Pain Relief for Tendonitis and Tendinopathy

What is it?

Tendonitis and/or tendinopathy is when one of your tendons becomes painful, irritated and sometimes swollen. This can occur in all tendons but most commonly at the Achilles, patellar and gluteal tendons.

More specifically we know that when a tendon is loaded beyond its capacity it starts to have increased cellular uptake. If this persists your body will start creating space between the fibers and then nerves and vessels start to infiltrate the spaced between your tendon fibers.

Now you have a bigger looking tendon and a more sensitive tendon due to increased nerve cells. At this point in time, your tendon will also have a reduced capacity for load.

How did it happen?

Load = Load = Load and Stress = Stress = Stress.

I wish they were all simple. Some are. Ie you increased your running kilometers from 15km to 25km in 1 week. Or you have started a heavy squat cycle at F45 or CrossFit. Sometimes it’s a change of footwear. Sometimes you did less work but added in hills for the first time. These examples are easy but…

Load = Load = Load and Stress = Stress = Stress.

This basically means that tendons are so multifactorial that the contributing factors can be increased stress, less sleep, poor diet and only a small increase in load. Sometimes it’s just your body telling you that you haven’t given it a great environment to heal in. These are often the people that fail traditional loading treatments.

Remember stress increases cortisol which is the inflammatory hormone in your body. Throw that in the mix with 2 hours less sleep every night and BOOOOM… those 15km weeks that were fine 3 months ago are now causing your tendons to become inflamed.

What do I do?

You need to reduce your load to the maximum your tendon can handle without producing greater than a 4/10 pain or irritation for more than 48 hours after the offending activity. This can take some time and usually some tweaking with your physio and trainer/coach.

Once you have done that you need to enter a graded loading program. This is fancy for saying we are going to rebuild your tendon without pissing it off… too much ;).

In the video above you can see a very basic starting point for a patella tendinopathy called an isometric contraction. These wonderful things have the ability to reduce pain just as well as taking a panadol or ibuprofen. Research showed that they also can give you 4-5 hours pain relief.

Quite simply you hold a static contraction against resistance. You should do this for 4-6 sets of 40secs per day. Notice in this video I am in quite an extended position. It is important with isometrics that you start with the tendon in a happy position rather than a fully stretched one. This is because we are learning that when the tendon compresses on bone this can contribute to irritation. Therefore doing this with a straight knee angle rather than bent at 90degrees is crucial.

How to progress?

Pain should start to ease after 3-10 days of doing isometrics. At that point, I would want to increase the weight 2-3 times before progressing to the eccentric exercise (adding in the down phase as well). Your progressions will depend on your activity and severity. Sometimes we progress the weight, other times we might progress the angle.

This is where you need the guidance of someone to tailor this program specific to your sport and specific to your bodies response to the previous load.