Tendon Pain – Common misconceptions

What is tendon pain?

A tendon connects the muscle to the bone. Tendon pain is the most common injury that we see at the clinic. Common tendon pains are:
Achilles tendon
Patellar tendon (knee pain)
Hamstring tendon pain
Plantar fascia (foot pain)
Adductor tendon (groin pain)
Tennis elbow
Shoulder tendon pain
Gluteal tendon pain (hip pain)

Usually, these take a long time to heal and can become quite problematic for some patients. There are also several misconceptions about how we should treat tendon pain. Here are a few:

Most tendons are not inflamed even though they’re painful
We used to call these problems ‘tendinitis’, however, a lot of research has shown us that there is no inflammation in the tendon even though they are painful. Therefore, any anti-inflammatories do not usually work (there are exceptions to this rule!), and most of the time they do not respond to rest and ice. The main cause of pain is due to changes within the tendon itself, and now we call these problems ‘tendinopathy’.

Tendon pain does not improve with rest
This is a very common mistake that patients and athletes make. They stop their activities for a week (or more) hoping that the pain will go away, however, the pain will return as soon as they resume the activity. Tendon pain does NOT improve with rest! The key to helping tendon pain is to load it gradually, and this is where a physiotherapist can help you return to function and sports. It is still a slow progress and healing takes long, but the good news is that you do not necessarily need to stop running / jumping / walking / dancing as you recover from tendon pain.

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I need an injection
Very few tendon pains need an injection because most of them are not inflammatory. Best to liaise with your physiotherapist who can guide you if and when an injection might be necessary, but usually this is a last resort.

Most tendons do not like stretching
This is a very common myth and like everything, there are always exceptions to the rule, however most tendon pain (like gluteal tendinopathy, hamstring tendinopathy and Achilles tendinopathy) do not respond well to stretching and can cause compression and more pain. So, think twice before you start stretching!!

Loading is the key to treatment and helps healing
As we said before, tendon pain does not like rest (especially not for a long time). If it is super acute, you might want to rest it for a few days (maximum a week), however, you then need to start loading it gradually. This load needs to be individualised to every particular patient and we need to make sure that you do not load it too much (because that will cause pain), but also load it enough to create healing. Finding a happy medium of load can be tricky and is not always easy, and guidance from a physiotherapist can help you find the right balance. Once you start the ‘loading’ exercises, you mustn’t keep doing the same exercises for weeks on end, but change the load and slowly progress it and make it harder so that the tendon becomes better at adapting to that particular load.

I got this injury because I was training too much
This is a common misconception; however, tendon pain can happen when there is a recent sudden increase in training but also when there is a decrease in training. Tendons do not like too much load (especially if done suddenly), but also do not like it when you stop for long periods of time.

KEY TAKE-HOME MESSAGES

  • Rest, injections and anti-inflammatories do not usually help.
  • The key is loading the tendon gradually (that means specific exercise training, preferably guided by a physiotherapist).
  • Healing requires time and a lot of patience!
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