Tendinopathy Update – Part 1

Healing Tendinopathy: How to take care of your crummy tendon tissue PART 1 – early stage.

Tendinopathy is a damaged state of tendon tissue that manifests in pain during activity. It differs from tendonitis in that the body’s normal inflammatory healing process is largely not active. In short, tendinopathy is damaged, thickened and painful tendon tissue that the body has given up trying to heal!

The onset of  the problem may be associated with a change in physical activity patterns. Increased running or jumping patterns are a common history. The reason for this is that while, like muscles, tendons do adapt in size and strength to exercise, they take considerably longer than muscle tissue to make these adaptive changes. Muscles will become relatively strong compared to tendons with the onset of the new exercise pattern and this will result in further load being placed on the tendon tissue for which it is not prepared.

I advocate a model of treating tendinopathy that places it into (broadly) two stages, an early staged called reactive tendinopathy – and a later stage called degenerative tendinopathy. In this first of two articles we’ll discuss managing a reactive tendinopathy.

Reactive stage tendinopathy is characterised by a more recent (less than 6 weeks) onset of pain. The pain is often associated with a recent change in activity pattern. It can also be triggered by a blow to the tendon. Treatment in this stage consists of:

⦁ Shielding the tendon from stress – Discontinue irritating actions, and give the poor tissues some much needed TLC! Hot packs (or better yet hot tubs!) for 20 minutes at a time daily are a great option for increasing local circulation, plus they feel great!

⦁ Cleaning up movement patterns – have your physio evaluate the way you are moving in those aggravating actions. This will help you to manage pain the right way by MOVING BEAUTIFULLY!

⦁ Isometric Exercise: There is good science showing that isometric exercise is a great way to reduce pain from tendinopathy. This type of exercise requires contracting the muscle without moving your limb, like you would when you push into a wall. Push hard! Research suggests contracting at 80% of your maximum strength. Typically the protocol would call for 5 sets of 45 sec contractions/day – 4 days/week. See the video for a demonstration of this exercise.

Treating your tendinopathy as early as possible will put you in the best position for full recovery and reduce the risk of further complications including tendon rupture. Remember that the treatment suggestions presented here  are appropriate for a diagnosed tendinopathy. They may be ineffective or even damaging for pain sourced from another type of injury. If you are unsure  as to the specific cause of your pain definitely check with a physiotherapist (Like me!) or your doctor to confirm the most appropriate treatment for you!

Further reading (if you really want to impress all of your friends).

Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409-416.


Habets, B., & Cingel, R. E. H. (2015). Eccentric exercise training in chronic mid‐portion Achilles tendinopathy: A systematic review on different protocols. Scandinavian journal of medicine & science in sports, 25(1), 3-15.


van Ark, M., Cook, J. L., Docking, S. I., Zwerver, J., Gaida, J. E., van den Akker-Scheek, I., & Rio, E. (2015). Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. Journal of Science and Medicine in Sport.


Van der Plas, A., de Jonge, S., de Vos, R. J., van der Heide, H. J. L., Verhaar, J. A. N., Weir, A., & Tol, J. L. (2011). A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. British journal of sports medicine, bjsports-2011.

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