What to Do for Tendinopathy: A Rehab Approach Backed by Science
So you have a cranky tendon that just isn’t getting any better? But you're stretching the heck out of it, skipping your gym sessions to rest it, and walking around with an ice-pack on it?
Well, my friend, no wonder that thing is pissed odd. It’s time to STOP stretching, resting, and icing & START strength training with isometrics and slow tempo isolation exercises.
We used to call cranky tendons tendinitis because it was thought inflammation was the main driver of pain. But, thanks to science (yay!), we now know it's more due to the thickening of a portion of the tendon that becomes disorganized from overloading.
There are 2 types of tendinopathy – reactive and degenerative (Cook et al 2016).
Reactive tendinopathy, formerly known as tendinitis, happens from doing too much, too fast, for what your body could currently handle. Basically, you increased your activity so fast that your tendons couldn't keep up. For this, you want to scale back on your training and incorporate some of the stuff I talk about later in this email.
Degenerative tendinoapthy, formerly know as tendinosis, happens when you overload the poor sucker for so long that permanent changes take place in that portion of the tendon. Now, don't let the word permanent scare you, because you still have a portion of the tendon that is still kicking and ready to get stronger to support the tendon as a whole – we'll get to that too.
Regardless of which time you have, you basically just made her angry by doing too much – oopsies.
So, here is what you are going to do and WHY – because we love educated brain gains ‘round here. Let’s use hamstring tendinopathy as an example, k?
⚠️ Stop Stretching
In many cases, when you stretch a tendon, it gets compressed against the bone. Compression is NOT a bad thing for happy tendons! But cranky ones? Not so fast.
Stretching can make things worse because it puts further compressive stress on an already irritated tendon. Stretching can also disrupt the natural healing process, leading to more pain and delayed healing.
That means no more hamstring stretches or popping your leg up on the counter top to try and get relief. This also means limiting the end range of motion for exercises that put the hamstrings on max stretch – deadlifts, RDLs, hamstring curls, stiff leg deadlifts, glute-focused bulgarian split squats.
⚠️ Stop Icing
Okay, okay so you don’t have to stop icing entirely IF you like it. BUT, ice is not likely to expedite your recovery. Sure, it can be used for short term pain relief, but it should NOT be accompanied by complete rest.
Movement is what’s going to actually heal the thing, not your bag of frozen peas. Plus, there are BETTER ways to reduce tendinopathy pain — almost there 😉
⚠️ Stop Resting
So you take some time off and ‘rest’ your painful tendon. Then once she feels better, you resume normal activities again. To your surprise, your pain comes back just as bad, or worse. Then you rest again, getting stuck in this shitty pain cycle.
Cranky tendons don’t like rest. They like LOAD.
So here’s a better approach👇🏼
✅ Isometrics
These are a type of exercise where you hold a muscle contraction, but don’t actually move the joint. And they can actually help to reduce tendinopathy pain in the early stages.
3-4 sets of 30-45 second holds at mid-range with 70% of your max force can actually reduce pain by 87% up to 45 mins (Rio et al 2015). Dosing these into your warmup is a GREAT way to get more gains with less pains.
Single Leg Hamstring Bridge Holds
90/90 Hip Lift With Hamstrings
✅ Slow Tempo Isolation Exercises
Tempo is the speed at which you perform an exercise. Isolation exercises focus on one muscle, on one side, of one joint.
For spicy tendons, moving slow through load can help the tendon adapt & build resilience! Shoot for 3 sets of 10 to 15 reps, lowering for a count of 3 and raising for a count of 3, performing the exercise 2 to 3 times per week.
Single Leg Elevated Hamstring Bridge
✅ Training With Pain
When it comes to forcing adaptations with tendons, it’s OKAY to experience some discomfort! I like to say pain that’s ’mild but tolerable’ or ‘sore but safe.’
Working into a 3-4/10 pain that decreases back to baseline 24 hours after your sessions is a great place to be to not push past your current capacity, but also load enough to where the tissue adapts aka gets better.
FREE Guide on How to Train with More Gains & Less Pains
FREE Guide on Using The Traffic Light System to Train With Pain
✅ Patience & Consistency
These things take TIME. Rehab, when it comes to tendinopathy, can take several weeks to several months. And, unfortunately, it's not 2-day shipping with Amazon Prime.
Loading appropriately, modifying where you need to, staying consistent, & getting help when self-treatment isn't working are KEY to finally overcoming cranky tendons.
Need help with your spicy tendons? Whether its hip flexors, hamstrings, elbows, wrists, whatever, my team and I would love to help. Learn more about Rehab Coaching, here, and what happy clients are saying, here.
