Tendinopathy: Load Management 101

Tendinopathy is one of the most frustrating conditions to manage - not because it's dangerous, but because doing nothing makes it worse and doing too much also makes it worse. Finding and maintaining the right load is both the challenge and the solution.

Why tendons become painful

A healthy tendon is a dense, regular structure of collagen fibres. When load repeatedly exceeds the tendon's capacity to recover - through a sudden increase in training, a change in surface, or returning from a long break - the tendon changes structurally. The collagen becomes disorganised, the tendon thickens, and sensitised nerve ingrowth occurs. This is tendinopathy.

The two mistakes people make

Mistake one is complete rest. Tendons need load to heal. Unloading for weeks allows the tendon to further degenerate and sensitise, and the surrounding muscles atrophy. Pain typically returns the moment activity resumes. Mistake two is pushing through significant pain. Loading a tendon that is highly irritable causes a reactive flare that sets recovery back weeks.

The right zone

The target is to exercise at a level that produces no more than mild discomfort (3/10 or less on a pain scale) during activity, and where any increase in pain after activity has settled within 24 hours. This is the load window that stimulates tendon adaptation without causing a setback.

Progressing load

Start with isometric exercises (sustained muscle contractions without movement), which load the tendon without the compressive and shear forces of movement. Progress to heavy slow resistance work - the most evidence-based approach for tendinopathy across all sites. Finally, reintroduce the specific sporting load that caused the problem, gradually and with ongoing monitoring of the tendon's response.