Stubborn Tendon Pain? Try this!

By Dr. Cathlin Fitzgerald, PT, DPT, CSCS

Tendon injuries can be incredibly frustrating. While you can have a lot of improvements quickly - a decrease in the amount of pain (less intense or severe), improved flexibility and strength, and better running - the pain can linger for quite awhile.

Tendon treatment has been a big topic for physical therapy research recently. We’re seeing a ton of great information coming out on how to make treatment more effective and how to get runners back out there as quickly as possible, so stay tuned!

For today, I’m focusing on one recent study that looked at the mechanics of pain in tendinopathy. The researchers looked at 3 different cases: two achilles tendon and one patellar (just below the kneecap) tendon. The theory was that the source of pain was due to an oversensitive nervous system, not necessarily the injured tendon itself. This can happen if there is a constant influx of stimulus telling the system that there is pain occurring. 

Based on this theory, researchers used three strategies to desensitize the nervous system, hoping to decrease pain at the injured tendon. The three strategies were 1) joint mobilizations performed by the physical therapist, 2) pain/neuroscience education for the athlete, and 3) aerobic exercise. All of these treatments have been individually shown to desensitize the nervous system in previous studies. All three were applied to the cases in this study as all of the participants had persistent, stubborn symptoms. It was a requirement of the study that the patient had reported functional problems for at least one year. It’s also worth noting that all three had had physical therapy before, and one had four different bouts of previous physical therapy!

The results showed that all three had improved in their threshold to tolerate pressure at the tendon and all three had pain-free movements targeting the injured tendons (single leg heel raises for the two with achilles tendinopathy and a single leg squat for the one with patellar tendinopathy). At the end of the study, the athletes’ return to run programs were just started, but all three could run at least 30 minutes without symptoms.


The takeaway here is that there are a few, less intuitive ways to decrease the pain you experience with a tendon injury. One is to continue some form of aerobic exercise that is pain-free; in this study the achilles pair used swimming and the individual with patellar tendinopathy used an elliptical. Another is to educate yourself about how pain works! The books "Explain Pain" by David Butler & Lorimer Mosely and “Pain is Really Strange” by Steve Haines are two great sources, and you can always ask your trusty PTs at Custom Performance! Both of these strategies will help to desensitize your nervous system, providing a big step towards get rid of that stubborn pain.

Jayaseelan DJ Weber MJ Jonely H. “Potential nervous system sensitization in patients with persistent lower extremity tendinopathies: 3 case reports”. JOSPT. 2019; 49(4): 272-279.