Tendinopathy The Ins and Outs

If you are an active individual, you have probably experienced tendon pain at some point. The following information has been sourced from many different areas including research and articles from Jill Cook, Peter Malliaras.

Tendinopathy is basically pain in a tendon caused by overuse or a sudden increase in activity that either use the tendon a lot to store energy or compresses the tendon. A really interesting fact about tendons is that they store energy which can be used for the next contraction. A great example is when you squat down a bit before jumping as high as you can. The squat down allows the tendons to store energy which is then used when you jump. If you’ve ever tried jumping without the first countermovement, you don’t get very far. This also happens with running at the calf with the Achilles tendon. Tendons also dislike compression. Examples of this would be the patellar tendon at the bottom of the squat or the proximal hamstring tendon when sitting. There are other factors either biomechanical or systemic that can increase your risk of tendinopathy.

You may have heard it referred to as tendonitis (-itis = inflammatory) but current research suggests that tendinopathy is more of a degenerative process than an inflammatory process. Degeneration sounds scary but it isn’t and it is relatively easy to treat. Additionally, the cellular changes associated with tendinopathy can still be present but you can be pain free. This also applies to imaging. Even if you see changes or tears or the imaging is abnormal, does not mean you are doomed and will be in pain forever and have permanent dysfunction. How that’s possible is complicated and dives into a pain science discussion which is outside the scope of this article.

So what do we do when we suspect we have tendinopathy? Firstly, make sure it’s actually tendinopathy so get evaluated by a healthcare professional. Next, resting is not the answer. Neither are passive therapies like IASTM, massage, needling, ultrasound etc. Tendons actually respond to load. We need to increase the tolerance of the tissue with loaded movements. You may have to back off the aggravating activity but there are many other ways to approach loading the area in a non-aggravating way. Basically, tendinopathy arises from a load management error so we need to back off for a bit then progressively load the tendon in a smart and systematic way. It can take 8-12 weeks for the tendon to improve and respond. You may or may not still have pain during this time. You can still train but will have to be patient with loading.

A common way to introduce loading to an annoyed tendon is through isometrics which can act as an analgesic or reduce pain. Research suggests isometric holds for 30-45s for sets of 5. You can use less time but accumulate more sets as well. The loading should be around 70% 1RM if you know that is for that exercise. Another good option is utilizing heavy slow resistance training via altering tempo at a load that is tolerable. For example, a common tempo used for main lifts is 3 secs down, 3 seconds up. You can start with higher reps (15) for 3 sets and slowly reduce the reps and add weight and sets every few weeks. This type of training emphasizes the eccentric component more than a regular tempo which has been shown to be beneficial for tendinopathy as well.

An important point about tendinopathy is that it can still hurt but you can train with the pain. Some good rules of thumb for training with tendon pain is to train at a pain level that is tolerable to you. An increase in pain during training and for a few hours afterwards is acceptable. If the pain is worse the next day, that means you overdid it the day before and will need to drop things down a bit before increasing them again. You can train with pain and still improve and eventually be pain free. It is not a prerequisite that you feel zero pain with training.

I hope this article helped you understand tendinopathy a bit better. It is best to find a healthcare practitioner who is knowledge about tendinopathy and programming to develop an individualized program for you and your training needs. Always remember, strength is the way!

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