Immediate and short-term effects of exercise on tendon structure: Biochemical, biomechanical and imaging responses

Alex Tardioli, Peter Malliaras, Nicola Maffulli

Research output: Contribution to journalReview ArticleResearchpeer-review

42 Citations (Scopus)


Introduction: Tendons are metabolically active structures, and their biochemical, biomechanical and structural properties adapt to chronic exercise. However, abnormal adaptations may lead to the development of tendinopathy and pain. Acute and subacute adaptations might contribute to tendon pathology. 

Sources of data: A systematic search of peer-reviewed articles was performed using a wide range of electronic databases. A total of 61 publications were selected. 

Areas of agreement: Exercise induces acute responses in collagen turnover, blood flow, glucose, lactate and other inflammatory products (e.g. prostaglandins and interleukins). Mechanical properties are influenced by activity duration and intensity. Acute bouts of exercise affect tendon structure, with some of the changes resembling those reported in pathological tendons. 

Areas of controversy: Given the variation in study designs, measured parameters and outcomes, it remains debatable how acute exercise influences overall tendon properties. There is discrepancy regarding which investigation modality and settings provide optimal assessment of each parameter. 

Growing points: There is a need for greater homogeneity between study designs, including subject consortium and age, exercise protocols and time frames for parameter assessing. 

Areas timely for developing research: Innovative methods, measuring each parameter simultaneously, would allow a greater understanding of how and when changes occur. This methodology is key to revealing pathological processes and pathways that alter tendon properties according to various activities. Optimal tendon properties differ between activities: more compliant tendons are beneficial for slow stretch shortening cycle (SSC) activities such as countermovement jumps, whereas stiffer tendons are considered beneficial for fast SSC movements such as sprinting.

Original languageEnglish
Pages (from-to)169-202
Number of pages34
JournalBritish Medical Bulletin
Issue number1
Publication statusPublished - Sep 2012
Externally publishedYes


  • biochemistry
  • exercise
  • imaging
  • physiology
  • structure
  • tendons

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