No one is immune to muscle pain, whatever your personal level of activity you’re vulnerable to it. Basketball players, ballet dancers and even office workers can all develop tendon injuries causing pain in their daily life.
If you live a very active life, you’re no stranger to this risk and you might have faced it before. But if this is the first time you’re experiencing muscle pain you’re probably confused and struggling with a pain that you believed would disappear after a while.
And worst of all you probably don’t feel it all the time. The pain may flare up but then it may recede and sometimes you’ll feel by all accounts fine. But then tendon pain may strike when you’re simply walking around your house. Now it’s standing in the way of you resuming your old activities.
You’re probably also exasperated because everything you try, everything you know and everything that is recommended to you by your friends or your practitioner doesn’t seem to do anything.
First off, don’t worry; it’s not your fault. There are a lot of misconceptions and myths surrounding tendonitis that you’ve probably been told over the years, maybe even some by your practitioner.
There are a lot of misconceptions and myths surrounding tendonitis Share on X
This has been a problem for a while and we, as a society, have to change the way we think about and discuss tendon pain. If we can change these things we open the door for developing positive strategies for healing tendon pain and getting people back on their feet.    
Interested in learning more about tendon pain? Listen to my interview with Dr. Ebonie Rio on the Healing Pain Podcast.

Who is most vulnerable to tendinopathy?

Tendons connect muscle to bone. For example, your Achilles tendon connects your calf muscle to the heel bone. Everyone is vulnerable to tendinopathy, however, there are certain groups that practitioners say have a higher vulnerability to tendinopathy than others.

• Dedicated Athletes are always vulnerable to injury. However, their higher tolerance and incredibly specialized activity serve as a sort of barrier to some tendon pain. If you’ve been athletic all your life then your body is incredibly vulnerable but is just better at handling stressors. You’ve probably already experienced and recovered from some kind of muscle injury, so when you hear that you have tendinopathy you might not be too surprised (2). Your practitioner might not be too surprised either; if you’ve had muscle injury before they’ve helped you through it. You or your practitioner will likely be able to locate what tendon exactly is injured and what you did to injure it. It’s not any easier but it’ll be a little more straightforward.

• Casual Athletes includes pretty much anyone who isn’t incredibly active in their personal life and is a rather broad definition (3). You could fit into this category if you’re someone who only jogs after work or if you’re a young professional most of whose exercise comes from walking to and from the train on your way to work. You could be older and only take walks around the neighborhood (4). You and your practitioner have a little more work to do as you two review your activity that led up to when you began feeling this pain.

Remember that despite the slight differences in vulnerabilities, understanding these differences is key in treating it. Because whether you’re a lifelong dancer, runner or basketball player or just an office worker carving out time for a walk after work, the way to treat it is going to be very similar.  

How to Treat Tendon Pain

There’s a handy framework for understanding how exactly you can recover from tendon pain as well as a way to break down the various segments of each.

• Proper Diagnosis: Because of the misconceptions shared by both patients and practitioners, establishing a proper diagnosis is the first step. This entails you and your practitioner reviewing your past activity from before this pain developed and focusing on three important questions that you should keep in mind when meeting with your practitioner.  
  • Where is your pain? Tendon pain is incredibly localized and whether you’re a veteran athlete or not, it’s going to be confined to one specific muscle like your Achilles tendon. Despite how painful it may be, the injury will never move and affect pain in any other parts of your body. Even if you don’t know every muscle, you’re probably going to be able to point to it on your body when you meet with your practitioner. If it’s hard for you to pinpoint, your practitioner may run you through some basic movements that will test different muscle groups until you can find a muscle or area that is being affected by pain.
  • What is aggravating your pain? Essentially this is reviewing everything you’ve done since the pain has developed and what has caused pain. So perhaps you’ve had this pain for about a week but it only strikes when you’re trying to run or when you walk upstairs. Once you’ve located where you’re experiencing pain, it’ll be easy to work out what movement is putting pressure on you.
  • What has changed? Once you and your practitioner have found what muscle is experiencing pain and then what movements are aggravating it, you now have to review what you did before the pain developed to find the exact activity that caused the injury.

It could be that you introduced a new exercise into your routine, such as running up a hill while your muscles were used to running on flat land. Or perhaps you switched to a new routine altogether. You could have just casually walked around your neighborhood before you started jogging and your body didn’t have time to acclimate.

• Exercise: Your practitioner has established a diagnosis of what exactly happened in your tendon. Working together you two have found where your pain is, what’s aggravating it and specifically what changed before that caused this injury. There is no set plan for reintroducing activity and stress to your muscles as everyone’s needs will be different. The lifelong athlete has a different history of activity, different pain capacity and different activity goals than someone who just wants to jog for exercise. Your practitioner will lead you through a highly customized plan that will reintroduce activity based on your start point and your ultimate goals. Essentially this plan is broken down by:
  • What’s your start point? Is your Achilles tendon pain so bad that you find it hard to walk around your house? Or does pain only flare up during certain activities? Did you have a high tolerance for pain before this? Essentially, what pain are you experiencing now and what activity are you able and not able to do?  
  • What do you want to be able to do? Would you like to return to running a mile every day? Would you like to return to a light jog? Or do you just want to walk around the office or your house without pain flaring up and ruining your day? This is your end goal for pain and activity. 

This exercise plan that you and your practitioner develop will focus on two aspects of muscle movement to help strengthen your muscles. Those are as followed:

• • Isometric: Physical action that builds up tension without actually contracting your muscles. These include many yoga poses, planks, and side bridges.
  • Isotonic: These are physical actions that maintain tension with normal contraction of your muscles. These include stair climbing, squats, bicep curls and push-ups.

Again, because of the varied nature of those with tendon pain, not all of these movements and exercises may be suited for you. It’s up to you and your practitioner to work closely and come up a comprehensive and customized exercise plan that specifically addresses your tendon pain and your goals for returning to an active life.

• Education: This is where the myths around tendon pain come in. Because of the misconceptions that many people believe, you need to be very honest with your practitioner about your level of understanding: what you know about tendons and muscle pain, how you think about it and what you’ve been told.  Once your practitioner is aware of what you know, they can answer any questions you have and clear up the misconceptions that you’re bound to have picked up due to what society thinks about tendon pain. Another part of the education stage is your practitioner helping you understand the limits of your body and your pain capacity. This is why you create a specific plan to reintroduce activity that can slowly build up this capacity that you once had. Being aware of the truth behind tendon pain as well as the limits of your body is how you can build a successful and healthy life going forward, ensuring that you never face this again. Nor will you develop bad habits that could cause this pain to interfere with your life again.

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Three Myths of Tendon Pain

1. Tendon Pain ≠ Tendonitis: You may believe or have been told in the past that the pain you’re experiencing is tendonitis. This is untrue and is considered an outdated term for tendon pain (5). But to ultimately treat and recover from tendon pain you have to know the difference.
Despite recent findings and efforts to get people to use the more appropriate term like tendinopathy, you or your practitioner may call it tendonitis by accident. Tendonitis is the term for the inflammation of your tendon, not the result of a direct injury to your tendon.
Tendonitis is the term for the inflammation of your tendon, not the result of a direct injury to your tendon Share on X

If you feel pain in your tendon, you may believe that you have to put ice on the affected region or ask your doctor for an anti-inflammatory prescription. Many people affected with tendon pain often go straight for the prescriptions believing it to be the quickest solution. And while it is effective in treating inflamed tendons, it is ultimately ineffective in treating a tendon injury.
If you’ve done this to treat tendon pain you probably noticed how it did little to heal you. You probably also noticed pain flaring up again, maybe even worse than it was before.
The most important thing to remember is that your tendon’s cells aren’t inflamed; they’re simply communicating to you that the tendon hasn’t been able to keep up with whatever new stress was introduced.

2. Rest is the Best Medicine: While resting may make you feel a little better than when you’re in pain, this will ultimately hinder your recovery and make it more likely that you’ll experience tendon injury again in the future.
You may be worried about causing pain, especially if you begin to associate spikes in tendon pain with everyday activity. This is quite normal for your brain as it is a natural response to pain. However, many who experience this kind of pain may begin to associate pain with everything they do.
To learn more about your brain’s response to pain and how it might be affecting you, listen to my interview with Dr. Beth Darnall on the Healing Pain Podcast.
Everyone’s nervous system has a set amount of pain that it can handle as part of its pain capacity. But becoming inactive only lowers this capacity. To help your recovery, you and your practitioner need to work together to learn about what your capacity for pain was before you injured your tendon. Then you two will have to discuss what capacity you’d like to return to. It will vary for everyone (6).
If you’re a lifelong athlete, you’re likely to have a slightly higher threshold than if you’re an office worker who maybe only jogs or walks after work. You may aspire to higher levels of exercise; perhaps your after-work jogs are working up to a marathon. That’s still entirely possible, however, you’ll need a little more time to let your tendon return to the capacity you enjoyed while a casual jogger.
When you sit on the couch and cut out your activity, you’re only harming yourself. Even worse is trying cure tendinopathy through anti-inflammatories or other medications. You probably hear that you have a tendon injury and assume that you need some medication. But you and your practitioner have so much control over how to treat your pain that any kind of passive treatment, whether rest or medication, is harmful and useless (7).
Your old life isn’t over; it’s only taking a short break and then before you know it you’ll be back out there (8).

3. It Only Comes from Stressful Activity: You might hear about tendon injury and the tears in your tendon and think about a frayed rope, perhaps caused by too much or too stressful of activity. This is the wrong way to think about it. In fact, your tendon is incredibly strong and very adaptable. Despite this, it still doesn’t like rapid and unexpected change.
If you’re very athletic and typically engage in a stressful activity such as rigorous exercise, your body likely has a higher level of pain tolerance and your tendons are used to adapting. But with this lifestyle you’re not immune to tendon injury, it is simply easier to diagnose because practitioners can pinpoint what unexpected change happened as well as exactly what tendon is affected.

It’s a little trickier if your body isn’t used to so much stress or you’re not highly active (9). You’re still very likely to experience tendon pain, often caused by something that you don’t expect. It could be from carrying a greater weight or it could be as simple as you stepped off the curb the wrong way. Or perhaps you’re trying to become more active and your body wasn’t able to adapt quickly (10).
There are also no general symptoms of perceiving tendon injury and you may feel fine for most of the day. If this is your case you may try to resume exercising and ultimately worsen your tendon pain.
Be patient and figure out what you’re used to, and then you and your practitioner can work to reintroduces stressors and rebuild your pain capacity. This allows your tendons to slowly and safely adapt to old activities rather than being forced to adapt quickly.
Tendon pain can seem confusing and it can seem difficult to manage, especially if it seems to come up out of nowhere and strike you at the worst times. Perhaps you’ve tried treating it in the past and your old treatment is ineffective.
You’re never powerless in dealing with pain and through understanding this pain, as well as the myths surrounding tendon pain, you can feel confident walking into your practitioner’s office and working out a plan that’s right for you, that gets you off the couch and back out into the world.