Rethinking Tendon Rehab

Is Your Tendon Pain Holding You Back? Here's What You Need to Know:

Tendinopathy — it’s a word that gets thrown around a lot when talking about overuse injuries, but what exactly is it? In simple terms, tendinopathy refers to any abnormal condition affecting a tendon. These strong bands of tissue connect your muscles to your bones, and they play a vital role in movement and stability. But when they’re not happy, you feel it.

What Causes Tendinopathy? Tendinopathy most often develops from overuse — a common issue among active individuals. But other factors can make tendons more vulnerable, including:

• Medical Conditions: Diabetes and the use of fluoroquinolone antibiotics (a type of broad-spectrum antibiotic) can affect tendon health.

• Aging: As we get older, tendons naturally lose some of their resilience and become more prone to injury.

When a tendon becomes irritated or injured, the brain often responds by inhibiting the muscles that support that tendon so that further injury of the tendon is spared. This inhibition weakens the entire system, leading to chronic pain and increasing the risk of reinjury.

Why Traditional Rehab Falls Short For years, heavy eccentric exercises were the gold standard for treating tendinopathy. But we now know they have some serious drawbacks:

• Pain and Discomfort: Eccentric exercises often cause significant pain with limited functional improvement.

• Low Compliance: The heavy loads required can be uncomfortable and difficult to maintain.

• Disproven Theories: The belief that subtle vibrations from eccentric loading change tendon structure has largely been debunked.

The New Approach: Isometrics and Rhythmic Exercise Research shows that healthy tendons rely on fluid flow to maintain their tensile strength and promote remodeling. Isometric exercises — where the muscle contracts without changing length — create the right kind of stress on the tendon, encouraging this fluid flow and building strength without excess pain.

Here’s the protocol for effective tendon remodeling:

• Load: 70% of your maximal force production

• Position: Lengthened muscle position

• Duration: 30-45 second holds

• Frequency: Up to 10 minutes of total exercise, repeated every 6 hours if needed

• Sets: 4 holds of 30 seconds each

For calf tendinopathy, a bent-knee heel drop is an excellent isometric exercise.

The Role of the Soleus and Why It Matters When it comes to non-insertional Achilles tendinopathy, weakness in the soleus muscle (the deeper of your two calf muscles) is the single best predictor of injury. Strengthening the soleus through isometric and rhythmic exercises can dramatically reduce your risk of reinjury.

Why Pain Persists and How to Fix It After a tendon injury, the nervous system can lower the pain threshold for the nerves around the area, making the region more sensitive. This leads to a vicious cycle:

• Cortical Inhibition: The brain suppresses muscle activation.

• Pain Sensitization: The injured area becomes more sensitive to pain.

• Tendon Pathology: The tendon itself weakens.

To break this cycle, we focus on isometric loading and rhythmic exercises like metronome-paced movements. By using a metronome at 80 beats per minute (BPM), you can time your eccentric and concentric phases, ensuring controlled, pain-free motion.

For foot and ankle tendons, try Toe Pro exercises or slant board exercises, aiming for 25 reps at 80 BPM while taking the rear foot through its full range of motion.

At Endura Chiropractic and Performance, we know how frustrating chronic tendon pain can be. If you’re dealing with ongoing pain or want to prevent reinjury, we’re here to help. Our approach focuses on keeping active people active through personalized care — including adjusting, soft tissue work, dry needling, and movement-based rehab.

Ready to get back to doing what you love — without pain? Book an appointment with Endura Chiropractic and Performance today!

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