Why Rest DOES NOT Fix Tendinitis

Exercise-related injuries are frustratingly common.  The gut reaction following an injury is to let it rest until the pain is gone, then return to activity.  This period of rest may only happen after several attempts to ignore the pain… I’m looking at you, runners.  Regardless, most of us have had to take some time off from activity due to pain.  Unfortunately, this time off is often followed by the pain returning.  This is particularly common with tendon related injuries.   

Tendon injuries typically happen from doing too much too soon with too little preparation.  A runner who runs her neighborhood 10k without sufficient training may develop runner’s knee.  A tennis player who plays 4 matches over a weekend too early in the season may develop tennis elbow.  Runner’s knee, tennis elbow, and many other injuries you may be familiar with, are forms of tendinitis.  

Tendinitis, however, is not always the most appropriate term to use when referring to these types of injuries.  The suffix -itis implies there is inflammation present.  Think appendicitis: inflammation of the appendix.  Inflammation can be present in tendon injuries in the early phases and during acute flare-ups, but it’s not the driving force.  

A more appropriate term is tendinosis, which refers to weakening (not inflammation) of the tendon.  This distinction is important, because if inflammation was the main concern, taking an anti-inflammatory medication would help.  In reality, NSAIDs (non-steroidal anti-inflammatory drugs) have been shown to weaken tendons over time.  

Since most tendon complaints fall into the tendinosis category, the appropriate treatment is to strengthen. Strengthening helps rebuild the damaged tendon while preparing it for the tasks ahead, i.e. running, tennis, golf.  Some amount of “relative rest” may be necessary in the short term if pain is high, but a gradual return to activity should be the ultimate goal.  

Since achilles tendinosis (AT) is so common in runner’s we’ll use that as our example, but this strategy can be applied to most types of tendon injuries.  Running injuries, including AT, happen from doing too much too soon.  Sudden increases in training volume and intensity can cause the tendon to become angry.  Angry tendons get weak and turn into tendinosis.  Tendinosis is painful, which may trigger a runner to stop running. 

Complete rest is NOT recommended for tendinosis.  The runner should decrease her weekly mileage and training intensity and supplement some of the lost mileage with achilles strengthening exercises.  Typically, some amount of running can be tolerated when dealing with AT.  Finding the right dosage in mileage and strengthening exercises is a conversation the runner should have with her qualified sports chiropractor.  Equipment like the AlterG Anti-Gravity Treadmill allows runners to continue running through injuries.  

Running, tennis, golf, and even everyday activities can put a surprising amount of stress on a tendon.  Rehabbing tendinosis with the proper exercises is key to fixing the injury and preventing recurrence.  Modifying the activity that caused the injury is necessary, but complete rest is rarely the answer.

If you’re struggling with pain or injury, give us a call or click HERE to begin getting back to the activities you enjoy!