Author: Alison Slevin

Date Published: 21 March, 2019

Do you have tendon pain? Tendon pain often feels like a stiffness when you commence an activity and has a warm-up effect as you continue exercising. The pain usually returns once you cool down. It may be present first thing in the morning when you get out of bed and, in some cases, cause significant pain when trying to sleep at night. Does this sound like you?

Tendons join muscle to bone and are responsible for distributing energy when using your muscles.

Did you know that tendon pain does not get better when you rest? There has been a vast amount of research in recent years investigating different management approaches for tendon pain (tendinopathy) and there is one thing that each and every research study found:

Tendons need progressive loading (i.e. exercise) to get better

“Ahh so that's why my hip / knee / ankle remains painful even though I have been resting it from running or playing basketball??”

Our tendon's capacity to do tasks is dependent on what load we put on them. If we rest from an activity such as running or basketball our tendons lose this capacity to deal with such tasks. So although it might be necessary (for a short period of time) to rest from an aggravating activity, exercise is essential to restore your tendon's ability to return to that activity.


The tendons in our lower limbs function differently to the tendons in our upper limbs due to their involvement in spring function - what we call the stretch-shortening cycle. What this means is, it is not as simple as doing strengthening exercises to ensure our tendons are healthy but we need to ensure they can effectively store and release energy through this stretch-shortening cycle.

The most common tendinopathies we see in the lower limbs are the Achilles (back of the ankle), patellar (knee), proximal hamstring (just below the buttock) and Gluteus Medius (side of the hip) tendinopathies. If you are having pain in these areas, the first port of call would be a physiotherapy assessment to determine if you do, in fact, have a tendinopathy.

At West Coast Physiotherapy, your assessment will not only involve a thorough assessment to reach an accurate diagnosis but it will also involve a full functional assessment of your day to day activities, work and sporting demands. This will help us to determine what the aggravating factors are, if there are any control or strength deficits and how your 'spring' is functioning.

A graduated rehab program will then be designed for you which may include:

* Isometric exercises targeted at reducing your pain levels.

* Motor control exercises to improve your muscle patterning (if appropriate).

* Slow strength-based exercises to improve your tendon's ability to tolerate load and strengthen muscles around the tendon and in the whole limb as required.

* Spring-like (plyometric) exercises specific to your activity demands, whether that be sporting demands such as running or basketball or your ability to undertake home duties and climb the stairs.

* If you are involved in sport, this program will also be tailored to whether you are currently in-season or out of season to ensure the most effective response to rehab.

* These exercises may also involve the addition of auditory cues (such as a metronome) and visual cues to 'train the brain'.

The following picture depicts a nice progression of this rehabilitation:

Cook and Dockling (2015)

Where you start within this exercise sequence may vary depending on your assessment. The key to this program is ensuring it is graduated. Many of our patients have developed their tendon pain initially due to changes (underload or overload) in their activities or training so it is imperative to gradually progress through the exercise program to prevent flare ups and restore optimum tendon function.


* Tendons do not improve with rest: EXERCISE IS ESSENTIAL

* There is more to tendon rehabilitation than just reducing pain levels in order to return to previous levels of activity

* A graduated program of loading including isometric exercises, strengthening exercises, motor control exercises, energy storage, and energy release (i.e spring function) is required to ensure your tendon has the capacity to tolerate the activities you undertake in daily life at home, work, and in sport.

If you are having tendon pain or reduced performance, get in touch and one of our Physiotherapist's will conduct an assessment and design a management plan specific to YOUR needs.

Phone: (08) 9341 2215

Online Bookings: www.westcoastphysiotherapy.com.au


Cook JL, Docking SI. “Rehabilitation will increase the 'capacity' of your…insert musculoskeletal tissue here….” Defining 'tissue capacity': a core concept for clinicians. Br J Sports Med 2015;49:1484-5. doi:10.1136/bjsports-2015-094849

Photo Credit: http://federateco.top/

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