Managing tendon pain, or tendinitis, is often a challenging and frustrating experience for many people. Tendon pain can be triggered by a quick and unexpected lengthening of the tendon (i.e. picking up an object that was heavier than expected) or by repetitive overuse (i.e. performing repetitive work on production lines). Like most injuries, after developing tendon pain an initial and short period of relative rest and anti-inflammatories can help to ease pain and discomfort. Individuals are still encouraged to remain active, as long as pain does not exceed a 2-3/10 on one’s subjective pain scale. It is absolutely safe to exercise with mild pain, this will not damage the tendon or prolong recovery. In fact, early exercise within an acceptable pain tolerance can promote faster recovery of the tendon.
Tendons will feel better with rest, but they do not get better with rest. Tendons need to be loaded, or stressed within reason, on a daily basis to help promote their healing response. Every tissue in the body has different healing timelines and processes. Muscles will typically heal very quickly due to the high supply of blood to the muscle tissue. Muscle strains will usually recover in 2-4 weeks with minimal to no intervention by health care professionals. Tendons, on the other hand, do receive blood supply but not in the same way or rate as muscles. Tendons need to be increasingly stressed in order to stimulate their healing response. For tendons, many people will rest or not use the affected body part for extended periods of time which can impair the ability for the tendon to heal. Heavy and slow loading has demonstrated to be effective with improving healing time, improving the strength of the tendon, and minimizing the risk of reinjury.
It should be noted that loading is very gradual and needs to be performed consistently. Tendon pain best responds to daily loading in small doses, rather than loading heavier and more aggressively 2-3 days per week. For most individuals, loading will start with isometric exercises (3-5 sets of 45 second holds), progressing to concentric exercises (3 sets of 8-12 slow reps), then eccentric exercises (3 sets of 8-12 slow reps) and wrapping up with sports
specific drills as appropriate. Often when rehabbing a painful tendon, the first set of an exercise may be mildly painful, but this pain will often dissipate as the remaining sets are completed. Loading a tendon, or putting stress on a tendon, will trigger an analgesic or pain relieving effect on the tendon which is an added bonus!
If you have any questions about managing tendon pain, please feel free to reach out to our physiotherapist Audrey at office@movetherapeutics.ca. If you are looking for online resources for managing tendon pain, we highly recommend E3 Rehab YouTube channel and website as an evidence based resource for exercise with tendon pain.
