Are you in Geelong and struggling with a stubborn tendon injury? At Move Sports Physio in Geelong West , we know that tendinopathy can be challenging to manage, especially with evolving research and treatment approaches. From the early days of “tendinitis” and eccentric exercises to today’s emphasis on progressive loading, it’s clear there’s no one-size-fits-all solution. However, our physio, Joseph Smith from Move Sports Physio in Geelong West, has put together some simple, evidence-based guidelines to help you navigate tendon rehab effectively. Read on for the key do’s and don’ts to get back to doing what you love—pain-free!
RULE #1 Tendon Rehab: Don’t Rest Completely
Rest isn’t always best—especially for tendinopathies. Instead, focus on relative rest, which means reducing the load without stopping activity entirely.
Why? Tendons need some load to adapt and heal. Absolute rest can weaken the tendon, delaying recovery.
How? Adjust your activity based on pain levels. Reduce aggravating movements during flare-ups but reintroduce loading as soon as possible.
Key Takeaway: Rest reduces pain temporarily but doesn’t improve tendons long-term.
RULE #2 Tendon Rehab: Do Progressively Load the Tendon
Tendinopathy stems from a failed healing response to load. The solution? Strengthen through progressive overload.
Focus on These Variables:
Intensity: Start with lighter loads and increase gradually.
Volume: Control the number of repetitions and sets.
Frequency: Balance rest and exercise days.
Best Practice: Research supports heavy slow resistance (HSR) training for tendons. This involves applying heavy (>75% max effort) loads with slow, controlled movements. Eccentric exercises (slowly lowering a load) also show strong benefits.
Key Takeaway: Tendons thrive on gradual, consistent loading.
RULE #3 Tendon Rehab: Don’t Completely Avoid Pain
Avoiding all pain during rehab can lead to underloading, which hampers recovery.
Pain Threshold Guide: Use the Pain and Activity Modification Scale:
Pain levels of 4 or less: Continue with current load.
Pain at 4–6: Proceed with caution; reduce load if needed.
Pain above 6: Stop and reassess.
Educate Yourself: Understand that pain doesn’t always mean damage. Managing this fear (kinesiophobia) is crucial for successful rehab.
Key Takeaway: Some pain is okay—monitor and manage it smartly.
RULE #4 Tendon Rehab: Do Set Realistic Timeframes
Tendon healing is a marathon, not a sprint.
Minimum Commitment: Research indicates that tendons need at least 3-6months of consistent loading to show significant improvement.
At Move Sports Physio in Geelong West , we emphasise setting functional goals rather than rigid timelines. Healing is determined by how your tendon responds to loading, not by an arbitrary calendar date. Stay patient, stay consistent, and trust the process!
Key Takeaway: Patience and consistency are your best allies.
RULE #5 Tendon Rehab: Do Use Isometrics for Pain Relief (When Effective)
Isometric exercises (holding a position under tension) can provide temporary relief—but they’re not a cure-all.
Key Points:
Effective only if performed at 80% of Max Voluntary Contraction (MVC).
Best used as part of a pre-exercise routine. Aim for 3–5 sets of 45-second holds with 2-minute rests.
Not everyone benefits, but for some, it reduces discomfort and provides a “buy-in” for rehab.
Key Takeaway: Isometrics are useful for short-term relief but aren’t universally effective.
RULE #6 Tendon Rehab: Don’t Compress or Stretch the Tendon
Healthy tendons are stiff, not stretchy. Overstretching or compressing them reduces their force-transmitting capacity.
Avoid:
Positions that stretch or compress the tendon.
Direct pressure, like massage, on irritated tendons.
Example: For Achilles tendinopathy, avoid dorsiflexion stretches and high-top shoes that press on the tendon.
Key Takeaway: Tendons hate compression—keep them in positions where they can function without excess tension. We can add these into your rehab as you progress
RULE #7 Tendon Rehab: Tendons Love HEAVY, SLOW LOAD
One of the most effective strategies in tendon rehabilitation is applying heavy, slow resistance (HSR) training. .Controlled loading is key, and at Move Sports Physio in Geelong West, we use HSR to build strength, reduce pain, and keep you moving. The physios at Move will help create a program specific to you.
This is an example....
How to Apply Heavy Slow Loading:
Start with Double-Leg Exercises:
Begin with exercises like squats or calf raises.
Aim for 45 seconds of time under tension per set, focusing on slow, controlled movements.
Progress to a load of 1.5 times your body weight (1.5 BW) for double-leg exercises.
Transition to Single-Leg Load:
Gradually shift to single-leg variations, such as single-leg calf raises or split squats.
Maintain the same 45-second time under tension.
Increase resistance progressively, aiming to support at least 70% body weight on each leg.(these figures are arbitrary but give you a guide)
When your tendon isn’t as reactive we then increase the speed and throw in some plyometrics.
Why It Works:
Tendons thrive under controlled, progressive load. Heavy, slow resistance minimizes shock loading, promoting collagen alignment and tendon strength. Remember to monitor pain levels, ensuring they stay manageable (below 4/10) throughout the process.
Key Takeaway: Tendons LOVE load—especially when it's heavy and slow!
Managing tendinopathy is challenging but entirely possible with a clear, structured approach. By understanding the mechanics of tendon pain and applying these six rules, you can navigate the rehab process more effectively. Remember: progressive loading, realistic expectations, and smart pain management are the keys to success.
Your tendons love load—just the right amount, at the right time. Stay consistent, stay patient, and stay informed. Book here if you would like extra info or some more tips and tricks how to level up your rehab !
If you would like to learn more about strength training - check out these articles.
Keen to learn more about the physio team that works at Move in Geelong? Check it out here!