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Here, we used a new approach to identify muscle\u2013tendon imbalances and personalize exercise prescription based on tendon strain during maximum voluntary contractions (\u03b5<jats:sub>max<\/jats:sub>) to mitigate musculotendinous imbalances in male adult volleyball athletes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Four times over a season, we measured knee extensor strength and patellar tendon mechanical properties using dynamometry and ultrasonography. Tendon micromorphology was evaluated through an ultrasound peak spatial frequency (PSF) analysis. While a control group (<jats:italic>n<\/jats:italic>\u2009=\u200912) continued their regular training, an intervention group (<jats:italic>n<\/jats:italic>\u2009=\u200910) performed exercises (3\u2009\u00d7\u2009\/week) with personalized loads to elicit tendon strains that promote tendon adaptation (i.e., 4.5\u20136.5%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Based on a linear mixed model, \u03b5<jats:sub>max<\/jats:sub> increased significantly in the control group over the 9\u00a0months of observation (<jats:italic>p<\/jats:italic><jats:sub>Con<\/jats:sub>\u2009=\u20090.010), while there was no systematic change in the intervention group (<jats:italic>p<\/jats:italic><jats:sub>Int<\/jats:sub>\u2009=\u20090.575). The model residuals of \u03b5<jats:sub>max<\/jats:sub>, as a measure of imbalances in muscle\u2013tendon adaptation, demonstrated a significant reduction over time exclusively in the intervention group (<jats:italic>p<\/jats:italic><jats:sub>Int<\/jats:sub>\u2009=\u20090.007). While knee extensor muscle strength increased in both groups by\u2009~\u20098% (<jats:italic>p<\/jats:italic><jats:sub>Con<\/jats:sub>\u2009&lt;\u20090.001, <jats:italic>p<\/jats:italic><jats:sub>Int<\/jats:sub>\u2009=\u20090.064), only the intervention group showed a trend toward increased normalized tendon stiffness (<jats:italic>p<\/jats:italic><jats:sub>Con<\/jats:sub>\u2009=\u20090.824, <jats:italic>p<\/jats:italic><jats:sub>Int<\/jats:sub>\u2009=\u20090.051). PSF values did not change significantly in either group (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>These results suggest that personalized exercise prescription can reduce muscle\u2013tendon imbalances in athletes and could provide new opportunities for tendon injury prevention.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00421-024-05525-z","type":"journal-article","created":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T11:03:12Z","timestamp":1717671792000},"page":"3201-3214","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Addressing muscle\u2013tendon imbalances in adult male athletes with personalized exercise prescription based on tendon strain"],"prefix":"10.1007","volume":"124","author":[{"given":"Kolja","family":"Weidlich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Domroes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Bohm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adamantios","family":"Arampatzis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7180-7109","authenticated-orcid":false,"given":"Falk","family":"Mersmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,6]]},"reference":[{"key":"5525_CR1","first-page":"109","volume":"67","author":"RM Alexander","year":"1981","unstructured":"Alexander RM (1981) Factors of safety in the structure of animals. 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