{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:16:11Z","timestamp":1790622971916,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Periodized rehabilitation for tendinopathies integrates principles of athletic training into structured protocols to optimize tendon healing and functional recovery minimizing recurrence. This review explores the role of concurrent and phasic periodization strategies in tendon rehabilitation, focusing on optimizing strength, power, and neuromuscular control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Areas of agreement<\/jats:title>\n                  <jats:p>Early phases prioritize pain management and load capacity through prolonged isometric contractions, to improve neuromuscular engagement without exacerbating symptoms. Heavy, slow resistance exercises, central to progressive loading, facilitate tendon remodeling and strength development. Subsequent phases incorporate energy storage and release, sport-specific exercises tailored to individual goals, using externally paced movements to enhance motor control and corticospinal drive. Neuroplastic training is promising, aligning physical rehabilitation with cognitive engagement to optimize motor learning and reduce maladaptive patterns.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Areas of controversy<\/jats:title>\n                  <jats:p>At present, no randomized controlled trials have tested the periodization concept in the management of tendinopathy conditions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Growing points<\/jats:title>\n                  <jats:p>Systematic evaluation, including range of motion, tissue flexibility, and limb biomechanics, is necessary to identify and address kinetic chain dysfunctions in patients with tendon ailments. Reintegration into sport or activity should follow clear benchmarks, such as symmetrical strength, pain-free function, and tolerance for high-intensity loads.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Source of data<\/jats:title>\n                  <jats:p>Analysis of the current literature, and expert opinion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Areas timely for developing research<\/jats:title>\n                  <jats:p>This evidence-based framework offers clinicians a practical roadmap for tendon rehabilitation, combining physiological and biomechanical considerations to support safe return to sport or activity. A structured individualized approach ensures optimal recovery by addressing movement dysfunctions, monitoring load tolerance, and reducing the risk of re-injury.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bmb\/ldaf006","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T15:49:23Z","timestamp":1748879363000},"source":"Crossref","is-referenced-by-count":7,"title":["Neuroplastic periodization in tendinopathy"],"prefix":"10.1093","volume":"154","author":[{"given":"Georgios","family":"Kakavas","sequence":"first","affiliation":[{"name":"Fysiotek, Spine and Sports Lab , Fysiotek Spine & Sports Lab, 17562 Athens ,","place":["Greece"]},{"name":"Department of Physical Education and Sport Science, ErgoMech-Lab, University of Thessaly , 38221 Volos ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Forelli","sequence":"additional","affiliation":[{"name":"Haute-Ecole Arc Sant\u00e9, HES-SO University of Applied Sciences and Arts Western Switzerland , 2800 Del\u00e9mont ,","place":["Switzerland"]},{"name":"Orthopaedic Surgery Department, Clinic of Domont, Ramsay Healthcare, OrthoLab , 95330 Domont ,","place":["France"]},{"name":"Soci\u00e9t\u00e9 Fran\u00e7aise des Masseurs\u2014Kin\u00e9sith\u00e9rapeutes du Sport Lab , 93380 Pierrefite sur Seine ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Korakakis","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, School of Life Sciences and Health Sciences, PhD in Physiotherapy Program, University of Nicosia , 2417 Nicosia ,","place":["Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Malliaropoulos","sequence":"additional","affiliation":[{"name":"Center of Orthopaedics and Regenerative Medicine, Aristotle University Thessaloniki , 54124 Hellas ,","place":["Greece"]},{"name":"Centre for Sports and Exercise Medicine, Queen Mary University of London , E1 4RQ London ,","place":["United Kingdom"]},{"name":"Sports Clinic, Mile End Hospital, Barts and the London , E1 4DG London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Maffulli","sequence":"additional","affiliation":[{"name":"Centre for Sports and Exercise Medicine, Queen Mary University of London , E1 4RQ London ,","place":["United Kingdom"]},{"name":"Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, Sapienza University , 00185 Roma ,","place":["Italy"]},{"name":"School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Keele University , Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB ,","place":["England"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"key":"2025060211491813100_ref1","doi-asserted-by":"publisher","first-page":"393","DOI":"10.2165\/00007256-199927060-00004","article-title":"Histopathology of common tendinopathies: Update and implications for clinical management","volume":"27","author":"Khan","year":"1999","journal-title":"Sports Med"},{"key":"2025060211491813100_ref2","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1186\/ar2723","article-title":"Pathogenesis of tendinopathies: Inflammation or degeneration?","volume":"11","author":"Abate","year":"2009","journal-title":"Arthritis Res Ther"},{"key":"2025060211491813100_ref3","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.1136\/bjsports-2012-091957","article-title":"Tendons \u2013 Time to revisit inflammation","volume":"48","author":"Rees","year":"2014","journal-title":"Br J Sports Med"},{"key":"2025060211491813100_ref4","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1016\/S0749-8063(98)70021-0","article-title":"Overuse tendon conditions: Time to change a confusing terminology","volume":"14","author":"Maffulli","year":"1998","journal-title":"Arthrosc J Arthrosc Relat Surg"},{"key":"2025060211491813100_ref5","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/s13018-024-04560-y","article-title":"Diagnosis and management of Achilles tendon ailments: The Scottish mist","volume":"19","author":"Maffulli","year":"2024","journal-title":"J Orthop Surg"},{"key":"2025060211491813100_ref6","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1136\/bjsports-2014-094386","article-title":"Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy","volume":"49","author":"Rio","year":"2015","journal-title":"Br J Sports Med"},{"key":"2025060211491813100_ref7","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1007\/s40279-022-01641-y","article-title":"Putting \u201cheavy\u201d into heavy slow resistance","volume":"52","author":"Morrison","year":"2022","journal-title":"Sports Med"},{"key":"2025060211491813100_ref8","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1111\/j.1600-0838.2009.00949.x","article-title":"Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy","volume":"19","author":"Kongsgaard","year":"2009","journal-title":"Scand J Med Sci Sports"},{"key":"2025060211491813100_ref9","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1177\/0363546506298279","article-title":"Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: A randomized controlled study","volume":"35","author":"Silbernagel","year":"2007","journal-title":"Am J Sports Med"},{"key":"2025060211491813100_ref10","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1519\/1533-4295(2003)025&lt;0019:PS&gt;2.0.CO;2","article-title":"Periodization strategies","volume":"25","author":"Plisk","year":"2003","journal-title":"Strength Cond J"},{"key":"2025060211491813100_ref11","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s40279-013-0096-z","article-title":"The pain of tendinopathy: Physiological or pathophysiological?","volume":"44","author":"Rio","year":"2014","journal-title":"Sports Med"},{"key":"2025060211491813100_ref12","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/s40279-013-0019-z","article-title":"Achilles and Patellar tendinopathy loading programmes: A systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness","volume":"43","author":"Malliaras","year":"2013","journal-title":"Sports Med"},{"key":"2025060211491813100_ref13","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000511228","article-title":"Periodization in anterior cruciate ligament rehabilitation: A novel framework","volume":"30","author":"Kakavas","year":"2021","journal-title":"Med Princ Pract"},{"key":"2025060211491813100_ref14","doi-asserted-by":"publisher","first-page":"541","DOI":"10.26603\/001c.73035","article-title":"Periodization in anterior cruciate ligament rehabilitation: New framework versus old model? A clinical commentary","volume":"18","author":"Kakavas","year":"2023","journal-title":"Int J Sports Phys Ther"},{"key":"2025060211491813100_ref15","doi-asserted-by":"publisher","first-page":"842","DOI":"10.2519\/jospt.2015.5880","article-title":"Tendinopathy: Is imaging telling us the entire story?","volume":"45","author":"Docking","year":"2015","journal-title":"J Orthop Sports Phys Ther"},{"key":"2025060211491813100_ref16","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1002\/art.22426","article-title":"Tenocyte responses to mechanical loading in vivo: A role for local insulin-like growth factor 1 signaling in early tendinosis in rats","volume":"56","author":"Scott","year":"2007","journal-title":"Arthritis Rheum"},{"key":"2025060211491813100_ref17","first-page":"251","volume-title":"Science and Practice of Strength Training","author":"Zaciorskij","year":"2006","edition":"2nd"},{"key":"2025060211491813100_ref18","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/JES.0b013e31823b5f13","article-title":"Skeletal muscle power: A critical determinant of physical functioning in older adults","volume":"40","author":"Reid","year":"2012","journal-title":"Exerc Sport Sci Rev"},{"key":"2025060211491813100_ref19","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1093\/bmb\/ldq008","article-title":"Sarcopenia: Characteristics, mechanisms and functional significance","volume":"95","author":"Narici","year":"2010","journal-title":"Br Med Bull"},{"key":"2025060211491813100_ref20","doi-asserted-by":"publisher","first-page":"374","DOI":"10.2165\/00007256-199315060-00003","article-title":"Velocity specificity of resistance training","volume":"15","author":"Behm","year":"1993","journal-title":"Sports Med"},{"key":"2025060211491813100_ref21","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1093\/rheumatology\/kel046","article-title":"Current concepts in the management of tendon disorders","volume":"45","author":"Rees","year":"2006","journal-title":"Rheumatology"},{"key":"2025060211491813100_ref22","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1177\/0363546508324283","article-title":"Management of tendinopathy","volume":"37","author":"Rees","year":"2009","journal-title":"Am J Sports Med"},{"key":"2025060211491813100_ref23","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1016\/j.jbiomech.2013.04.022","article-title":"Patellar tendon adaptation in relation to load-intensity and contraction type","volume":"46","author":"Malliaras","year":"2013","journal-title":"J Biomech"},{"key":"2025060211491813100_ref24","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1113\/jphysiol.2007.139105","article-title":"Human tendon behaviour and adaptation, in vivo","volume":"586","author":"Magnusson","year":"2008","journal-title":"J Physiol"},{"key":"2025060211491813100_ref25","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1136\/bjsm.2008.051193","article-title":"Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy","volume":"43","author":"Cook","year":"2009","journal-title":"Br J Sports Med"},{"key":"2025060211491813100_ref26","doi-asserted-by":"publisher","first-page":"048002","DOI":"10.1088\/1748-9326\/11\/4\/048002","article-title":"Consensus on consensus: A synthesis of consensus estimates on human-caused global warming","volume":"11","author":"Cook","year":"2016","journal-title":"Environ Res Lett"},{"key":"2025060211491813100_ref27","doi-asserted-by":"publisher","first-page":"2633","DOI":"10.1007\/s00421-011-1879-2","article-title":"A review of the acute effects of static and dynamic stretching on performance","volume":"111","author":"Behm","year":"2011","journal-title":"Eur J Appl Physiol"}],"container-title":["British Medical Bulletin"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bmb\/article-pdf\/154\/1\/ldaf006\/63418140\/ldaf006.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bmb\/article-pdf\/154\/1\/ldaf006\/63418140\/ldaf006.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T15:49:24Z","timestamp":1748879364000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bmb\/article\/doi\/10.1093\/bmb\/ldaf006\/8155211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,4]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,4,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bmb\/ldaf006","relation":{},"ISSN":["0007-1420","1471-8391"],"issn-type":[{"value":"0007-1420","type":"print"},{"value":"1471-8391","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2025,4,4]]},"article-number":"ldaf006"}}