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Tendon Recovery: Common Myths

Learn common misconceptions regarding tendon injuries and rehab of them

Author: Dr. Britt Dalton, PT, DPT, OCS, COMT, FAAOMPT

Tendon injuries are a very common problem in the general population, ranging from mild strains to complete tears. These injuries may be acute or chronic and can be significantly different in how painful they are or how much they impact someone’s life.

Before discussing some of the common myths regarding management of tendon injuries, let’s go through some basic info about tendons. First, a tendon is a tissue in the body that connects a muscle to a bone. They are responsible for transmitting the force generated by the muscle, helping the bones to move. The term “tendinitis” refers to inflammation of a tendon. “Tendinosis” often refers to a more long-term problem in which the tendon has started to degenerate. Many times, you will hear the term “tendinopathy”, which is commonly used to describe dysfunction and pain in a tendon. Taking this into account, let’s now look at some common myths regarding managing tendon pain.

Myth 1: “Tendon damage is usually from a specific injury”

• While a tendon can be injured from a trauma, such as a fall, a majority of tendon problems are from overuse. When we work our muscles and tendons with exercise or daily activities, we are in essence breaking them down. When done correctly, this results in rebuilding a stronger, more resilient tendon. However, if the workload on the tendon is more than it can handle, either through too much work at once or too much over time, then our tendon may not be able to rebuild fast enough and starts to break down, resulting in pain and dysfunction.

Myth 2: “Rest is best for healing tendons”

 • Often people who have tendinitis are advised to rest. This may be appropriate for 2-3 days if pain is acute and severe, as very early on you may need a little time to let symptoms settle. However, as mentioned above, tendons respond best to a certain amount of stress. Early on in the rehab process, when symptoms are most severe, the type of exercise or loading performed may need to be very light. As symptoms diminish, it is appropriate to gradually try and increase the stress placed on the tendon in order to create stronger healing. Think of exercise and activity in terms of “medicine”: we know it’s the right type of medicine, we just need to make sure we have the right dosage.

Myth 3: “You cannot rehabilitate a torn tendon”

 • First, it’s important to know how tendon tears are classified. They are usually Graded 1-3, based on the side of the tear. A Grade 1 tear is usually minimal tearing of the tendon fibers. A Grade 2 tear has a moderate amount of tendon fibers torn, but is still intact. A Grade 3 tear means the tendon has fully torn in two. Most often, with Grade 3 tears, there is significant weakness to go along with the pain. More times than not, a Grade 3 tear does require surgery in order for function to return. However, Grade 1 and 2 tears will often heal without the need for surgery. We often tell our patients we want to “strengthen the donut, not the hole”. In other words, we focus on building up those parts of the tendon that are still intact, as well as the surrounding muscles, which will lead to a reduction in pain and return of function. For further evidence that you can live well with a tendon torn, research has shown that in the general population, particularly those over the age of 60, up to 45% have a rotator cuff tear WITHOUT experiencing symptoms.

 Myth 4: “A steroid injection will fix it”

 • Steroid injections are often given for tendon pain, as they have a strong anti- inflammatory effect. Steroid injections certainly can be effective in the short- term for reducing pain. However, this can come at the expense of breaking the tendon down and taking longer to heal, which steroid injections can also do. This is mainly because the injections are only made to help in the short-term with pain. They do nothing to rebuild the tendon. If you have been trying to rehabilitate your tendon for several weeks and the pain remains severe, then an injection may be worth it, as it may then allow you to progress with your rehab or workouts and better rebuild the tendon. However, if you just have the injection and do nothing to rebuild the tendon or address the reasons why your pain developed in the first place, then you will likely see the pain return and take even longer to resolve.

Myth 5: “If it hurts, I don’t need to do it”

  • So, there is a gray area to this. For many tendon problems, especially chronic ones, it is okay to feel some pain when working out. The reasoning is that for some tendon issues, especially long-standing ones, you may feel pain in the absence of doing any damage. Knowing that we need to put some stress on the tendon for it to heal appropriately, the benefits of exercising with a little pain outweigh the risks. Everyone’s case is different, but in general, if pain from exercise is present, it needs to be a very tolerable amount (both during and afterward) and your pain level should return to its baseline within about 24 hours. If both of those two criteria are not being met, then adjustments should be made.

Hopefully, this will clear up some misconceptions that are out there about tendon injuries and what can be done to help them. The biggest thing I consistently remind my patients about is that tendon recovery takes time. Even if things go perfectly, it can still take months for tendons to return to normal, and often there will be up’s and down’s during the process. But, if you remain optimistic and consistent with your program, you can be confident that you can return to feeling good and doing the activities you love.