Tendon Injuries: Rest rusts, excess is?harmful

For my entire life, I’d been using my tendons without giving them a second thought. It was only twenty years ago when I began weightlifting with a lot of enthusiasm and not much technique that my tendons loudly announced to me their existence and importance.

If you’ve never had a tendon injury, you should try to avoid the experience.

It’s not fun.

Fortunately, at the time, I was in University studying Biokinetics, and so I was able to connect my real-world experience with some anatomy. Our joints are held together with two major forms of connective tissue — ligaments and tendons — and understanding the difference between them should come as a standard piece of knowledge for any human being moving about the world.

Ligaments are passive. They connect bone to bone. They restrict movement and keep everything in line. As a result, they are engaged with every movement.

Tendons are active. They connect muscle to bone. The harder you work and move, the more your tendons have to get engaged. However, when you move without any resistance, they don’t have to do much.

The result is that you can feel very clearly the difference between a tendon and a ligament injury.

If ANY movement hurts, you have a ligament injury. You should rest it and avoid moving it at all until it no longer hurts. Ligaments are terrible at self-repair. You should consult a doctor, and you may need surgery. These are often sudden and come with a dramatic pop.

If you can move the joint and have no pain, but when you lift weight or create resistance, then there’s pain, then you probably have a tendon injury. Tendon injuries are difficult to heal, but they can heal themselves, and movement is vital to that healing process. By contrast, these tend to be slower onset injuries that take time to build up.

There’s a handy dutch saying, which perfectly captures how to approach tendon injuries: “Rust roest, overdaad schaadt” or rest rusts, and overdoing it is harmful.

Understanding the difference between tendon and ligament injuries will save you a lot of heartaches. Take, for example, a client of mine named Errol. Errol had knee pain and stopped all running and did not train his legs for six weeks. He contacted me when his patellar tendonitis came back within a week of starting running. The problem wasn’t in Errol’s response. Rest is a great response to a ligament injury. The problem was that he misdiagnosed a tendon injury like a ligament injury. In fact, he had patellar tendonitis.

In future posts, I’ll take a look at how to deal with tendon injuries in various parts of the body like the knee and elbow. However, for now, here are four key things to understand about treating tendon injuries.

1. Rest rusts: Complete rest is ineffective for most tendon injuries. They need movement to heal.
2. Overdoing it is harmful: Pain is the body’s messaging system. With a tendon injury, on a scale of 1–10, you want to be feeling a three for optimum recovery. If you’re feeling no discomfort, you’re not challenging the tendon to heal. If you’re in excruciating pain, you’re doing more damage.
3. Tendonitis vs Tendinopathy: Tendinitis is not technically correct because the “itis” means inflammation which in this situation is not the cause of the pain. Tendinopathy is the correct term for this chronic pain because it refers to the breakdown of the tendon over time, due to insufficient time for the tendon to adapt to the stresses it is put through. It is the decay of the collagen, the main structural component of the tendon.
4. Listen to Your Tendons: By intentionally loading the tendon with weight, you are giving it time to respond to the movement and the load. Listen to the pain your body is sending to guide you on the degree of pressure you can put on your specific tendon at that moment.