Tendon properties in relation to muscular activity and physical training

Movement is caused by force transmission from contracting muscles to bone via tendon. The collagen structure of tendon is organized in a very hierarchical manner. The collagen fibril is considered the basic force-transmitting unit of tendon, and it is embedded in a hydrophilic extracellular matrix of proteoglycans, glycoproteins and glycosaminoglycans. It has recently been shown in human peritendinous tissue is more metabolically active in response to activity than previously thought, although it remains to be established, if the level of activity influences affects fibril diameter and/or total tendon cross-sectional area. Moreover, it cannot be unequivocally concluded that tendon adaptation to physical activity is one of a quantitative and/or qualitative nature. The currently available information is almost exclusively obtained from animal data, however, techniques such as microdialysis for tendon metabolism and ultrasound combined with MRI for tendon mechanical properties has already provided information on human tendon behavior, and is likely to further add to our understanding of how tendon adapt to physical activity. This review will address the structure and function of tendon, and the current knowledge of how tendons respond to activity with respect to biomechanical properties.