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Tendinitis, To Rest Or Not To Rest?
Ever heard this? “Just rest it!” For some things, rest can definitely be helpful, in the right dosage. Many times, people take this as rest for one month and then go back to the exact same intensity they were working at before. This is a pretty good way to make sure you don’t recover quickly from a tendinitis issue (which really likely isn’t tendinitis… the more correct term is “tendinopathy”. )
The term tendinitis is actually not used as much anymore and is a bit of a misnomer as there is usually not a clear inflammatory process taking place. The -itis at the end of “tendinitis” means inflammation. What seems to be happening at the cellular level is more of a general tendinopathy which as shown in the image below is “a disorder of the tendon in which pain and degeneration are present. It usually comes on after engaging in activities that exceed your tolerance.”
In patellar tendinopathies, gluteal tendinopathies, hamstring tendinopathies, and even bicep tendinopathies, typically the initial rehab and physical therapy approach taken should be heavy weights (as tendons require heavy weights to remodel) and this keeps the overall reps down (lots of reps tend to irritate already irritated tendons.)
I remember one patient I worked with who had been dealing with a persistent right proximal (close to shoulder) bicep tendinopathy. Once we’d determined that this was the issue I had her start bench pressing heavy and doing slow and controlled pushups. Within two weeks of doing this consistently her symptoms greatly improved.
This is just one of many examples of people who come in who have been resting for multiple months, afraid to get back to normal activity, who are able to see significant improvement in a very short amount of time with the proper loading protocol. This does get a little trickier when we talk about “in-season,” rehab as an athlete will likely not want to take any time off from their sport. In this case, a careful loading protocol should be created, monitoring the acute:chronic workload.
Ultrasound, e-stim, ice and heat are likely a waste of time if you are doing these in the clinic as they have been shown to be no better than placebo and can be used at home without being charged for them. They are merely symptoms modifiers (make it feel good for a short amount of time) rather than providing long term solutions.
Ultimately tendon rehabilitation comes down to placing stress through the tissue in the form of weights. This means loading them up heavy (in most cases) and monitoring the response the day following to make sure that soreness has not significantly increased due to the exercise session.