Tendonitis, technically inflammation of a tendon, is a common source of chronic pain often resulting from an overload injury. Most long-standing tendon issues are now categorized as tendinopathy, reflecting degeneration and disorganized tissue structure rather than acute inflammation. Successful rehabilitation requires a phased approach that balances initial pain reduction with progressively restoring the tendon’s capacity to handle load. This process moves beyond simple rest toward controlled therapeutic exercise, which drives structural change and long-term recovery. A structured plan transitioning from immediate pain management to specific strengthening and activity integration is necessary to rebuild a resilient tendon.
Immediate Steps for Acute Pain Relief
The first response to a painful flare-up is to manage discomfort and protect the tendon from further irritation. Protection involves temporarily modifying activities or using a brace to shield the tendon from painful movements.
Optimal Loading is a shift away from absolute rest, which can weaken the tendon, toward relative rest where pain-free movement is encouraged. This means avoiding the specific activity that caused the injury while remaining active in ways that do not aggravate the tendon. Applying ice to the affected area can offer short-term pain relief, but its effect on long-term healing remains debated, as it may suppress the natural healing cascade.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can be used judiciously for short-term pain control during the initial acute phase. Using NSAIDs for extended periods may impair the tendon’s natural repair process. It is recommended to use these medications only briefly to reduce pain to a level that allows for the safe initiation of therapeutic exercise. The goal of this immediate phase is to calm the tendon, making it receptive to subsequent strengthening work.
Structured Exercise Progression
Once acute pain subsides, rehabilitation begins with a progressive loading program designed to stimulate the tendon’s structure. The first stage involves gentle, high-intensity isometric contractions, which are exercises performed without changing the muscle length or joint angle. This loading produces an analgesic, or pain-relieving, effect on the tendon that can last for up to 45 minutes.
A typical isometric protocol involves holding a contraction at a pain-free, high-load position for 30 to 45 seconds, repeated three to five times. This desensitizes the painful tendon and prepares it for more dynamic exercises. For instance, a person with patellar tendon pain might hold a leg extension in a mid-range position, or someone with an elbow issue might press their wrist against a stable object.
The next stage involves transitioning to dynamic resistance exercises, specifically focusing on eccentric loading. Eccentric contractions involve the controlled lengthening of the muscle-tendon unit while under tension. This is widely considered the most effective way to restore the tendon’s ability to tolerate stress, as it stimulates the production and organization of collagen fibers, strengthening the internal structure.
A common example is the heel drop exercise for Achilles tendinopathy, where the calf muscle slowly lowers the body from a raised position. For elbow tendon pain, this might involve slowly lowering a dumbbell using the wrist extensors or flexors. These exercises must be performed slowly, often taking three to five seconds for the lowering phase, and should initially use a manageable load. Load and resistance are gradually increased over weeks and months. Minor discomfort during the exercise is often acceptable, but sharp or increasing pain signals a need to reduce intensity.
Integrating Movement and Preventing Reinjury
As the tendon adapts to heavy loading, the focus shifts to integrating the newly built strength into functional and sport-specific movements. This phase is governed by load management: the careful, gradual increase in the intensity, frequency, and duration of activities that previously caused injury. Returning too quickly to high-impact or high-volume activities is a common reason for a relapse.
Long-term prevention requires addressing underlying biomechanical and environmental factors. For example, elbow tendon issues may be linked to a poor grip on a tennis racquet or repetitive, awkward movements at a workstation. Simple ergonomic adjustments, such as modifying chair height, adjusting keyboard angle, or switching to a lighter tool, can significantly reduce future strain on the tendon.
Maintaining the strength gains achieved during the structured exercise phase is important. This includes continuing heavy resistance exercises two to three times per week, even after the pain has resolved. Proper warm-up routines are necessary before strenuous activity, preparing the tendon for mechanical stresses and improving its tolerance to strain.
Knowing When to Consult a Specialist
While self-management is effective for many cases, certain signs indicate that professional medical guidance is necessary. If pain worsens despite two weeks of diligent self-management and adherence to the structured loading program, or if you experience severe, sudden pain, consult a specialist.
Other red flags include the inability to bear weight on the affected limb, significant swelling, or signs of systemic infection like fever or chills. These symptoms may suggest a more serious injury, such as a partial tear or an infection, requiring immediate medical attention. Consulting a physical therapist can provide a personalized diagnosis and a tailored exercise plan. In cases that do not respond to conservative measures, a doctor may recommend specialized imaging, therapeutic injections, or, in rare instances, surgical intervention.