Tendon pain is a common issue that can affect the shoulder, elbow, knee, Achilles tendon, and other areas of the body. You may have heard terms like tendinitis or tendinosis, but healthcare providers often use the broader term tendinopathy to describe tendon-related pain and dysfunction.
What Is Tendinopathy?
A tendon connects muscle to bone and helps transfer force during movement. Tendinopathy occurs when a tendon is unable to tolerate the demands being placed on it, resulting in pain and changes within the tendon.
Researchers often describe tendon injury using the continuum model of tendinopathy, which includes:
- Reactive tendinopathy: An early response to increased stress or overload.
- Tendon disrepair: Structural changes begin to develop within the tendon.
- Degenerative tendinopathy: More chronic changes occur over time.
The good news is that tendons can adapt and become stronger when loaded appropriately.
Common Causes of Tendinopathy
The most common cause is overload, meaning the tendon is exposed to more stress than it can currently tolerate.
Common contributing factors include:
- Sudden increases in exercise or activity
- Repetitive movements at work or during sports
- Muscle weakness
- Poor recovery between activities
- Previous tendon injuries
- Age-related changes in tendon capacity
How Physical Therapy and Performance Training Helps
Research consistently shows that progressive loading programs are one of the most effective treatments for tendinopathy.
Physical therapy focuses on gradually improving the tendon’s ability to tolerate force while reducing pain and restoring function.
A typical progression may include:
1. Isometric Exercises
These exercises create muscle tension without joint movement.
Examples include wall sits or static calf raises.
Benefits may include:
- Temporary pain relief
- Early tendon loading
- Maintaining muscle activation
2. Isotonic Strengthening
As symptoms improve, exercises progress to controlled movement through a range of motion using resistance.
Examples include squats, heel raises, and strengthening exercises for the shoulder or forearm.
3. Heavy Slow Resistance and Eccentric Loading
Research supports both heavy slow resistance (HSR) training and eccentric exercises, which emphasize the lowering phase of movement.
These exercises help improve tendon strength, function, and load tolerance. Current evidence suggests that no single exercise approach is superior for everyone, but progressive strengthening remains the key ingredient.
4. Return to Activity
For active individuals and athletes, rehabilitation may progress to jumping, running, or sport-specific activities to prepare the tendon for higher demands.
