Tendon Pain & Pathology + Physio

a. Tendon Rehab Part 1

What Should I Do?

Tendinopathy, tendonitis, tendon pain. The terminology has changed a lot over the last few decades and you’re forgiven for being confused about what to do and what not to do.

Stretch/don’t stretch?

  • Ice/heat?
  • Rest/load it?

Its easily one of the least understood injuries that we see patients present with.

The thing is, a lot of the typical management that people associate with muscular related aches and pains involves a period of resting, followed by some stretching and then on to some strengthening.

The reality is that tendon pain is managed quite differently to this. And it can be a niggle that flies in and out, annoying and not necessarily getting better with rest.

Tendon pain comes on as a response to a change in load. What does this mean?
– Have you switched up training recently?
– Have you returned to exercise or load after a period of rest/holidays?
– Have you changed your footwear?

These are but SOME of the stories we hear when people present with tendon pain but sometimes the causes are even more subtle still.

Regardless, the priority here is to desensitise the tendon. And improve its tolerance to load.

Often this means, avoiding instances where we are likely to overload or compress the tendon. This often includes stretching.



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b. Tendon Rehab Part 2

Rest It or Load It?

The aim is to ultimately expose it to gentle but controlled load and improve its tolerance over time as it becomes stronger. As physios we can also facilitate this process by looking at other areas that may be contributing to extra load on the tendon. But be warned, it can be a lengthy process and one that reflects the time in which you’ve had it. Had it for 2 months? Could take about 2 months. Had it for 12 years? -you’re looking at a longer time line but you’ll get results nonetheless if you get the dosage right and stick to the plan.

Hot tip #2: Instead of rest, try loading it, isometrically.


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c. Tendon Rehab Part 3

Is This An ICE Thing or a HEAT Thing?

Tendon pain or tendinopathies are not characterised by inflammation. This is why we have done away with the Tendonitis terminology.

So we normally ice inflammatory issues, but this isn’t an inflammatory issue. So what to do?

Well we can classify tendons further into:

Reactive tendon pain

Although tendinopathies are not caused by inflammation, there is still an instance when if acutely irritated, inflammation can occur.

Eg: You’ve gone on a 30km uphill hike in new boots and you pull up the day after with painful, noticeably puffy achilles tendons.


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