When it comes to tendon injuries, there’s a lot more to healing than just rest and light exercise. Our recent clinical team meeting dove deep into the latest research to refine our approach to tendon rehab. Here’s a breakdown of the critical insights we gained and how we’re using them to enhance our treatment plans.
Key Insight #1: Tendons Thrive on a Specific Strain Magnitude
A major takeaway from our discussion was the idea of “strain magnitude” in tendon adaptation. Studies show that tendons need a precise amount of strain to trigger positive changes like increased stiffness and strength. Too little strain can lead to underloading, while too much can cause injury or maladaptive responses. One article we reviewed specified an ideal strain of about 4-6%, especially for the Achilles tendon. However, this doesn’t directly translate across all tendons, so clinicians need to be flexible and rely on the specific needs of each tendon.
We can’t always measure strain directly, but we use tools like force plates to assess stiffness and strength improvements in areas like the Achilles tendon. These allow us to check for consistent progress in patients over time, providing real-time insights to determine if the exercises prescribed are creating the desired adaptive response.
Key Insight #2: Pain as a Guide, Not a Limit
Pain monitoring plays a big role in our approach. For tendinopathies, we aim for a “sweet spot” where discomfort is present but manageable. During exercises, if a patient feels around a 3 out of 10 pain level, that’s often an indicator that they’re in the right range for promoting adaptation without overloading the tendon. This approach helps us tailor loading more precisely to each patient, moving beyond rigid one-rep-max percentages and instead focusing on what’s feasible and tolerable on an individual level.
Key Insight #3: Balancing Rest and Loading for Tendon Recovery
There’s a critical balance between loading and rest, especially in the early phases of recovery. Initially, rest is essential to prevent further damage. However, delayed loading can actually prolong recovery, as prolonged immobility leads to misalignment in tissue fibers and an increased risk of chronic pain. Early, controlled loading helps the fibers realign, building a foundation for better movement and reduced pain as recovery progresses.
Key Insight #4: The Importance of Eccentric and Isometric Loading
For chronic tendinopathies, eccentric loading (lengthening of the muscle-tendon unit under load) has been shown to promote tendon remodeling. If a patient can tolerate it, we prioritize eccentric movements early in rehab, followed by heavier isometric holds. These forms of loading allow tendons to adapt progressively to higher strain without causing additional pain, helping build tolerance and strength gradually. This loading is especially crucial for athletes dealing with chronic tendinopathies, allowing them to push to their limits safely.
Key Insight #5: Individualized Rehab Plans Through Constant Re-Evaluation
Every tendon injury is unique, so we don’t believe in a one-size-fits-all approach. We use tools like force plates and patient feedback on pain and stiffness to reassess regularly and fine-tune exercises based on progress. We’ve found that a consistent reevaluation schedule helps ensure that our patients are not only healing but are on the path to stronger, more resilient tendons.
In cases like ACL recovery, or other surgeries, this re-evaluation becomes even more essential. If we don’t consistently check for improvement, there’s a risk of plateau or even regression due to compensation patterns.
Key Insight #6: Gradual, Intentional Overloading for Tendon Health
Lastly, progressive overload is a foundational principle in our approach to tendon rehab. Each time a patient masters a load, we gradually increase it to keep up with their improving strength and endurance. This process, individualized for each patient, ensures that we’re not underloading or overloading but keeping them right in that adaptive range.
Moving Forward: Applying These Principles to Tendon Rehab
This approach to tendon rehab takes patience, precision, and collaboration, but we’re seeing excellent results in reducing recovery time and promoting long-term tendon health. As we continue to analyze and integrate new research, we’ll keep refining our methods and enhancing outcomes for every patient who comes through our doors.
We’ll be selecting new research articles each week to keep our discussions and approaches fresh, with the goal of staying at the cutting edge of sports rehabilitation.
This approach helps us ensure that tendon injuries don’t just heal but also become stronger, allowing our athletes and patients to get back to what they love doing with resilience and confidence.
Ready to take the next step in your tendon recovery journey?
At Petroski Physio, we’re committed to providing personalized, research-backed rehabilitation plans to help you heal stronger and regain confidence in your movement. Whether you’re recovering from a recent injury or managing a chronic condition, our expert team is here to guide you every step of the way. Let us help you get back to doing what you love with resilience and strength—contact us today to start your recovery!