7 Facts About Tendons

7 Facts About Tendons

A guide to keeping you moving

The Raptors made famous the term Load Management when they effectively utilized the strategy to manage an ongoing patellar tendon injury for fun guy, Kawhi Leonard, during the 2018-2019 championship season. As a result, load management has gained attention as a style of rehab to maximize performance and output on the floor across the world of sports. The evidence behind load management stems from extensive sports medicine research that links excessive sports- and activity-related workload with fatigue decreased performance and increased risk of injury. 

Today, we’ll talk about the fundamentals of load management and the rehabilitation guidelines related to tendon injuries. Tendon injuries affect individuals of all ages and of all activity levels. It doesn’t just occur in runners, weightlifters and those who play sports, but can also affect desk workers, welders, chefs and even parents of a newborn. 

Let’s talk tendons:

Tendons are strong, thick and flexible bands of tissue that connect muscle to bone. Their role is to absorb and release energy with movement or to be stiff with loading. Think of a spring.

Tendinopathy is an umbrella term used to describe a syndrome of tendon pain, dysfunction and thickening. It often occurs in tendons that are near joints and is the consequence of various factors compounding together over time, including increased levels of activity, excessive or inappropriate loading strategies, decreased neuromuscular control and inadequate muscular strength, especially at the hips and glutes complex for lower-body injuries.

Common Tendon Injuries

Rotator Cuff – Overhead activity, throwing

Elbow – Tennis elbow, golfer’s elbow.

Wrist – Newborn parents: changing diapers (De Quervain’s tendinosis)  Chefs, welders, mechanics: repetitive activities with hands.

Glutes – Weightbearing activities or prolonged positions (sitting, side-lying)

Patellar, Achille s-
Running, jumping, landing, cutting and pivoting.


The Function of Tendons: 

  • Thick, strong bands of tissue
  • Connects muscle to bone
  • Absorb and release energy with loading and movement


What Does Tendon Pain Feel Like? 

  • Classical Presentation: Pain is worse the next day (24-hour response). 
  • Tendon pain can also present at the beginning of acidity, disappear during activity and reappear when cooling down.

7 Facts About Tendons: 

Tendon Pain Does Not Improve with Rest

Pain may settle or go away, but upon returning to activity, it often becomes painful again.
Why? This is because nothing has been done to change the loading capacity or function of the tendon.

Risk Factors for Tendon Injury

The most common risk factor is a sudden increase in activity level, especially after a period of inactivity. 

    • Poor muscle and strength endurance
    • Non-optimal movement patterns
    • Previous injuries (e.g. fractures, past tendon injuries)
    • Systemic factors (e.g. older age, menopause, elevated cholesterol)
    • Individual factors (stress, anxiety, poor nutrition)

Tendons LOVE Heavy Slow Loading

Rest and immobilization cause tendon to lose their function, muscles to lose strength, and our brain to misinterpret loading/movement. Tendons love heavy slow loading, in fact, it is healthy for the tendon to undergo such loading. Physiotherapist and tendon expert, Jill Cook, advocates “to never rest a tendon completely”.

Exercise is Medicine

Exercise is vital in ingredient to tendon rehab. 

  • Isometrics: static holds can provide immediate and short-term relief from tendon pain. 
    • Protocol: 5 sets, 45 second holds @ 75% max voluntary contraction with 2 minutes rest between sets. 
  • Eccentrics: eccentrics is the lengthening phase of an exercise (or “negatives” in training). Heavy slow resisted eccentrics is beneficial for tendon health but must be combined with other forms of training. In isolations, the effectiveness of eccentric training is greatly reduced.

Load Modification

Listen to your body. Slowly progress the intensity.
Load management is important, especially in the short-term, as a tendon that is not capable to take loads needs to have progressive strengthening and perhaps other bio psychosocial modifications before going back to activity.

Painful tendons

Pushing into pain will create unloading of stresses to other body structures (e.g. muscles, joints, ligaments) which can drive pain. Severe pathology such as tendon tears or degeneration does not mean poorer outcomes but rather signifies the need for proper load management and progression.

Exercise must be individualized

Myth: rest will take my pain away and I’ll be good to go.
Fact: Tendon rehab is a lifelong commitment but done properly can improve pain and function.
“It’s never “you have to stop”, it’s always “you have to modify” – Dr. Jacob Harden