Tendon Pain and Exercise
Tendon pain can be extremely frustrating, as it seemingly comes out of nowhere and is relatively debilitating. It can also mess up our workout mojo and prevent us from doing some of the things we love. We understand that you want to live your active lifestyle and train pain free, so the focus of today’s blog is to help you determine how to structure exercise based on the type of tendon pain you’re experiencing and how to get rid of it.
We are talking today about tendinopathy. It used to be thought that there were two types of tendinopathy. “Tendinitis” where tendon pain is caused by inflammation, and “tendinosus” where there is tendon degeneration with no inflammation present. This is why “tendinitis” used to be treated with NSAIDs and cortisone shots.
Newer research however suggests the continuum model, where an affected tendon can move from a “reactive” state to a “degenerative” state. A reactive tendon is onset with stretching/contracting of a muscle and/or compression, where the tendon is pressed against something bony during movement. Typically this happens when we do too many cyclical movements – movements that are low load and fast (think air squats, kipping anything, olympic lifts, push ups). At this point, the pain you’re having is simply your body trying to prevent you from further hurting yourself – it is protective. With rest, the tendon can revert back to its normal state.
How do you know you’re still in this state of tendon damage? As you warm up, your pain gets WORSE!
However, if this goes on chronically for a long time, then tendon can move from reactive to degenerative. This happens quite frequently with youth and elite athletes, and the older population. Typically, this is nagging aches/pains over the course of years. The difference here is that this tendon will NOT go back to normal with rest – It needs to be stimulated, or in other words loaded strategically. Typically in this state of damage degeneration you will actually feel BETTER as you warm up!
How to get back to a healthy tendon
If your tendon is reactive, it needs to rest a bit. Typically two weeks. If it doesn’t get better without loading it for 2 weeks, it’s probably degenerative, not reactive.
If the tendon is degenerative, it needs to be loaded – and slowly! The intervention we use is called HSR. If you’re in our classes you’ve become quite familiar with the HSR tempo (3 seconds up, 3 seconds down). It is challenging, but it’s just what you need to get your tendon moving back in the healthy direction. There are specific sets & reps, and exercises depending on which tendon you’re dealing with so it’s important to be assessed by a coach before trying any of this!
In this case the standard advice “If it hurts, don’t do it!” is actually terrible advice! We need a bit of irritation.
Another thing you can do in the meantime is use isometrics. For example if you have bicep tendon pain, holding a bicep curl at 90 degrees for 30 seconds. Isometrics have been shown to decrease pain (and allow you to workout for the time being). (wall sits are another example)
Preventing tendon pain from coming back
Once your pain is gone, you’ve got to stop it from coming back again. The key here is managing the type of movements you do. We want to do more movements that build your tendons than break them do.
Cyclical movements break down tendons. Air squats, push ups, olympic lifts, kipping, running, rowing, burpees etc. Light load, fast, little control.
Mechanical movements build up tendons – DB Rows, Loaded controlled squatting & deadlifting, 1 arm high pulls and press, etc. Slow, control, heavier loading.
Are you having tendon pain? Talk to coach and get an assessment – there is no good reason to continue dealing with frustrating tendon pain when there is a solution for you. If you’re lucky we may even prescribe you an HSR cycle and you’ll get stronger AND get out of pain at the same time.
Email email@example.com to schedule a free assessment and start your path to pain free training!