In this blog post, we wanted to discuss rehabbing tendon injuries. Tendinopathy due to overtraining and not allowing the tendon to properly recover is one of the most common injuries treated by a physical therapist. Tendinopathy results from degeneration of the tendon. When we exercise, our muscles and tendons experience micro-tears which our bodies quickly repair. However, in some cases, repetitive exercise may cause micro-trauma, which our body is unable to repair fast enough leading to pain, swelling and discomfort on a tendon.¹ Our barbell athletes often struggle with bicep tendinopathy, our climbers with elbow tendinopathy, our jumpers with knee tendinopathy, and our runners with achilles tendinopathy. We wanted to break down the stages of tendinopathy rehab and ways to improve your symptoms.
Physical therapy generally resolves symptoms in most athletes. Initially, it is important to reduce the volume and frequency of training, particularly the activities that increase symptoms and discomfort. However, we want to modify our activities, not rest altogether. In order words, we want to find exercises that can strengthen the tendon so an athlete can return to their sport with less pain. Research shows that rest alone leads to muscular and tendon atrophy and will likely result in tendinopathy again when an athlete returns to their sport.¹·² So, let’s dig in and break down tendinopathy into 4 phases. The table below outlines each phase and the exercises performed to help athletes manage their symptoms.³
| Phase | Goal | Safe Exercises |
| Phase 1 – Isometrics | Reduce Pain | Isometric in pain-free range of motion (ROM) |
| Phase 2 – Functional Strengthening | Improve Strength | Heavy Slow Resistance / Eccentric Resistance Training |
| Phase 3 – Dynamic Strengthening | Increase Power | Increase velocity of movement for proper tendon loading / preparation for sport. |
| Phase 4 – Sport Specific | Return to Sport / Maintenance of Tendon Health | Return to sporting activities along with exercises for tendon maintenance and prevention of re-injury. |
Tendinopathies take roughly 12 weeks to recover fully but athletes are often able to return to their sport sooner. Each individual is unique, and no one rehab will look the same. For example, if an individual is coming in with extremely irritated elbow tendinopathy from lifting or climbing, we often start with isometric exercises for light strengthening and pain management. Once you progress past phase 1 and pain has improved – there are often 3 approaches – eccentric resistance training, heavy slow resistance training, or a combination. Ultimately, a physical therapist should tailor your program based on which approach you respond best to. Once an athlete’s tolerance to functional strengthening improves, then a PT will progress you into the 3rd phase in which you increase the velocity of movements to properly load the tendon and best prepare you to return to your sport. Finally, during phase 4 it is important to continue with tendon strengthening for a few months to prevent an injury from reoccurring.¹·²·³
If these symptoms resonate with you, come see us at Unbroken Rehab and Athletics and get back to your sport pain-free!
References:
- Rees JD, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med. 2009;37:1855-1867.
- Reinking MF. CURRENT CONCEPTS IN THE TREATMENT OF PATELLAR TENDINOPATHY. Int J Sports Phys Ther. 2016 Dec;11(6):854-866. PMID: 27904789; PMCID: PMC5095939.
- Mason, P. (n.d.). A guide to tendon rehabilitation. https://orthosports.com.au/pdf-download/Understanding-tendon-rehabilitation-Paul-Mason.pdf
- Featured image courtesy of jcomp on freepik.com
