Tendon Healing Through Exercise


Tendon injuries (the tissue that connects muscle to bone) can be incredibly painful! ‘Tendinopathy’, formerly known as ‘tendinitis’, is the result of degenerative changes in the tendon; mainly due to overuse. For example, if you pick up running as a habit and decide to run for 5 miles without having run for years prior, you may be putting yourself at risk for a tendon injury. These occur most commonly in the Achilles’ tendon, patellar tendon and the common extensor tendon of the forearm (‘tennis elbow’). However, there is reason to be optimistic about it as we have no shortage of research studies that have examined the effects of various forms of exercise on tendon pain relief!

One thing to consider is that, because a ‘tendinopathy’ lacks inflammation and, thus not a ‘tendinitis’, anti-inflammatory medications will NOT be effective in tendinopathy management and are being discouraged from use. Insert exercise! Before recently, tendon rehab was predominantly centered around one form of tissue loading: eccentrics. Eccentric loading places an emphasis on the slow lengthening of a tendon in an effort to provide enough of a stimulus to heal. Though found to be effective, traditional eccentric loading practices call for up to 180 repetitions of tendon loading per day! Because eccentric loading is usually done slowly, let’s assume that 20 minutes of your day will be spent performing calf raises. That’s quite a bit!  On the contrary, recent studies have demonstrated benefits of progressive tendon loading (combination of isometric, isotonic and plyometric contractions) and externally-paced training (with a metronome) on pain relief in comparison to eccentric loading in isolation. Even though eccentric loading is preferred to no exercise, progressive loading appears to better prepare athletes for return-to-sport demands (e.g. running, jumping, etc.)

With the help of a licensed physical therapist, you will receive guidance on how to progress from the early stages of tendon pain and limited movement to later stages and return to sport safely!

  1. Breda, S. J., Oei, E. H., Zwerver, J., Visser, E., Waarsing, E., Krestin, G. P., & de Vos, R.-J. (2020). Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: A randomised clinical trial. British Journal of Sports Medicine, 55(9), 501–509. https://doi.org/10.1136/bjsports-2020-103403
  2. Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2015). Tendon neuroplastic training: Changing the way we think about tendon rehabilitation: A narrative review. British Journal of Sports Medicine, 50(4), 209–215. https://doi.org/10.1136/bjsports-2015-095215 

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