Ahh, tendons.  Tendons have to be in the top 5 of things physical therapists talk about everyday.  Whether we’re dealing with a new injury or old injury, a neurological condition or an orthopedic condition, a strength issue or a mobility issue, tendons play a role.  Anytime our bodies move, a tendon is involved so understanding their role in movement can benefit performance and prevent injury.  

Tendons connect muscle and bone, but they are distinctly different in structure from both muscle and bone.  Bones are hard and inflexible, while muscles are soft and pliable and have the ability to shorten or lengthen.  Tendons are similar to bungee cords – able to stretch under load while still being quite dense.  The elastic quality also makes movement more efficient.  Tendons allow us to move without injuring ourselves – without tendons, our muscles would tear doing simple things like running or jumping.  

It’s hard to rest tendons, and tendons generally get less blood flow compared to muscles. This is why tendon injuries can become so nagging and debilitating.  Less blood flow makes it harder for nutrients to be delivered to tendons when they need it.  As we perform more vigorous activities, our tendons and muscles will have small tears that, under optimal circumstances, are repaired.  Without proper rest and nutrition, and depending on your current use of that tendon, those micro tears might not quite repair.  This can lead to inflammation in the form of tendinitis or a tendon that has just become painful due to improper healing in the form of tendinosis (sometimes called tendinopathy).  

Keeping your tendons in top shape can be challenging, but there are ways to build them up and prevent problems.  

• Build strength – Tendons only know one thing – tension.  More and more research points to the necessity of heavy resistance training for tendon health.  Exercises like weighted calf raises for the Achilles or weighted wrist extensions for tennis elbow (often related to tendon pain) are easy examples.  Keep in mind that “heavy” is relative to each person; body weight exercises might be more than enough (or too much!) for any individual while another person might need a great deal of additional weight.  Typically you’ll perform reps of exercises with a specific tempo:  lowering for 3-8 seconds, holding the stretch position for 1-2 seconds, quickly lifting the weight, then lowering without pause.  The lowering phase is variable due to how long it takes to perform a movement.  Performing a squat of 8 seconds is challenging but you’re definitely moving the whole time, while an 8 second wrist curl barely feels like movement at all.  Don’t forget that a tendon issue is rarely just a tendon issue. There are likely other areas of your body underperforming, so work on the surrounding areas as well. 
• Rest and nutrition – If we’re doing all of these exercises to build strength and restructure the tendon, we need to make sure we’re doing everything we can to allow the body to repair it.  Avoiding, or at least limiting, painful activities is a great place to start so you can give the tendon time to heal.  Rest also means getting sufficient sleep.  Sleeping is absolutely necessary as this is where our body is able to repair everything that was broken down during the day.  Eating regular, healthy meals gives your body the fuel it needs to make repairs.  
• Soft tissue work – Work on the soft tissues around the painful tendon to help it heal.  Whether it’s getting a professional massage or DIY with your hands, a tennis ball, foam roller, or whatever else you have, get the muscles around the tendon more pliable.  This is often slightly painful in the “hurts so good” sense, not the “will this bruise ever go away?” sense.  5-10 minutes a day goes a long way, especially if your symptoms are from overuse.  
• Progress to plyometrics – Once your pain has settled down (this may take weeks/months), you can start to reintroduce quicker movements that challenge the elastic properties of tendons.  Jumping, bouncing balls (think like dribbling a basketball), catching/throwing drills… there are a lot of possibilities.  Start with small dosages and build up slowly while you maintain your strength training.  

Tendons are notorious for being pesky, but with properly dosed exercise, rest, and nutrition, you can be back doing what you love without worry.  

Got questions?  Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR and Albany, OR can show you how to discover your future without limits.  

***The above information, including text, images, and all other materials, is provided for educational purposes only, and not as a replacement or supplement to professional medical advice.  Please contact a certified healthcare professional or your primary physician for any personal concerns.