Based on updated modern knowledge of tendinopathy, tendinitis, or tendon pain, let's shed some light on the best ways to rehabilitate for complete recovery. Part of this discussion will bust several "myths" or "misconceptions" that have existed about the treatment and management of tendon pain.
- MOVE! It is best to avoid complete rest as movement and blood flow is the driving force to the recovery and healing mechanisms of the body. Complete rest is ineffective as it decreases the ability of a tendon to handle load. Rather, you should reduce loads to a level that the tendon can tolerate and gradually rehabilitate the tendon back to proper function. It's important to understand what your movement sensitivities and limitations are and adapt accordingly. Being told to completely rest is poor advice as medical understanding of healing tendinopathies has greatly improved.
- PRIORITIZE ACTIVE REHAB OVER PASSIVE TREATMENT. Again this builds off our first point. Active rehabilitation that requires the movement of your body through proper joint range of motion under appropriate pain-free loads is proving to be the golden standard in recovery from tendon and joint pain. Passive treatments such as electric stimulation, laser, ultrasound, taping and cupping have very little evidence to support their long-term efficacy in treatment outcomes. But people love them cause they are easy. They are done to you, not by you. Sure they may provide short-term symptom relief, but they do little in regards to long-term progress. Why? Because these treatments do nothing in regards of improving the ability of the tendon to absorb and handle load. Therapeutic exercises aimed at restoring proper movement patterns with progressive loading is the key to retraining the ability of the tendon to handle load appropriately. Thus resulting in successful long-term outcomes from tendon pain. The reality is, the most effective stuff is usually the hard stuff. This is true in training, nutrition, and recovery. The hard stuff is always more effective than the easy stuff. Sure you may need some passive treatment to help control pain, but you will never fully heal a tendon without long-term focus on exercise-based rehabilitation.
- STOP IGNORING YOUR PAIN. Pain is the your body's way of telling you that the load you are placing on your tendon is too much. You must stop ignoring this and reduce your training load, volume or frequency. Again tendon pain is caused by routinely overloading the tendon. If you continue to overload your tendon, why do you ignore the pain or expect it to magically heal? Don't ignore the pain and realize your body is sending your a message that's worth your attention.
- DON'T STRETCH YOUR TENDONS. Stretching your tendons will only serve to further irritate and exacerbate your tendon pain. Stretching tendons can be detrimental to their structure and health. Our tendons work like a spring, absorbing and releasing forces as we move. Tendon stress is at it's highest when we do activities such as sprinting, jumping and throwing. This is when the spring function of a tendon is most critical. This is important to understand, as for many people they may only experience tendon pain during sports or exercise. If you stretch a spring, you will compromise it's function. Springs don't need to be flexible so please don't stretch your tendons.
- AVOID SHORTCUTS WITH REHABILITATION. When it comes to tendon pathologies or tendon pain, there are no shortcuts in rehab. There is no magical potion or pill or modality. Treatments or interventions that promise cures often provide short-term pain relief only for the pain to come back again. Even injection therapy has shown to be effective only when exercise-based rehabilitation is not. You must realize that our tendons need time to rebuild strength and proper function. Often they need a significant amount of time and rehabilitation can take months. If exercise-based rehabilitation is not a priority, then we have our answer as to why many deal with chronic or recurrent tendon pain as they aren't addressing the reason why their tendon pain developed in the first place.
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