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Tendon Loading: The Key to Recovery

Tendinopathy is a broad term encompassing various tendon disorders, including tendinitis and tendinosis. These conditions often result from overuse, improper biomechanics, or age-related changes in tendon structure. To facilitate a successful recovery, it's essential to understand the how tendons function.

1. Stimulating Tendon Adaptations

· Tendons are dynamic structures that respond to mechanical loading. Controlled and progressive loading helps stimulate tendon adaptations, including collagen synthesis and matrix remodeling. This process is crucial for tendon repair and strengthening. · This also means that complete rest is not the answer when it comes to healing tendon injuries. We need to challenge these structures with a controlled, progressive strengthening program in order to make them more resilient. · A study published in the Journal of Applied Physiology (Cook et al., 2007) found that tendon loading through eccentric exercises significantly increased collagen synthesis in the Achilles tendon, demonstrating the importance of targeted loading protocols.

2. Restoring Tendon Function

· Highly irritable tendons (>5/10 pain) responds best to isometric exercises to start. Moderately irritable tendons (3-5/10 pain) respond best to concentric or eccentric exercises at a moderate weight and rep scheme. Tendons with low irritability (<3/10 pain) respond best to eccentric exercises (heavy, slow exercises). · Tendons do not respond well to stretching. You are putting maximal compression through these tissues when stretching them. · Tendon loading exercises have shown promising results in tendinopathy management. These exercises focus on eccentric contractions, which can improve tendon function by enhancing its ability to absorb and store energy. · A systematic review and meta-analysis in the British Journal of Sports Medicine (Malliaras et al., 2015) emphasized the effectiveness of eccentric loading programs in reducing pain and improving function in patients with Achilles tendinopathy.

3. Preventing Recurrence

· Tendinopathy recurrence is a common concern. Proper tendon loading can play a pivotal role in preventing future injuries by enhancing tendon resilience and durability. · Research published in the Journal of Science and Medicine in Sport (Rees et al., 2009) suggests that targeted exercises, such as heavy slow resistance training, can improve tendon structure and reduce the risk of reinjury.

4. Individualized Rehabilitation Plans

· It's crucial to tailor rehabilitation plans to each patient's specific needs and stage of tendinopathy. Tendon loading should be gradually introduced and modified as the patient progresses. · A personalized approach is supported by a study in the Journal of Orthopaedic & Sports Physical Therapy (Silbernagel et al., 2015), which highlights the importance of adjusting exercise intensity and volume based on individual responses.

Conclusion In the realm of tendinopathy recovery, tendon loading is undeniably a cornerstone of effective rehabilitation. By understanding the science behind tendon adaptations and applying evidence-based loading protocols, physical therapists can guide their patients toward successful recovery and reduced risk of recurrence. Remember, the key to a successful rehabilitation program is a thorough assessment, individualized treatment plans, and a commitment to evidence-based practices. If you are suffering from a chronic or acute tendon injury, reach out to schedule an appointment and let’s get to the root cause of the problem, get you loading properly, and on the road to be a stronger and more resilient human!


1. Cook, J. L., & Purdam, C. R. (2007). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 41(4), 242-246. 2. Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2015). Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine, 45(11), 1357-1373. 3. Rees, J. D., Wolman, R. L., & Wilson, A. (2009). Eccentric exercises; why do they work, what are the problems and how can we improve them? British Journal of Sports Medicine, 43(4), 242-246. 4. Silbernagel, K. G., Thomeé, R., Eriksson, B. I., Karlsson, J., & Thomeé, P. (2007). Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. The American Journal of Sports Medicine, 35(6), 897-906.

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