3 Mistakes People Make When Rehabbing Tendons
If you’re reading this you’ve probably dealt with a nagging tendon injury before. These injuries can be annoying and feel like they are never going to go away. Over the years as a physiotherapist I’ve seen plenty of people who come through our doors with tendon injuries and most of the time they’re making 1-3 of the mistakes I’m about to cover. The good news is I’ll also provide you with a few takeaways on how you can get started on treating tendons the right way.
Here are the mistakes:
Let’s get these mistakes out in the open for all to see.
Over stretching
Compression
Under loading
Now that you see what they are…have you made one of these mistakes before? Don’t worry! So have I.
Over stretching
This is a common mistake we see because as a society it’s ingrained in us that if we have pain or tightness in an area…we must stretch it!
The problem with this is that sometimes when tissues are injured they actually don’t like to be overstretched. This holds true when it comes to tendons. This type of uncomfortable stretch loading often happens when the tendon is stretched over bone. For example when your knee pushed pushes over your toe it will stretch your achilles tendon over the bone. It probably won’t like this. If you continue to stretch thinking it’s the right thing to do, there is a high chance that it’ll cause you more pain not less.
Compression
Another ingrained response to pain and injury that falls just behind stretching is compressing. Whether this be through self massaging, foam rolling, or jamming a lacrosse ball in to the painful area, compression can be another mistake you’re making when managing angry tendons. The tricky part to this is that in the moment the above things may feel good. But, the after effect of this compression may show itself later as pain or may be the reason that overall the pain hasn’t gone away. A common area we see this done in is the high hamstring just below the sit bone (ishial tuberosity if you’re fancy). Although you may feel the urge to do this we encourage you to refrain from doing this early on the rehab process
Under loading
This last one can be a bit tricky to navigate which is why we’re here to help. The trouble with load for tendons is its both the poison and the antidote. Overloading the tendon either acutely or chronically can cause the tendon to become painful. But, the only way to improve the tendon is by loading it gradually and progressively so it can adapt to take on the appropriate demands.
We often find that people are actually under loading the tendon by focusing on doing the above 2 things. Stretching, foam rolling, and soft tissue work often don’t put enough proper load to the tendon in order for it to adapt. The tendon often needs heavier and more slow resistance in order for it to adapt. So things like stretching, foam rolling, and even light resistance exercises will not do enough to adapt the tendon and return it to be able to meet the demands that are required.
A big reason why “just resting” is not the answer.
Now that I’ve broken down the 3 mistakes people often make, let’s highlight some ways to manage tendons correctly.
The Solution
Early Phase
During this phase, the goal is to desensitize the tendon and be able to use more load with less pain. We can do this with multiple loading bouts daily. We may start with with 4-6 hour breaks between lighter bouts and gradually progress to heavier loads with greater rest. The key is to respect the pain and not over do it. We often use the stop light analogy to monitor these symptoms.
This phase may consist of a combination of isometric exercises (load with now movement), slow eccentrics (when the muscle is lengthening eg., straightening your elbow during a bicep curl), or slow eccentric/concentric movements (both stretch and shortening contractions). It’ll really depend on how you’re responding to one of these types of loading strategies.
Late Stage
During this phase the goal is to increase the load tolerance of the tendon. We want to start to use more load with less pain so that we can develop tendon gains and prevent the tendon pain from coming back. Although things are feeling better in this stage we often still have work to do. This phase will consist of a combination of heavy slow loading, where we can use isometric, eccentric, and concentric loading patterns to do this. The major key here is that the load is heavy! We need heavy load to adapt the tendon. We may also start to re-introduce plyometric movements in this phase of rehab as well. This is where the tendon is under going a high velocity stretch/shorten cycle. An example of this would be the achilles tendon during an activity such as hopping. It’s important we expose the tendon to all types of loading during the rehab process.
To wrap up
You now have the 3 common mistakes I see people make with tendon pain and a few ideas of how you can start to manage them in the right way. Tendon issues are probably the most common injury we see at The Movement.
Despite what people think ,they can be very tricky to manage and are often the injuries that become chronic. So in order to help people continue to educate themselves on tendons we dove even deeper into this topic in an ebook we created called, “Tendon Pain & Tendon Gains”.
You can grab a copy here for free!
If you’re tired of dealing with a tendon injury and want to get it under control we can help you. Click the button below and we’ll set you up with one of our Physiotherapists who’ve successfully helped hundreds of clients overcome these types of injuries. Don’t believe me? Check this out.
