How To Rehab Tendon Injuries & Pain (Exercises & Education for Tendinitis, Tendinosis, Tendinopathy)

Summary

Key Points

• Tendinopathy is characterized by the presence of inflammatory markers, but inflammation is not considered the primary driver, and imaging changes are common even in asymptomatic individuals, making them unreliable for diagnosis or treatment guidance. 1:39
• The classification of tendon injuries has evolved from "tendonitis" (acute inflammation) to "tendinosis" (degeneration) and is now preferably termed "tendinopathy," which describes persistent pain and loss of function related to mechanical loading. 2:30
• Tendinopathies often result from load management issues where the intensity, frequency, or volume of loading exceeds the tendon's capacity to recover, leading to a "boom-bust" cycle that should be avoided by consistent, gradual loading. 7:02
• Effective rehab requires careful pain monitoring during exercise, immediately after, and critically, the day after, to ensure that the exercise dosage is appropriate and does not lead to a significant worsening of symptoms. 8:53
• Beyond direct loading, lifestyle factors such as sleep, stress, nutrition, and overall well-being can influence chronic low-grade inflammation and the persistence of tendinopathy symptoms. 10:27
• A typical rehab framework progresses through stages: isometrics, heavy slow resistance, energy storage and release (plyometrics), and a gradual return to sport, with overlap between these categories. 11:08
• Exercise progression involves starting with controlled movements like isometrics, moving to heavy slow resistance exercises (e.g., squats, step-downs with a slow tempo), then incorporating faster, more complex plyometric movements, and finally sport-specific activities. 11:08
• Heavy, slow loading, particularly for durations of at least 3 seconds per contraction, is crucial for inducing positive tendon adaptations, such as increased stiffness, which helps reduce strain and prevent pain. 12:02
• The main goals of tendon rehabilitation are to improve the tendon's tolerance to various forms of mechanical loading and to restore the function of the affected tendon, muscle, and the entire limb. 22:30
• There are no quick fixes for tendinopathy; injections and passive modalities like foam rolling or icing are generally not effective long-term or do not provide additive benefits to a structured, consistent exercise program. 22:54