Tendinopathy Update – Part 2

Healing Tendinopathy: How to take care of your crummy tendon tissue PART 2 – late stage.

In this second of 2 articles on managing tendinopathy we’ll look at what to do when you are experiencing later (degenerative) stage problem. If your tendon pain has been around for more than 6 weeks this is likely more where you fit – if you are unsure just ask your physiotherapist.

Remember that tendinopathy is a damaged state of tendon tissue that manifests in pain during activity and that the immune system is not doing a great job of actively healing. The onset of  the problem may be associated with a change in physical activity patterns.

As discussed 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.

This later degenerative stage is notable by the longer presence of symptoms (more than 6 weeks). The tendon is notably thickened and very tender to touch. Treatment in this stage counterintuitively requires heavy eccentric strength training. You should avoid this exercise if you cannot reduce or eliminate the day-to-day activities that aggravate your tendon. Note that if you cannot discontinue the activities that aggravate your pain you may choose to perform the isometric exercise protocol described in part 1 of this series.


Eccentric strength training is resistance training where the muscle/tendon unit is contracting while lengthening at the same time.  These exercises will stimulate your body to remodel the tendon tissue into a stronger and better organised structure. At the achilles tendon for example this would consist of heel drops as are demonstrated below. Other tendons would require different type of eccentric exercise specific to them. The volume of exercise required is heavy and high. Load should be added so that you are lifting about 80% of your maximum. Research suggests 5 sets of 15 repetitions/day for 12 weeks! This is a heavy commitment (pun intended) but the research consistently shows that this type of intervention is effective treatment. Some pain is acceptable  during exercise but if it lasts longer than 30 minutes afterward speak with your physiotherapist about possible modifications.

In thevideo above I show an eccentric heel drop (for an achilles tendinopathy). Holding a weight in my hand I let my heel drop from tiptoe height to a level below that of the step that I am on. Notice that as I come up onto my tiptoes, I use both feet to assist up, but drop down on only the injured (painful) side. To view a video expanding on this article and showing this exercise Google “James Braithwaite Tendinopathy Update – Part 2”.

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 or your doctor to confirm the most appropriate treatment for you!


Further reading (if you really want to impress your freinds)

Beyer, R., Kongsgaard, M., Kjær, B. H., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy A Randomized Controlled Trial. The American journal of sports medicine, 0363546515584760.
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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