So you think you have tendonitis. This feels like pain around your Achilles, knee, shoulder, or elbow that won’t seem to go away. You’ve always heard to rest so you try that, but the pain comes back right back when you get active again. You’ve also tried to just push through it, but that only seems to make it worse. You’re not sure where to go from here. It can be a tricky thing to treat, so let’s break down how to treat tendonitis the right way.
What is tendonitis?
To understand how to treat tendonitis, first you have to understand how your tendons function. Tendons are very thick, elastic structures that connect muscle to bone. Their main job is to help the muscle produce force. Literally every movement you do that involves lifting, jumping, climbing, walking, and playing sports works your tendons. Tendonitis happens when a tendon gets angry and inflamed and there are two main causes:
1. You significantly increase your activity over a short period of time. Think things like helping someone move over the weekend, cleaning out the closet and reaching overhead a lot, doing a ton of stairs and hills on a hike one day, or doing a heavy workout after not having lifted for a while. This type of activity is typically much more than what your tendons are used to doing and they get a little cranky after having to work harder than usual.
2. You do a lot of intense activity over a long period of time. This scenario typically happens in very active people and athletes like baseball players, tennis players, lifters, cross fitters, and runners. These people do a lot of repetitive activity, usually at a high intensity, and over time, the tendons become overworked.
Why does tendonitis happen?
Tendons were made to work. After all, their primary job is to produce force with the muscle, so working is what they do best. While it may sound contradictory since I just told you about how overworking your tendons can lead to tendonitis, the key is to work them just the right amount.
It’s just like Goldilocks and the Three Bears. Tendons don’t like to work too little or too much—they like to operate right in the middle. When a weak muscle and tendon (aka one that is underused) works too much, or when a strong muscle and tendon works too much, you start to feel pain.
What makes tendonitis worse?
Contrary to what you may have heard, rest is the WORST thing you can do for tendonitis. There’s been a ton of research on how to treat it and the old recommendation of resting a tendon has recently been shown to actually make things worse!
I rarely say never, but I’m about to here. If you have tendonitis, NEVER go into a walking boot, sling, or brace that restricts movement. Remember, tendons love to work. If you take away all the work they normally do, this actually limits healing and recovery.
How to treat tendonitis
So how do you treat tendonitis? It’s all about pairing the right amount of work with the right amount of muscle and tendon strength to keep everything happy. Load the tendon in the “Goldilocks” range. Load too much and pain can flare up. Load too little and no real healing is happening.
The best way to start loading a tendon and promoting recovery is through something called an isometric. In an isometric, the muscle is contracting, but no movement is happening. This includes things like a wall sit, pushing into a wall or sturdy object, or holding a dumbbell and not letting it move.
Let me give you an example. Consider tendonitis in your Achilles. The Achilles tendon attaches your calf muscle to your heel and is the thick, ropey structure you feel at the back of your ankle. To do an isometric for the Achilles tendon, we need to activate the calf muscles. My favorite way to do this is to stand on the edge of a step with just the ball of your foot on the step with the rest hanging off the edge. If the tendonitis pain isn’t too bad, you can stand on just one leg. If the pain is bad, then stand on both feet. Hold this position, feeling your calf working and keeping your foot parallel to the ground. Voila!
To do an isometric to heal tendonitis, you need to generate a pretty significant amount of force. It should be challenging! Hold this contraction for 45 seconds, rest for 45 seconds, and repeat 5 times. Pain should be a 3/10 or less while performing the isometric. If pain exceeds this level, reduce the intensity of the isometric.
Isometrics have an amazing way of reducing pain. When done correctly, you should have less pain immediately after performing the isometric. Pretty cool to see such an immediate improvement! Once there is less tendon pain with activity, then you can move to the next phase, which is building a lot of strength. This is done through something called heavy, slow resistance. You need to lift heavy and you need to move slowly. This maximizes tendon strength and healing.
How long does it take to recover from tendonitis?
It can take quite a while to recover from tendonitis, especially if it’s been going on for a while. Depending on your history and level of activity, it can take anywhere from 3-12 months with consistent effort. Once you heal from tendonitis, it unfortunately is more likely to come back. This is where having a good exercise routine that keeps the tendon working in a healthy way is very important.
I hope you have a better understanding of what causes tendonitis and how you can get on the path to recovering from it. Need a more customized plan to treat your tendonitis? Thinking “Where can I find physical therapy near me?” Contact us to see how we can help you feel your best.
