The 7 Rules of Tendon Rehab
Updated: 3d
Struggling with a stubborn tendon injury? At MOVE Sports Physio Geelong, we know tendinopathy can be challenging to manage, especially as research and treatment approaches keep evolving. We've moved on from the days of "tendinitis" and eccentric-only programs to today's emphasis on progressive loading, and it's clear there's no one-size-fits-all solution.
Our physio Joseph Smith has put together seven simple, evidence-based rules to help you navigate tendon rehab. Read on for the key do's and don'ts to get back to doing what you love.
Rule #1: Don't Rest Completely
Rest isn't best for tendinopathy. Instead, focus on relative rest: reducing the load without stopping activity entirely.
Why? Tendons need load to adapt. Complete rest reduces tendon capacity and can delay recovery.
How? Adjust your activity based on your symptoms. Reduce aggravating activities (often jumping, sprinting or hills) during flare-ups, but keep moving and reintroduce load as soon as you can.
Key takeaway: Rest eases pain temporarily, but it doesn't improve your tendon long-term.
Rule #2: Do Progressively Load the Tendon
Tendinopathy is best understood as a tendon that hasn't kept up with the load placed on it. The solution is to build its capacity through progressive loading.
Intensity: Start with a load you can manage and increase it gradually.
Volume: Control the number of repetitions and sets.
Frequency: Balance loading days with recovery days.
Best practice: Heavy slow resistance (HSR) and eccentric programs both have good evidence, with similar long-term outcomes. Recent research suggests the most important factor is that the load is progressive and consistent, rather than the exact type of exercise.
Key takeaway: Tendons thrive on gradual, consistent loading.
Rule #3: Don't Completely Avoid Pain
Avoiding all pain during rehab can lead to under-loading, which slows recovery. Research supports using a pain-monitoring model:
Pain up to 5/10 during exercise is generally acceptable.
Pain should settle within 24 hours, and morning pain and stiffness shouldn't be worse the next day.
If pain is higher, or worse the next morning, reduce the load slightly rather than stopping completely.
Understand your pain: Pain doesn't always mean damage. Reducing fear of movement (kinesiophobia) is an important part of successful rehab.
Key takeaway: Some pain is okay. Monitor it and adjust your load smartly.
Rule #4: Do Set Realistic Timeframes
Tendon rehab is a marathon, not a sprint.
Minimum commitment: Expect at least 12 weeks of consistent loading before judging progress, with many people needing 3-6 months or more.
Goals, not dates: We set functional goals rather than rigid timelines. Progress is guided by how your tendon responds to load, not an arbitrary calendar date.
Key takeaway: Patience and consistency are your best allies.
Rule #5: Use Isometrics If They Help (But They're Not Magic)
Isometric exercises (holding a position under tension) were once thought to give reliable immediate pain relief. More recent studies show they're no better than other forms of loading for short-term pain relief, and responses vary a lot between people.
Where they fit: A useful starting point when your tendon is very irritable, or as part of a warm-up before activity.
A common approach: 4-5 holds of 30-45 seconds at a moderately heavy effort, with a short rest between.
Keep it in perspective: Isometrics are one tool. Long-term improvement comes from progressive loading.
Key takeaway: Use isometrics if they help you, but don't rely on them alone.
Rule #6: Don't Compress or Overstretch the Tendon (Early On)
Healthy tendons are stiff, like a spring, not stretchy. Positions that compress or stretch an irritable tendon can aggravate it.
Avoid early on: Stretching the affected tendon, deep end-range positions, and direct pressure on irritated tendons.
Example: With insertional Achilles tendinopathy, avoid calf stretches and heel drops off a step, and watch for shoes that press on the back of the heel.
Key takeaway: Tendons dislike compression. We'll reintroduce these positions gradually as your tendon becomes stronger.
Rule #7: Tendons Love Heavy, Slow Load
Heavy slow resistance training is one of the most effective strategies in tendon rehab. Controlled loading builds strength, reduces pain and keeps you moving. Your physio at MOVE will create a program specific to you. Here's an example:
How to apply heavy slow loading
Start with double-leg exercises such as squats, leg press or calf raises. Aim for slow, controlled reps (around 3 seconds up and 3 seconds down), building towards loads of roughly 1.5 times your body weight for double-leg exercises.
Transition to single-leg load with exercises such as single-leg calf raises or split squats, increasing resistance progressively.
Then add speed: When your tendon is less reactive, we introduce faster movements and plyometrics (hopping, jumping and running drills) to restore the tendon's spring.
These figures are a general guide only. Your program will be based on your testing results and goals.
Key takeaway: Tendons love load, especially when it's heavy, slow and progressed over time.
Want to Learn More?
Your Tendon Can Get Stronger
Managing tendinopathy is challenging, but entirely possible with a clear, structured approach.
Progressive loading, realistic expectations and smart pain monitoring are the keys to success.
👉 Book your tendon assessment with one of our experienced physiotherapists today.
