Non-insertional Achilles tendinopathy (NIAT) induces morpho-mechanical changes to the Achilles tendon (AT). However, evidence on how triceps surae motor unit firing properties are influenced by altered tendon mechanics in NIAT is limited. This study investigated motor unit firing properties (mean discharge rate (DR), recruitment and de-recruitment thresholds, and discharge rate variability (COVisi)), motor unit firing-torque relationships (cross-correlation coefficient between cumulative spike train (CST) and torque, and neuromechanical delay), and neural drive distribution (connectivity strength and functional networks) of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SO) muscles during isometric plantarflexion contractions at 10%, 40%, and 70% maximal voluntary contraction (MVC) using high-density surface electromyography on 26 individuals with NIAT and 25 healthy controls. Furthermore, AT’s morpho-mechanical properties (thickness, cross-sectional area, length and stiffness) were assessed via ultrasound imaging. NIAT individuals showed reduced tendon stiffness and increased thickness (p<0.01). Motor unit properties changed in a load and muscle-dependent manner. LG DR increased (p=0.002) and de-recruitment threshold decreased (p=0.039) at 70%MVC in the NIAT group compared to controls. The CST-torque cross-correlation coefficient of the LG decreased at 10%MVC (p<0.0001) and increased at 70%MVC (p=0.013) in the NIAT group. Connectivity strength for the 0-5 Hz and 5-15 Hz frequency bands decreased (p<0.01) in the NIAT group at 10%MVC. This study shows that individuals with NIAT exhibit load-dependent changes in motor unit firing properties, motor unit-torque relationships, and neural drive distribution to the triceps surae. These alterations may be due to muscle-specific compensations for the modified mechanical properties of the AT.

KEY POINTS

- Individuals with non-insertional Achilles tendinopathy (NIAT) have changes of the neural drive to the lateral gastrocnemius (LG) muscle and altered contribution of the LG to the net plantarflexion torque.

- Individuals with NIAT show a more uneven distribution of neural drive to the triceps surae muscle at low force levels, characterized by reduced intermuscular coherence between the medial and lateral gastrocnemius in the 0-5 Hz and 5-15 Hz bands compared to the control group.

- Our findings support the idea that the LG may have a central role in the pathophysiology of this condition, possibly affecting the load transmission to the Achilles tendon (AT).

The authors have declared no competing interest.

This work was supported by ANID PhD Scholarship awarded by the Government of Chile. Recipient: Ignacio Contreras-Hernandez, Scholarship ID number: 72200295 Francesco Negro was funded by the European Research Council Consolidator Grant INcEPTION (contract no. 101045605) Eduardo Martinez-Valdes is supported by an Orthopaedic Research UK Early Career Research Fellowship (ORUK ref-574)

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The Science, Technology, Engineering and Mathematics Ethical Review Committee of the University of Birmingham, United Kingdom, gave ethical approval for this work (Approval number: ERN_20-0604A)

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