Dealing with a bad (or mild) case of tendonitis?
Before you read the rest of this article, let me give you one BIG piece of clinical advice… STOP STRETCHING - it’s going to be ok!
I get it, that seems wrong doesn’t it?
When something hurts, we tend to stretch it instinctively. But are you finding that stretching is really helping your pain in the long term? Have you ever wondered why stretching sometimes makes your pain even worse?
What is Tendonitis or Tendinopathy?
Tendonitis and tendon-associated pain or injury exists on a pretty wide spectrum.
I commonly explain to Limitless clients that tendon pain can be
Mild (you just injured it on a run or an overhead lift and it feel ticked off; may/may not have some swelling associated with the pain)
Severe (tendon rupture, full-thickness tear; usually associated with a high energy movement; sometimes can audibly hear a “pop”; often times with swelling and/or bruising)
Or really anything in between.
Tendonitis has, for a long time, been thought to exist on the more mild end of the spectrum.
However, for anyone who has experienced the kind of tendon pain that lasts for months (even years?), it certainly doesn’t feel “mild”. Sometimes it’s hard to kick a bout of bad tendonitis.
What some of the research on tendon pathology tells us is that tendon pain tends to float between two groups (Cook & colleagues, 2016)
(1) A “reactive” tendon injury
Example: I just hurt my achilles tendon yesterday for the first time while sprinting up a hill and it hurts right now.
We often refer to this incident as “acute overload”, because in this example the tendon must not have been prepared to handle the amount of stress & stretch that was required to run up that hill quickly.
(2) A worn-down tendon experiencing a “flare up”
Example: I injured my biceps tendon 3 years ago while doing muscle-ups at my CrossFit box. It hasn’t bothered me recently until yesterday when doing some heavier-than-normal overhead presses. Now it hurts bad all over again!
In this situation, it is likely that the biceps tendon and muscle were never fully built back up to its former glory 3 years ago. Sometimes degenerative changes creep into the tendon in this situation, and the tendon’s fitness and resiliency to exercise & strain remain quite low until, one day, you push it a little too hard at the gym, and the tendon goes right back into “reactive” mode.
It’s OK to Stop Stretching!
The science of tendon pain is very complex and still being understood. But one thing we can say with confidence is that STATIC/PASSIVE STRETCHING (for example: touch your toes and hold for 30 seconds…) rarely ever plays a crucial role in successful tendon rehab.
Many individuals even report that when they STOP stretching, symptoms improve substantially.
Some individuals actually sustain the original injury from an over-stretching stimulus in the first place…
Track & Field: Longer than normal stride during a sprinting event
CrossFit: Catching a full snatch further back than you normally do
Distance Running: Training runs on much greater incline/elevation change than you’re used to
In this case, if we perform static stretching where we are trying to use tension to lengthen the muscle/tendon unit, this too closely mimics the stress that caused the injury in the first place.
[Especially] If tightness or stiffness are not contributing to the problem, then stretching likely won’t help you.
The root of a tendon problem stems from (1) lack of resiliency/toughness of a tendon & muscle or (2) us exposing our muscles & tendons to more than they’re currently able to handle…
NOT from a “tight” or “stiff” muscle that needs stretching…
So then what should we do?
What You Should Do Instead
If one of the main problems that leads to a tendon injury is a lack of resiliency, strength, or preparedness, then that means that the solutions to fix the tendon need to address those things.
This means that a lot of the time, the BEST approach to solving tendon problems in the long-term are things like:
Isometric Training (a strong muscle contraction, but without any actual joint movement)
Concentric Resistance Training (the squeeze/contraction part of an exercise)
Eccentric Resistance Training (the “negative” or lowering part of an exercise)
Concentric + Eccentric Resistance training
Plyometric Training (rapid muscle contractions, such as in jumping/hopping)
Sport-Specific Movements that mimic the physical demands of the activity you’d like to get better at/not have pain with
If you truly want to get out ahead of tendonitis, eliminate pain, and improve your performance, then these elements of training need to be in your rehab plan.
It may seem counterintuitive to ask someone with a history of tendon pain through the stress of resistance training…but these kinds of stress are what build up your tendon for better long term health!
Over the next several weeks, I’m going to be releasing a whole load of video content (make sure you’re following us on Instagram & Facebook below!), showing you some of my favorite alternatives to “stretching it out” based on some of the most common body regions where I see tendinopathy occur.
So hang on, and join me in the discussion, and if you want to hear about a specific area that you’re struggling with, drop a comment for me!
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