jake (38:56)
you
Falk (39:04)
There is certainly a connection between mechanical, structural and clinical aspects of tendinopathy, but how these aspects are connected is very individual and really hard to predict. Yeah, so maybe one final word on that. So the inconsistencies we see in patient outcomes
Jake (39:23)
Yeah.
Falk (39:34)
both in the clinical setting and particularly also in research. think a lot of this is also due to the fact that until now or in almost every study I would say, we actually do not know the degree of mechanical loading that was applied to the patients, to the tendon of the patients because usually it’s, yeah.
the loading is defined with regard to warm repetition maximum or isometric maximum or something like that. So we focus on the muscle capacity and to patients with the same exercise intensity the actual strain on the tendon can be very different. And maybe there are some good results with regard to low or moderate loads because the strain of the tendon was actually high.
This is still something I think these stories in the next 10 years may be also rewritten if in the experimental studies there is more control over the actual strain of tendons.
Jake (40:50)
Yeah, okay, going back a little bit here, you said earlier on the, okay, the tendon cell, the stimulus reducing with the high strain rates. So I’m thinking you don’t see these gains in tendon stiffness and that has to come from the tendon cell stimulus, right? So I’m thinking of these high strain rate things. Are the cells just shielded from strain? Is that what you think’s happening?
Are they shielded from getting a pull on them or is it that the cells need a little bit of time under tension of a pull to get this mechanotransduction? Because even going back to the whole anabolic catabolic thing is if the high strain rates are not getting this tendon cell stimulation, it would not be a catabolic thing for the tendon cell. Or is it catabolic because you break down a bunch of collagen and then the cells can sense that? Yeah.
if you can kind of piece together my question there.
Falk (41:49)
Yeah, I can understand. It’s excellent question. And I wish I would have a good answer for that. so I could imagine basically if we are looking at this issue that primary loading has very homogeneous responses. this one thing is this viscoelastic property that may lead to
a lower number of tinnocides receiving effective stimulation and also let’s say in homogeneous development of the mechanical micro damage that affects some facetals maybe more than others at high loading rates and that more homogeneous mechanical loads to the tissue.
Jake (42:47)
you
Falk (42:49)
with a homogeneous simulation of the tinnitus sites basically leads to a better possibility to also repair the wall of the tissue. Is that the right word actually?
Jake (43:05)
Yeah, no,
actually makes a whole lot of sense. Yeah.
Falk (43:08)
But unfortunately, this second point, which we argued, I think, in some papers like that, that also when there’s high strain on the tissue, there are some mechanosensitive channels opening up at the t-side and cause, for example, an influx of porcelain. And until now, I do not know any study that
that modulated this. Now, as I said, in vitro studies, we do not have a period of constant strain that is maybe changed between protocols to actually see what happens, for example, on the cellular level. So this is just a speculation so far. I would be greatly, greatly interested into getting this answer, but unfortunately I don’t have one.
Jake (44:02)
Yeah, that does, I mean it makes a lot of sense to me because like patellar, I spend a lot of time with patellar tendinopathy and it’s the area of pathology is like usually the posterior kind of medial region that just gets overloaded time and time again and it’s like if that’s, if you’re getting inhomogeneous strain on the tendon, maybe that’s the location that you’re getting it from the fast activities and then the slow ones can kind of get maybe more well developed tendon, you know, a more thorough development of the whole tendon.
I’m curious on this when I was telling you before this Berlin method I had seen it maybe maybe it was a year ago and I had never heard of it and I was just like it just seemed like it came out of nowhere because in the tender world you have like the Elfertson calf raises you have like a four stage process or you have longer isometric holds how did you guys arrive at this what is what is the exact thing four sets of three second contractions done for four sets
with a three second, yeah, can you kind of explain the set rep scheme, but how did this even come about?
Falk (45:05)
Yeah. So basically it started in Cologne when Professor Arnpuff was interested in systematically modulating this factors strain magnitude, strain rate, strain duration, and strain frequency and see the effect of the adaptation of tendon mechanical properties. And in his first study, they performed these five sets of
three repetitions, sorry, five sets of four repetitions with three second contraction and three second rest. And in that study they changed the loading magnitude, so 90 % MVC which corresponded in that participants to 4.5 to 5 % strain, and 55 % of the MVC which corresponded to 2.5 to 3 % strain, something like that.
Jake (45:46)
you
Falk (46:04)
and they performed to achieve the same overall mechanical load, they performed a higher number of repetitions. But nevertheless, only the high-legitude loading caused a change in the tendon stiffness. So in the next series of experiments, they used this protocol as reference and reduced the contraction duration by…
factor three. So they increased the number of repetitions by the factor of three as well to keep the overall loading volume constant. And yeah, that was in the next study where they had this one repetition contract generation, one repetition rest. And then here Berlin, we addressed the issue of strain rate.
using plyometrics to obtain a very high strain rate as opposed to these isometric constructions which we had before. Also there, I think the factor was around 2.5 of something like that, so a 2.5 higher strain rate. And the contraction duration was modulated with regard to our reference protocol over 12 seconds. So basically…
with all these different combinations, we were able to get a better image of how the single factors affect them in adaptation and which factors are important, like for example, strain magnitude, and which factors may, yeah, maybe not too important. And then at one point, we tried to condense basically all of this
knowledge into a paper.
handout material that can be given to practitioners. And since Arne Parts is a modest guy and didn’t want to put his name on it, he said, okay, let’s call it the Berlin Method. So that’s the name, the reason why it’s called Berlin Method. But actually, it’s just a collection of experimental findings from systematic research that address
basically these four main components that determine the mechanical stimulus for tendons, so magnitude, rate, duration and frequency.
Jake (48:43)
Have you thought, so you guys have done it with patellar and Achilles, have you thought if this could work for other tendons or if or or not because these are the these are the the quote energy storage quote-unquote tendons the bigger ones that experience the big strains. Do you think other tendons would benefit? Would they even need this level of intensity?
Falk (49:09)
The reason why we investigate the patella and Achilles tendon is methodological reasons. What we do, so measuring tendon stiffness in vivo, this to date can only be done with patella and Achilles tendon, because we don’t only need to measure accurately the deformation of the tendon in vivo.
Jake (49:28)
Yeah.
Falk (49:36)
You also need to calculate tendon forces as good as possible and there are lot of limitations with the approaches that exist and so currently the most valid approach in vivo is Achilles and Patella tendon. But basically the overall composition and the mechanisms that translate the mechanical node into a cellular signal
Jake (49:48)
you
Yes, yes.
Falk (50:06)
they are similar in different tendons. There is, for example, with regards to the ultimate strain of tendon, there is a striking consistency across tendons and even across species. So we are very confident that our general recommendations, that they apply to all human tendons. With regard to the specific exercises that we…
Jake (50:19)
I like to take a student downstairs and then I’m just going outside. I guess I’m going outside.
Falk (50:34)
basically suggests or that we give as inspiration for the practical field. you know, guys from the practical field, as you, you are way more creative and knowledgeable with regards to this exercise selection, you know, which muscle tendon needs to know which conditions, which exercises, but basically the overall scheme of how to characterize the mechanical load.
Jake (50:35)
Okay.
Falk (51:04)
This is something that we want to provide and we are confident that this works for other tendons as well. We receive some feedback of course from the practical field, for example elbow tendinopathy or spinatus tendinopathy. And what we receive as feedback is very positive that the approaches provide good outcomes. But we need to be clear here.
There is not the miracle solution that works for everyone, particularly if we actually do not know a given load magnitude that we prescribe, what does actually, how does this brain of a tendon, how high is the actual magnitude. Now this is particularly in patients still, yeah, huge challenge.
Jake (52:00)
Okay, we got a few minutes left before you got to go, but the thing we haven’t talked too much about is the other thing. So you have the Berlin method and the stiffness of the tendon, mechanical strain. The other thing that I’ve kind of tried to understand, haven’t understood too well, is the muscle tendon imbalance thing. How did you guys come about with this idea that the muscle could be overdeveloped in the tendon is laying, or the tendon is overdeveloped in the muscle’s leg?
How did you guys arrive at this?
Falk (52:32)
That is basically based on the findings of this first experimental study that Aram Patsit has been doing alone on the tendon adaptation, where this high-magnitude, high-strain loading and low-strain loading was compared, because in the protocol with the lower strain magnitudes, which was…
corresponding to 55 % of an isometric MVC. These participants, didn’t have a change in tendon stiffness, but they had a change in muscle strength. that basically the result was that during a maximum effort muscle contraction, the strain of the tendon was higher. And at about the same time, there have been some reports first in rats and then in humans as well from the group of like the care they get.
go lot into the physiology of tendon adaptation in which factors are involved with that. And they also had some indications that a high number of loading cycles, fatiguing contractions with rather moderate load, that the expression factors for muscle adaptation
demonstrate a stronger response than those for tendon. And they also started to speculate that it could be possible that certain types of loading could be more effective for the muscle as opposed to tendon. And that is basically how this idea came across. And in my PhD, for example, we were looking specifically into that, into Adidas and FD.
in the large scale longitudinal study where we had five measurement time points over one year measuring the same participants multiple times and also a control group and we’re actually observing exactly that, that we had rather high fluctuations both in muscle strength and in tendon stiffness in the athletes as compared to controls. So let’s say
physical activity or sport activity on the lead level is a strong disturbance, let’s say, of the tissue homoestasis of both muscle and tendon. And that this adaptation, in lot of cases, does not go in line. yeah, we can have increases in strength at rather constant levels of tendon stiffness there.
And sometimes we even observed changes in tendon stiffness without increases in tendon strength. And there’s a lot of things we do not know for the reasons that are associated. But I mean, we have now much more evidence demonstrating what particular modes of loading have the potential to…
change for example muscle strength, muscle capacity more than in tendon stiffness and we also have some evidence from the group by Kiros Karanganidis for example who was in London, did a lot of work there and for example they’ve been showing they’ve been training I think in one program in three times a day and it was very soon
that they observe a reduction in tendon stiffness. So while when we come back to our earlier point with the discussion, during one acute bout of loading, usually the muscle would fatigue earlier than the tendon. But if you give the muscle some rest to recover and you train over several days, multiple times a day, then you reach a point where the…
the tendon seems to be mechanically worn off or there’s an accumulation of micro damage in the tendon which cannot be compensated for by its metabolism. And then this leads for example to a decrease in tendon stiffness and maybe potentially also overload in the long or in midterm.
So, yeah, think it’s a, from this individual predisposition, which could lead to a less sensitive tendon with regard to adaptation, think particularly load management is something which is in general very important and in some athletes or some people in particular. Also coming back to tendinopathy, right, this Alfredson loading protocol, in my view.
The mechanical loading provided with this protocol is way too much. Still it has good outcomes in terms of pain in lot of cases, but in terms of tendon structure and tendon mechanical properties, the outcomes are not so convincing.
Jake (58:03)
Yeah. What do you see? Yeah, I said at one hour. You have one hour, so I got a couple minutes. You said the deficit in muscle strength is rare earlier. You mostly see a deficit in tendon stiffness, right? Yeah. So what would be your suggestion for people? people listening…
they probably have a, well, maybe not probably, but it’s more likely that they would have a deficit in tendon stiffness. What is your suggestion for the loading? Like the Berlin method is one way to increase it. The loading, the rest periods, the, yeah, what would you suggest?
Falk (58:44)
So in general also not to be misunderstood because I’ve been mentioning a lot of times that plyometric loading is not as effective on tendon adaptation and that athletes which are subjected to high volume of plyometric loading, they many cases develop overuse injury. lot of athletes when we do workshops and so on are asking…
are we not allowed to do plyometrics anymore? And I just want to say, of course you are, and of course it’s extremely important for sports performance to use plyometrics because it’s very well capable of improving your muscular function, and particularly the muscle-tendon interaction aspect, which we did not discuss much about now, but for performance that is really the precise.
neural control of this interplay is extremely important. So definitely you can do that. But my suggestion is for almost everyone who does not know if there is, for example, muscle tendon imbalance, currently we do not have, you know, widely available methods to determine if that is the case. We have a lot of studies where we applied
Jake (1:00:04)
She was telling me that it’s not I like, it’s not sauce. She was like, I love that sauce.
Falk (1:00:11)
specific tendon training to a group of athletes without personalized load prescription and also without identifying any deficits beforehand. So just we integrated as part of routine about 15 minutes, three times a week at the beginning of their exercise session. So after the general warmup, they did both isometric
Jake (1:00:19)
Yes, that’s a lot of sauce.
Falk (1:00:40)
and also some dynamic exercises which were loading the tendon rather high, so rather high loads, rather slowly applied, held for a certain duration, three to six seconds per execution, and the overall loading volume of this was rather small. in general, we had very positive outcomes. We had a lower rate of…
Jake (1:01:01)
Shooting file for…
Falk (1:01:07)
athletes that developed overuse symptoms from athletes which already had mild symptoms. had a higher rate of improvements. Also on the structural side, saw that athletes which had rather high strains, that they did not show structural changes of attendance, which…
Jake (1:01:12)
Yes, I learned the girl.
Falk (1:01:35)
are sometimes already an indication of structural deterioration. So the outcomes were, in general, very positive, and the time investment was quite low. So particularly, if you’re ambitious, if you train maybe more than three or more sessions per week in jump.
intensive sports like basketball, general the game sports and jump disciplines from the track and field. My strong suggestion would be to implement this on a regular basis, maybe three times a week, three to five sets with four repetitions of moderate duration, three to six seconds, contraction duration, rather high loads. These are the general recommendations.
Jake (1:02:34)
Yeah. Okay. I don’t want to take any more time. This was good. I probably have 20 more questions for you, but we’ll have to do it another time. Tell people where to find you online. I know you’re not in too many places, but yeah.
Falk (1:02:49)
Yeah, we have not really a social media presence, but maybe you can post the link to our department homepage under this description of this podcast and also my email address. And I’m glad to answer all the questions when just write an email and we receive a response.
Jake (1:03:16)
Okay, yeah, yeah, I’ll do that. You also had a few studies. I’m going to email you to get those studies you were talking about because I’ve never seen those before. alright, folks, thanks for coming on. This has answered a lot of my own questions and now I’m questioning a lot of things as well. But, yeah, thank you. Thank you for coming on.
Falk (1:03:35)
Thank you very much, it was a pleasure. It’s always good if some questions are answered and new ones are coming up. This is my daily business. When I’m able to answer two questions, have three more myself.
Jake (1:03:44)
Yeah.
Yeah, yeah, exactly. All right, thank you. Stop it.
