Overuse Injuries - Tendinopathy: Myths, Management and effective approaches
Tendinopathy is a common condition that affects both athletes and non-athletes alike. Characterized by pain, stiffness, and reduced function in the affected tendon, it can significantly impact daily activities and athletic performance. However, managing tendinopathy effectively requires a clear understanding of its nature and a commitment to evidence-based approaches. In this blog, we’ll explore key aspects of tendinopathy management, debunk common myths, and highlight insights from leading experts like physiotherapist Jo Gibson.
What is Tendinopathy?
Tendinopathy refers to a spectrum of tendon disorders, typically involving pain and dysfunction. It is often the result of overuse, where repetitive loading exceeds the tendon’s capacity to recover and adapt. Unlike the older term “tendinitis,” which implies inflammation, tendinopathy is more accurately described as a condition involving changes to the tendon’s structure and function, although this is still widely debated and there may be an inflammatory component even without obvious inflammatory
Myth 1: Rest is the Best Solution
One of the most persistent myths about tendon pain/ tendinopathy is that complete rest is the key to recovery. While it will often settle down symptoms if the tendon is currently being overloaded, therefore providing temporary relief from pain - rest alone does little to address the underlying issue. Tendons require mechanical loading to stimulate healing and regain strength, Prolonged rest can lead to deconditioning and reduce the tendon’s capacity to tolerate load, often leading to a lower threshold for the symptoms to return or a higher level of pain when trying to go back to previous activity levels. This deconditioning also increases the risk of other overuse injuries.
Optimal Loading: The Cornerstone of Recovery
The most effective approach to managing tendinopathy is optimal loading— in short, giving the tendon just enough load that it can tolerate it and slowly adapt. Too little loading and we will get that deconditioning effect, too much loading and you will see a worsening of symptoms and possible the pathology itself. This loading needs to be specific to the individual also taking into account the types of activity they want to return to and need to perform on a daily basis. In simple a graded and progressive exercise program tailored to the individual’s needs. This involves:
Starting Slow: work out what the current daily load on that tendon is (work, hobbies etc) and where possible match that to what the current symptoms allow.
Progressing Gradually: start adding manageable amounts of loading, this could be isometric for very irritable cases or low level isokinetic exercises performed 3-4x per week building up to a point of fatigue or pain tolerance. This needs to be progressively increased to match the demands the on the tendon for your given sport or activity.
Monitoring Load: Keep track of how much and how often you’re loading the tendon and what the symptoms response to that loading is to avoid overdoing it.
Research has shown that appropriate loading not only improves tendon structure but also enhances its capacity to handle stress, reducing the risk of re-injury.
Myth 2: Pain During Exercise is Harmful
A common misconception is that all pain during exercise should be avoided. In tendinopathy, a mild increase in pain during or after exercise is generally acceptable, as long as it settles within 24 hours. This highlights the importance of monitoring the 24-hour pain pattern rather than focusing solely on symptom response during activity. If pain levels remain elevated beyond this timeframe, it may indicate that the load was too high and adjustments are needed.
Things That Feel Better vs. Things That Make It Better
Another critical concept in tendinopathy management is recognizing the difference between activities that provide temporary relief and those that promote long-term improvement. For example:
Things That Feel Better: Modalities like icing, massage, and passive stretching may help alleviate symptoms in the short term but do not address the root cause or increase the tendons capacity for load. Often in clinic we see people overloading their tendon but then performing these short term pain relieving strategies with the thought that if they just keep performing them eventually it will go away. This doesn’t particularly ring true and often leads to a a miss management of load.
Things That Make It Better: A structured exercise program designed to improve tendon capacity and function over time. Consistancy. Patience
While symptom relief can be helpful, the primary focus should always be on interventions that lead to meaningful and lasting change.
Expected Timeframes for Recovery
Patience is key when dealing with tendinopathy. Tendons adapt more slowly than muscles due to their lower metabolic rate and blood supply. Recovery can take several months, with most people experiencing significant improvements within:
6-12 weeks: Initial gains in strength and pain reduction.
12-24 weeks: More substantial improvements in tendon capacity and function.
Consistency and adherence to a progressive loading program are critical for achieving these results.
Additional Considerations
Avoiding Sudden Increases in Activity: Tendons do not respond well to abrupt changes in load. Whether you’re an athlete returning to sport or someone resuming daily activities, gradual progression is essential.
Incorporating Eccentric Exercises: Exercises that emphasize the lengthening phase of a muscle contraction have been shown to be particularly effective for tendinopathy.
Seeking Professional Guidance: A physiotherapist or other musculoskeletal specialist can help design a personalized program, monitor progress, and make adjustments as needed.
Key Takeaways
Tendinopathy is not just about inflammation but involves changes in tendon structure and capacity.
Rest alone is not the solution; optimal loading is essential for recovery.
Pain during exercise is not always harmful—monitor the 24-hour pain pattern to guide loading.
Distinguish between temporary symptom relief and strategies that promote long-term improvement.
Recovery takes time and requires consistency and patience.
At The Injury and Performance Clinic, we specialize in evidence-based approaches to managing tendinopathy. If you’re struggling with tendon pain, our team can provide the guidance and support you need to return to the activities you love. Contact us today to learn more about how we can help.
