I get a lot of clients come to me after failed management and frustration with Tendinopathies.

What is a tendinopathy (you may know it as tendinitis)? 

Your muscles become small, stiff, strong tissues that attach to your bones. These are known as tendons and their main job is to transmit force from the muscle onto the bones to allow movement. Some well known ones are Hamstring, Patellar and Achilles Tendinopathies.

When a tendon is exposed to load above a point that it can tolerate, it can become painful. It can be overloaded due to poor strength, too much activity or biomehcanical/movement factors. What is load?

The reason they become painful is still quite poorly misunderstood, but from what we know, there is a biochemical reaction in the tendon where it is trying to adapt to the load but can’t. This is why they become painful.

Once they’ve become painful they become really poorly managed. You’re icing, stretching, foam rolling, you’ve got a strapping to “offload” the tendon, you’ve rested it and massaged it, but you’re not getting better! That’s because all of these are essentially useless.

Essentially, your tendon is weak and you need to strengthen it. Tendons react well to an appropriate level of load. This is why they become painful when you do too much and also why they don’t get better when they’re not strengthened.

Why does the rehab fail so often? 

  • Because it’s not targeted at improving a tendons capacity/strength
  • Peoples activity levels aren’t modified well enough. It tends to be an all or nothing, either complete rest or still doing too much activity
  • Most importantly, the client hasn’t been educated on both of these and this lack of understanding is so damaging for progression

If you have a Tendinopathy, forget the nonsense that’s not making you better, focus your time on:

  • Slow, heavy, resistance training: ie. Calf raises for Achilles Tendinopathy or leg extensions for Patellar Tendinopathies.
  • Modifying your activity to a manageable level
  • Look at the biomechanical factors to why your tendon is becoming overloaded

The best thing you can do is see an experienced physiotherapist. You need to be guided through a rehabilitation process of strengthening, moving better and managing activity levels.