How to CURE Tendonitis
The Definitive Guide to Fix ANY Tendinopathy
by Alec Enkiri | 7/24/21
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Today we're going to talk about tendonitis, or as it's often referred to these days tendinpoathy. The former implying there being some degree of inflammation of the tendon, however, it's now known that not all painful tendons are actually inflamed, so the term "tendinpoathy" refers to general tendon pathology. Accordingly, in the case of many tendinopathies what you have is not necessarily inflammation, but rather degradation of the tendon. Thing about tendons is they are relatively avascular - they do not have good blood flow compared to muscles, for example. So if you have a dinged up tendon and you just leave it alone, it's never actually going to heal. This is why the old school advice of just resting and using anti-inflammatories until the pain goes away is flawed. This would be akin to noticing that you have a crack in the foundation of your house and deciding to move out of the house for a couple months under the assumption that when you move back in a few months later the crack will somehow be gone.
But obviously the crack will still be there because you never fixed it. This is the same way your tendons are. If you have a tendinpoathy and all you do is rest it, yes, the pain will go away in time because you have ceased performing the aggravating activities. However, in that case you have done nothing to fix the problem at the root here which is degradation and disorder of the tendon and its cross links. Thus, the minute you return to normal activity the pain will come right back because the tendon is still broken and it still cannot perform its job correctly, which is to transmit force from the muscles into the skeleton.
An analogy that I've heard and that I like is to think of the cross links of collagen that make up your tendons as bundles of spaghetti noodles tied up in a nice perfect line with each other. When you injure one of them some of those spaghetti noodles break, and in the presence of acute or semi-acute injury the body will do its best to throw it all back together as best as it can, but inevitably you end up with some cross cross shit. So now instead of having perfect bundles of intact noodles lines up with each other in neat rows, you get a mish mash of broken pieces strewn about and sewn back together in haphazard fashion.
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The acute phase eventually passes and the body stop worrying about it. So you can potentially end up having a tendon injury that for all intents and purposes has "healed" even years ago - the body doesn't care about it anymore because its done with it at that point - but the tendon can still be painful because it's in a state of chronic disarray and disorder. So when you try to transmit force through it, it gets pissed off at you. And since the tendons are avascular once that healing ship has sailed, that's it. It's over. That will be the state of the tendon forever UNLESS you get proactive and do something about it.
So today I'm going to give you guys a 2 phase plan for dealing with these annoying tendonoses and tendinopathies that are an inevitable part of training hard. Everyone gets them. There's no shame in it. But dealing with them and moving past them in a swift and efficient manner is something that every hard training lifter and athlete needs to figure out if they want to stay in the game for the long haul and continue performing the activities they love without requiring significant modifications. I have personally used the method that I am going to outline here today to cure a bicipital tendinopathy in my right arm at the distal tendon of the biceps. I originally got that one from going pretty nuts with weighted chin-ups and I left it alone for a couple years because I was too lazy to deal with it. Eventually it got to a point where I couldn't set up for a strict overhead press anymore because the pressure on the tendon hurt so damn much, and at that point I knew I had to stop being lazy and fix it. Using the methods I'm about to describe I was able to heal that completely and it's been a couple years now and is still feeling 100%. I also used these methods to cure a gluteal tendinpoathy in my right hip that had gotten to a point where the hip was so tender that I couldn't sleep on my right side. That has also been fixed up for a couple years now and it doesn't bother me at all.
Now as mentioned a minute ago we know that the job of the tendons is to transmit force from the muscles to the skeleton. So accepting and transferring load is something that a tendon absolutely MUST be able to do without becoming aggravated by it. That means that exposure to load is a necessary component of encouraging proper tendon remodeling, as opposed to total rest. Another aspect of tendons is that they are avascular, they have poor blood flow. So another component of encouraging tendon remodeling will be high frequency bouts of low load activity designed to pump massive amounts of blood into the tendon so that true healing can take place.
I also recommend using a voodoo floss band every day on the affected area, just for a minute or two. A voodoo floss band is just a thin rubber band. You wrap the affected tendon with it to create a compressive effect, and then move the tendon and the joint through a couple different stretches or low intensity movements. It is not known for certain why voodoo floss bands are helpful with tendinopathies, but it's theorized that the compressive movement helps encourage proper reorganization of the collagen cross links - basically realigning those broken spindles of spaghetti noodles that I talked about earlier. As well, the rush of blood into the area after the compression is released is also thought to be helpful. Either way, they seem to be beneficial so I recommend starting off your protocol each day with 1 to 2 minutes of voodoo flossing. Wrap the area moderately tightly and then move the joint around. If it's a knee or hip do some lunging movements. If it's an elbow curl some very light dumbbells and knock out a few pushups. That kind of thing.
Phase 1 - Pump it Up!
Now the next two parts of the protocol are the most important. First up is Phase 1, and here you want to find an exercise that hits the affected area and reproducers the pain to a slight degree. You should start off with a resistance level that allows you to get in about 20 clean and smooth reps without having the pain exceed a 3 on a scale of 1 to 10. After you do the exercise, the pain should not linger for more than maybe 1 to hours at most initially, and over a period of a few weeks it should fade away almost entirely. As the pain fades you should very very gradually increase the resistance to apply more load to the tendon. If the general pain level does not decrease at all or gets worse after two weeks then you should choose a different exercise because that means the one you are currently using is probably not acting therapeutically. Once you have found an effective exercise you should perform it twice per day every single day, once in the morning or early afternoon and once again in the evening.
For example, with my biceps tendinpoathy I performed regular dumbbell curls twice per day every single day for sets of 20 reps. I started my protocol with just 10bs per arm with slight pain and after about 2 or 3 months I had increased that to 25lbs per arm with no pain whatsoever. And remember, this was a tendinopathy that had lingered for 2 years! And I cured it in about 3 months when I decided to knuckle the heck down and fix the damn thing. The most important parts here are to find an exercise that reproduces the pain slightly and use that pain as your guide.
A little bit of pain initially means the exercise is stressing the area.
If that pain dissipates quickly then you are taking steps forward.
If that pain lingers then you are stepping backwards.
When you are doing things right the pain will actually fade away to a relatively substantial degree over the course of 3-4 weeks. You just have to perform very controlled reps, be consistent and do this exercise every single day, and increase the load very slowly over time but ONLY if the pain level continues to dissipate. Remember, the main goals here are to pump a lot of blood into the tendon to encourage remodeling and to create a baseline level of load tolerance within the tendon.
Phase 2 - Controlled Eccentrics (Building Load Tolerance)
The second part of the protocol, Phase 2, consists of controlled eccentric work. I recommend initiating Phase 2 about 3-4 weeks after you initiate Phase 1, but again, you should use the pain as your guide. If you have been doing Phase 1 for a few weeks and your pain level has decreased to a moderate degree then it is probably a good time to start Phase 2, but if your pain level has not decreased at all then you should not start Phase 2 yet regardless of how long you have been doing Phase 1. Instead, you should find a different exercise and recommence Phase 1 from the beginning. As well, you should continue to perform Phase 1 concurrently the entire time that you are performing Phase 2.
Phase 2 is a little bit more intensive than Phase 1, so you should only perform this portion of the protocol twice per week. Here you need to find an exercise that moderately stresses the tendon and perform 3-4 sets of 6-8 controlled, negative only reps on it. So for example, if you have a distal biceps tendinpoathy like I had then eccentric only chin-ups with a supinated grip would be a great option here. Jump up to the top and resist the lowering portion for 6 to 8 seconds.
If you have a distal hamstring issue then you could use a leg curl.
For a proximal hamstring issue then an RDL would be a good choice.
For an Achilles tendinopathy you could use a calf raise.
For patellar tendinpoathy a squat with the heels elevated would probably work.
In any case, the same rules as Phase 1 still apply. Your pain should not exceed a 3 on a scale of 1 to 10 while you are performing the exercise and it should not linger for more than 1-2 hours afterwards, otherwise the stress is too high for the current load tolerance level of the tendon and you will begin to regress if you keep applying that level of stress to the tendon.
Over time you should slowly add resistance so long as the pain level continues to dissipate - add just 5lbs at a time - every 2 to 4 weeks depending on what area is affected an how large the corresponding muscles are. All told you should perform Phase 1 in isolation for about a month, and then you should perform Phases 1 and 2 concurrently for about 2 more months after that, bringing the total duration of the protocol to 3 approximately months. By the time you reach this point you should have a pretty good idea of whether you have been heading in the right direction or not.
If there is still some small lingering pain then you may want to continue the protocol for another month
If the pain is 95% gone or more than you can probably safely segue back into your normal training routine at that point.
At this stage it will be important to break yourself back in properly. If you do too much too soon then you may just re-injure the tendon all over again, so start off conservatively and rebuild gradually over time. If you're an athlete be sure to start off with low intensity sprinting and jumping variations! Don't just jump full bore back into super intense explosive movements. But if you heed my advice you will be back to your old strength and explosive levels in no time and this time you will have a healthy, remodeled, and pain free tendon. In the grand scheme of things this isn't too much time to put into getting healthy again, and if you let your tendinopathy get so bad that you have to stop training the affected are altogether, well, who's fault is that anyway?
Either way, now ya know! I have completely cured many a tendinopathy this way and taken tendons with incredibly low load tolerance back to 100% again - absolutely no pain and total functionality in terms of load tolerance, both in low speed strength movements AND high speed explosive movements. Just remember to use the pain as your guide. If the pain is continually trending downward then you are stepping in the right direction - you are creating more positive stimulation to the tendon than you are negative degradation. On the other hand, if the pain is continually trending up, even just slightly, then you are likely causing more breakdown of the tendon and the remodeling process is not taking place effectively. So use the pain as your guide, be consistent with your rehab, be honest with yourself about how you are feeling (take notes in a journal if you have to!), and focus on controlled movement and gradually increasing the exposure to load over time. If you can follow these steps then you'll be rid of that lingering tendinopathy once and for all!
I hope you enjoyed this one and that it helps you stay tendinopathy free in the long run. If you did enjoy it please feel free to support the production of more free content like this by picking up one of my training programs! Keep training hard and I will catch you guys next time!