Mechanical, material and morphological adaptations of healthy lower limb tendons to mechanical loading: a systematic review and meta analysis

Review written by Dr Seth O’Neill info

Key Points

  1. Mechanical load adapts tendon tissue.
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Various forms of exercise are used in attempts to “improve” the material, mechanical and structural properties of tendons. However, it is not known which type of intervention produces the best adaptations.

This systematic review set out to determine:

  1. The effect of mechanical loading on tendon stiffness, modulus and cross-sectional area (CSA)

  2. Whether adaptations in stiffness are driven primarily by changes in CSA or modulus

  3. The effect of training type and associated loading parameters (relative intensity, localized strain, load duration, load volume and contraction mode) on stiffness, modulus or CSA

  4. Whether the magnitude of adaptation in tendon properties differs between age groups

It is currently not known which type of intervention produces the best adaptations to the structural properties of tendons.
Contraction type seems less important, however certain types of contraction likely offer more stress and strain and would therefore produce superior benefit.


  • The paper was a systematic review searching 5 key and highly relevant databases. The study followed important steps – PROSPERO REGISTRATION, and was compliant with the relevant reporting guidelines, PRISMA.
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