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Level Up your rehab for tendon pain with TNT: Tendon Neuroplastic Training

Loading is the most important intervention for rehab of individuals with tendon pain. The caveat though is : HOW you do it matters. To maximize results for patients with tendinopathy I have been using external pacing with a metronome during the earlier phases of rehab. Read on to find out more about Tendon Neuroplastic Training, also known as TNT.

Who developed the term TNT? Ebonie Rio from La Trobe University in Australia while doing her research for her PhD.

TNT is a “neuroscience-enhanced” method of loading that is done during the isometric and isotonic phases of tendinopathy rehab. Loading is synced with a metronome for external pacing instead of self pacing.

The research to date on TNT has been done on individuals with patellar tendinopathy (see this link for the Open Access (ie, free) article


Anecdotally, Rio cites success using TNT in dancers with Achilles tendinopathy.

Check out this very informative YouTube video from Ebonie Rio:

There are many impairments found in individuals with tendinopathy. Best evidence thus far has shown loading muscle-tendon produces results in decreasing pain and increasing strength but tendinopathies are often resistant to treatment and likely to recur.


Despite all the progress we have made on identifying the benefits of loading over the years, perhaps we are still missing something. We have learned how to facilitate tissue adaptation but what about cortical (brain) adaptation?


It’s not just about reps if you want to change the motor cortex” -E. Rio


The brain and CNS: that’s what TNT is about. External pacing with a metronome during loading helps guarantee we have time under tension and load but also produces changes in the excitability and inhibition of your motor cortex.

How is it done? Check out my video demonstration:

The details on the protocol used in research:

  • Metronome set at 60 bpm- Note: this is important because it fires up both sides of your brain

  • ISOMETRIC PHASE: 4 x 45 seconds

  • ISOTONIC PHASE: 4 x 8 reps : 3 seconds concentric - 4 seconds eccentric

  • Note: Slightly longer eccentric component is important: it fires up your frontal lobe is important for planning

  • Motor drive changes primarily happen in the first 4 weeks (ie, 4 weeks to normalize corticospinal excitability and inhibition.

Give it a try! Level Up


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