Tendon Pain Treatment: 10 Things to Avoid

Achilles Tendonopathy

If you have ever struggled with tendon pain, you know how frustrating and difficult recovery can be. As a result, tendon problems often limit your ability to train like you want to.

Tendon Problems commonly fall within 2 categories, tendinitis and tendinosis.

To start, tendinitis refers to an inflamed tendon or tendon sheath.

Where as, tendinosis often occurs due to micro-tears from chronic overloading.

Now, the most common lower limb tendon problems occur in the patellar tendon (below knee cap) and achilles tendon (back of heel).

With Tendon Pain Treatment, the research strongly suggests specific rehab protocols.

Likewise, the research is equally as robust in what NOT to do.

Below, you will find 10 treatments to avoid when trying to rehab lower limb tendon problems.

Avoid these 10 things

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Tendon pain and dysfunction are the main symptoms of tendinopathy.

Treatment should be:
Active
Consistent
Ongoing

The following 10 points highlight what research shows DOES NOT improve lower limb tendinopathy.
1️⃣
Do not rest completely.

Treatment should initially reduce painful, high tendon load (point 2) and introduce beneficial loads (eg, isometrics). .
2️⃣
Avoid incorrect exercises.

To be effective, tendons must be loaded quickly with spring-like Exercises, such as:
Jumping
Changing direction
Sprinting
3️⃣
Prevent reliance on passive treatments.

Passive treatments do not increase the load tolerance of tendon and are not helpful in the long term.
4️⃣
Skip injection therapies.

Injections of substances into a tendon have been shown to be no more effective than placebo in good clinical trials.
5️⃣
Don’t ignore tendon pain.

Pain usually increases 24 hours after excess tendon load.

An increase in pain of >2/10 on a daily loading test should initiate reduction in aspects overloading the tendon (point 2).


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6️⃣
Pass on doing stretches for the tendon.

Stretching only adds detrimental compressive loads to the tendon.
7️⃣
Do not use friction massage.

An effect on local nerves may reduce pain (Short-term), only for it to return with high tendon loads.
8️⃣
Avoid tendon images for diagnosis, prognosis or as an outcome measure.

Abnormal tendon images (ultrasound and MRI) in isolation do not support a diagnosis of tendon pain as asymptomatic pathology is prevalent.
9️⃣
Abandon worry about rupture.

Pain is protective as it causes unloading of a tendon.

🔟
Stay Patient, don’t rush rehabilitation.

Tendons, muscles, kinetic chain, and the brain need time to build up strength and capacity .

(3 months or more)
❗️❗️❗️
Summary
The best treatment for tendon pain—Exercise-Based Rehabilitation. .
❗️
Starting with a muscle strength program, progressing through to more spring-like exercises,
and including endurance aspects will load the tendon correctly and give the best long-term results.

SOURCE:
Cook, J. 2018. Ten treatments to avoid in patients with lower limb tendon pain. BJSM.

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