Runners at the start line. Running is one of the most common sources of tendon pain.

Sports rehabilitation is a newer and evolving form of medicine. The novelty of this medical field means patients are sometimes given the wrong advice concerning their sports injuries. Sports rehabilitation experts in Australia list ten strategies to avoid when recovering from an injury causing tendon pain.

Tendinopathy, or tendon pain, is a term that refers to a disease of the tendons. The tendons are fibrous connective tissues that connect muscle to bone. Tendinopathy is often characterized by tenderness to touch and pain. Effective strategies for tendinopathies include ongoing, exercise-based regimens that slowly build up muscle power and tendon strength.

Dr. Jill L Cook recently published an article in the British Journal of Sports Medicine that identifies ten strategies to avoid in patients with lower limb tendon pain. The ten points are highlighted below:

  1. Complete rest of the tendon progressively decreases its strength and reduces muscle power which ultimately prevents rehabilitation. An effective strategy, instead, involves gradually increasing tendon load.
  2. Correct exercises need to be prescribed at different stages of rehabilitation. Putting too much load on tendons early during rehabilitation can further damage the tendon and prolong recovery.
  3. Passive treatments, including electrotherapy and ice, are effective in temporarily alleviating pain but do nothing to heal the tendon itself.
  4. Like passive treatments, the use of injections may be useful in controlling tendon pain, but they do not address the pathology of tendinopathies, or solve the underlying problem.
  5. Don’t ignore, or push through, tendon pain. It is important to adjust exercise regimens if the strategy results in excessive tendon pain.
  6. Don’t stretch the tendon. Tendon stretching can add compressive loads that negatively affect tendon healing and prolongs recovery.
  7. Avoid friction massage. Massaging tendons can temporarily reduce pain, only for it to return more significantly when the tendon experiences high load.
  8. Abnormal tendon images do not support diagnoses of tendon pain and should not be used as a measure of tendinopathy outcomes.
  9. Patients should not be concerned with tendon rupture because there is no associated tendon pain. This means that patients with tendon pain are unlikely experience a tendon rupture, as the pain is, in itself, protective against rupture.
  10. Don’t rush recovery. For long-term outcomes, ongoing rehabilitation is necessary to build tendon strength and capacity.

Effective strategies should begin with a muscle strength program and then progress to more spring-like exercises to increase tendon load and endurance. Inappropriate strategies and exercises may prolong rehabilitation and lead to poorer health outcomes in patients with lower limb tendon pain.


Cook, J. L. (2018). Br. J Sports Med. Ten treatments to avoid in patients with lower limb tendon pain.

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