Tendons Under Tension: A Smarter Approach to Chronic Tendon Pain
Argan Athlete | Performance Blog
If you’ve been dealing with stubborn Achilles, knee, or elbow pain for more than a few weeks, chances are you’ve been told to rest, ice it, or just stop the activity altogether. But when it comes to tendons, rest isn’t always the solution—and in some cases, it actually makes the problem worse.
At Argan Athlete, we treat tendinopathy with a different lens. It’s not about eliminating movement—it’s about introducing the right kind of tension, at the right time.
Understanding Tendinopathy
Tendinopathy is not an inflammatory condition—it’s a failed healing response. Instead of healthy, organized collagen, the tendon tissue becomes disorganized and degenerative. Pain typically appears with load (jumping, running, gripping), yet ironically, avoiding load often prolongs the issue.
Common types include:
Achilles tendinopathy
Patellar tendinopathy
Gluteal tendinopathy
Lateral elbow tendinopathy (tennis elbow)
Most people dealing with these conditions are highly active—runners, lifters, racquet sport players—who push through discomfort until the pain limits performance.
What the Research Tells Us
1. Rest Is Not Effective
Complete rest reduces tendon tolerance and can delay remodeling. Tendons require mechanical loading to stimulate proper healing.
(Malliaras et al., 2013)
2. Isometrics Offer Immediate Relief
Heavy isometric holds can reduce pain through cortical inhibition, especially in the reactive phase of tendinopathy.
(Rio et al., 2015)
3. Heavy Slow Resistance Builds Long-Term Adaptation
Compared to eccentric-only exercises, Heavy Slow Resistance (HSR) has shown better outcomes in pain reduction, tendon structure, and function.
(Beyer et al., 2015)
4. Progressive Loading Is Essential
Successful rehab doesn’t follow a timeline—it follows the tendon’s load tolerance. Programs must adapt based on irritability, performance goals, and loading response.
(Cook & Purdam, 2016)
How We Structure Tendon Rehab at Argan Athlete
We use a three-phase approach rooted in progressive loading, symptom monitoring, and performance integration.
Phase 1: Isometric Loading (Pain-Modulation)
Used during high pain or acute flare-up periods.
Wall sits (patellar)
Bent knee heel raise holds (Achilles)
Long-lever side planks (gluteal)
Wrist extension holds (lateral elbow)
Load is held at 30–70% of max effort for 30–45 seconds, repeated several times daily.
Phase 2: Heavy Slow Resistance (Tendon Remodeling)
Used to build tendon capacity and reverse disorganization.
Slow tempo heel raises
Decline squats
Glute bridges with band resistance
Eccentric wrist extensions
2–3 sets of 6–8 reps at moderate to high intensity, 3–4 days per week.
Phase 3: Reactive Plyometrics & Return to Performance
Used to restore stretch-shortening cycle function and dynamic load tolerance.
Hops, bounds, jump squats (low amplitude at first)
Med ball throws
Acceleration drills
Sport-specific deceleration patterns
Criteria to progress:
Pain ≤ 2/10 with loading
Minimal morning stiffness
Normal strength symmetry
No pain during or after plyometrics
How We Individualize Care
No two tendon cases are the same. We assess:
Load history and movement mechanics
Tendon irritability and stage of degeneration
Joint or postural factors (e.g., ankle stiffness in Achilles tendinopathy)
Strength asymmetries and neuromuscular timing
We also collaborate with your coach or training team to modify volume while keeping you as active as possible.
What to Avoid During Rehab
Passive treatments as a primary strategy (ultrasound, massage, ice alone)
Random exercise selection without progression
Complete rest or inconsistent activity
Stretching directly into the tendon
These often prolong symptoms or worsen the degenerative cycle.
Key Takeaways
Tendinopathy is not an inflammation problem. It’s a load regulation problem.
Pain does not mean damage. Tolerable load is therapeutic.
Progression matters more than modality.
The right kind of tension heals.
If you’re dealing with ongoing tendon pain that hasn’t responded to typical treatment, we can help you retrain your body to move, load, and perform again—with strength that lasts.
