A Guide to Tendinopathy Recovery
By Bri Keary AEP Grad Cert. Mental Health (Candidate)
Tendinopathy can be a frustrating and tedious condition to treat, especially when it interferes with the sports or activities we love.
Tendons undergo continuous remodelling in response to the forces they encounter, thereby constantly changing. Repetitive overload creates an opportunity for positive adaptations, leading to stronger tendons. However, insufficient recovery time can cause unfavourable structural changes, triggering inflammatory responses and subsequent pain (source).
How to Promote Tendinopathy Recovery
- Firstly, be patient. Tendons heal slowly and may take up to 3 months before showing improvements. Full recovery can take up to 12 months depending on severity and management (source).
- Provide optimal loading of the tendon. This will mean managing the type of stress, volume, and time between loading.
- Understand that there are MANY factors contributing to recovery including training history, medical history, emotional health, sleep health, social health, values and beliefs, stress management, genetics, different perspectives of pain, etc (source).
Evidence-Based Exercise for Tendinopathy Recovery
Isometric exercises are a safe and effective place to start. They help decrease pain sensitivity, increase blood flow, decrease muscle inhibition, and decrease unhelpful guarding in those with tendinopathy. While every case will be unique, here is a general rehab guide:
- Aim for 5×10-45 second isometric holds 2-3 times per day, at up to 70% maximum strength. It is important to build up to these volumes and intensities slowly as are tolerated (we’ll further explain how to gauge this soon).
- If this is well tolerated, move to normal isotonic strength training on non-consecutive days with 48 hours in between where possible, 2-3 times per week.
As a general principle through rehab, start with slow, controlled movements, and GRADUALLY move towards powerful/energy storage movements such as plyometrics. (source)
Should I Push Through Pain?
It is widely accepted now that pain does not directly equate to structural damage. There are many factors involved in how pain is experienced. Where mild increases of pain return to baseline within 24 hours, it is generally safe and necessary to mindfully move through some discomfort. Load progression is probably needed if there is never any discomfort during or after training. It is not helpful or realistic to avoid all pain. It IS, however, helpful to understand when we need to let the recovery rate catch up to the rate of stress on those structures.
Some signs that we may need to temporarily decrease load and allow for more recovery time:
- Pain is spiking above 3-4/10 (where 10 is the worst pain you can imagine and 1 is very mild discomfort),
- There is a considerable increase in pain for over 24 hours after the activity,
- There is a sudden spike of pain afterwards and there is swelling, heat and redness in the area.
Outcomes are generally the best when we aim to treat tendinopathy conservatively first. If recovery is resistant to conservative treatment, there are some surgical options with positive long-term outcomes that can be discussed with your general practitioner and other specialists.
Heat or Ice?
Ice therapy in conservative amounts may be helpful where there are obvious signs of inflammation present (redness, heat, swelling, and pain). Heat is helpful when there is no obvious signs of inflammation to promote blood flow, muscle relaxation, and recover
Tendinopathy treatment can be challenging, but optimal loading, mindful progression and optimising other lifestyle factors will help you return to the activities you love.
Ready to take the first step towards your tendinopathy recovery? Book an appointment with an exercise physiologist at Gold Coast Health & Performance today and start your journey towards pain-free movement and optimal performance.
