Recovery

Tendon pain: why complete rest is rarely the answer

Irritated tendons usually respond better to the right amount of load than to doing nothing — the trick is finding that amount.

Tendons connect muscles to bones, and they adapt to load more slowly than muscles do. Tendon pain, often called tendinopathy, commonly appears in the Achilles, the patellar tendon below the kneecap, the outside of the elbow or the shoulder, usually after a rapid increase in training volume, intensity or a new type of activity. It tends to feel stiff in the morning or at the start of exercise, may ease as you warm up, and often feels worse the day after a heavy session.

For a long time, the standard advice was complete rest, but rest alone tends to relieve pain only temporarily while also making the tendon weaker and less able to tolerate load when you return. Current approaches focus on loading the tendon in a controlled way. Programs often begin with isometric holds or slow, heavy exercises within a tolerable level of pain, then progress over weeks to heavier strength work and eventually to faster, springier movements such as hopping or jumping that the tendon needs to handle in sport.

A practical rule many clinicians use is that some discomfort during exercise is acceptable if it stays mild, roughly 3 to 4 out of 10 at most, and settles by the next morning; if pain is clearly worse the next day, the load was too much and should be reduced. Reduce the activities that aggravate the tendon most, such as sprinting or jumping, without stopping all training. Recovery commonly takes weeks to months. If pain is severe, came on suddenly with a pop, involves swelling or does not improve with sensible changes, see a physiotherapist or doctor.

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