Tendon(itis) – rest isn’t always best


Tendon issues are tricky. The progress can be slow and frustrating. In athletes, the most common tendinopathies occur at the Achilles tendon, and Patella tendon, but it can occur in the hips, elbows, and shoulders as well. The self management advice has generally been toward rest and conservative care. However,  the latest evidence in tendinopathy research has shown rest isn’t always best. The volume and intensity of activity should be managed, but complete avoidance of activity isn’t recommended.

Tendons as a structure respond better to load than to rest. Too much load could lead to increased symptoms, but too much rest could lead to a boom or bust cycle in which the tendon’s capacity decreases and can’t meet the demands of the required load for the activity/sport.

We used to label tendon pain as tendonitis.Research has since confirmed that tendinopathy is a better term than tendonitis.  The latest research outcomes have created better self management tips and a more positive outlook for people dealing with tendon symptoms.

The term tendinopathy is a clinical diagnosis and encompasses symptoms such as pain, decreased function, and reduced exercise intolerance. Symptoms are localized, persistent, and specifically associated with load, but inflammation isn’t the main culprit. There can be an initial inflammatory stage but it only lasts about 24-48 hours.

“In the past, tendon injuries have been treated as an inflammatory process. Therefore, nonsteroidal anti-inflammatory drugs like naproxen or ibuprofen were prescribed or an anti-inflammatory medication like corticosteroid was injected. However, it is now known that these medications do not help the healing process, and studies point to them having a negative effect long-term, although they help reduce short-term discomfort.” ACSM health and fitness journal

Tendinopathy treatment must be personalized, rather than cookie cutter. The right approach will vary considerably depending on the body part, the stage of the tendinopathy, one’s function and activity status, the client’s history, their physical health, and their beliefs/expectations/goals.

To summarize the best evidence for tendinopathy, here are 5 facts and 5 tips.

5 Healthy Tendon Facts

  1. Tendons takes longer to recover than other tissues like muscle and bone.
  2. Tendon pain is localized and increase in pain is dependent on the loading dose.
  3. Tendons warm up with activity and can be worse the next day after.
  4. When worse the longer you run then it could be overloading the peri tendon (area around the tendon)
  5. Tendon rehab is about increasing one’s tolerance to load and one’s capability in line with their goals.


5 Healthy Tendon Tips

  1. Strengthening is vital – for example isometrics, and heavy slow resistance
  2. You can be active when pain is present – Pain doesn’t necessarily mean more damage.
  3. You will have setbacks – don’t panic.
  4. Create a training diary to keep tabs on your tissue load and training load.
  5. Listen to your tendon –
    1.  If after 24 hours, your pain/stiffness has gotten worse the tendon may not be happy, adjust the program.
    2. When pain is low and stable you can increase the load.  


Client stories

Achilles tendinopathy: Kristin loves to run, but would wake up each morning with awful pain in her Achilles tendon. The worst pain would be at the beginning of the run but after the first mile, she felt good enough to run a few more miles. But each day it was the same scenario no matter what she tried. She benefitted from a plan to vary her training load and add in more strength based exercises. She is back to running and happy she didn’t have to quit.

Patella tendinopathy: Andie plays for her high school basketball team. Her left knee felt a sharp twinge with running and jumping and it was affecting her practice and play time. She benefitted from isometric exercises and a plan for managing her training load. She is now playing during season without difficulty.

If you are local and want to return to sport following tendinoapthy, contact me. 

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