Tendinopathy essentially means ‘pain and dysfunction in the tendon’. This can happen for various reasons, most commonly small tears or a strain.
Tendons come in different sizes, shapes, and functions. Tendinopathy is common and will likely affect most of us at some point. Many of us have already experienced it without even knowing.
Tendon injuries can range in severity. The level of pain experienced can range from mild to severe and depends on the location and extent of the injury.
In the past, tendinopathy treatment focussed on stretching and massage. However, recent research shows that strengthening exercises produce more effective outcomes.
What causes tendinopathies?
Sudden stress or overuse of the tendon is a cause of tendinopathy. Often, these injuries arise after repetitive impact activities. For example, more than half of tennis players suffer from tennis elbow, which is how it got its common name. Repeatedly hitting a tennis ball can strain the extensor carpi radialis tendon, causing pain and swelling.
Diagnosis of Tendinopathy
Doctors often use MRI, ultrasound, and physical exams to diagnose tendinopathies. MRI is considered the gold standard. However, recent studies found that issues shown in imaging don't always mean symptoms will be present.
If you think you may have tendinopathy, seek medical advice for proper diagnosis.
Why Resistance Bands?
Various treatment options for tendinopathies include soft tissue release, dry needling and even surgery. However, eccentric training consistently stands out as the most effective method. This type of training specifically targets the "eccentric" phase of a movement, which occurs when the muscle elongates while resisting a force, such as lowering a weight or decelerating after a jump.
Research indicates that eccentric exercises are more effective than other treatments like PRP injections, electrotherapy and surgery for managing conditions like patellar tendinopathy. Eccentric training is also affordable, safe and reduces the risks of downtime present in other treatments. Including this exercise in rehab programs can improve tendon health and function, avoiding the need for more invasive treatments.
How to Create an Effective Tendinopathy Exercise
Note: Always consult a medical professional for correct diagnosis and treatment before beginning any exercise or rehabilitation programme.
With over 4,000 tendons in the human body, developing exercises tailored to each tendinopathy is crucial. To create a tendon exercise, follow these steps:
- Identify the motion. Determine the exact motion performed by the muscle associated with the affected tendon.
- Prepare the resistance band. Find an immovable object to place your band around as an anchor or secure the band beneath your feet by standing on it.
- Perform the exercise.
- Concentric phase: Contract the muscle to shorten it against the band's resistance. An example of a concentric phase is moving your forearm up next to your bicep during a bicep curl. For tendinopathy recovery, you should help the muscle into its shortened position. For example, using the hand of the other arm to help move the arm into a bicep curl.
- Eccentric phase: Slowly return the muscle to its original length, controlling the movement. In a bicep curl, the eccentric phase is when you lower your forearm away from your bicep.
Here are some examples of practical eccentric exercises using a resistance band for different tendons.
For all these exercises, choose a band that you can complete 12 repetitions with moderate effort; it should feel neither too easy nor too hard. As you continue to perform the exercises over several weeks and they start feeling easy, progress to a higher resistance strength.
Exercises for Rotator Cuff Tendinopathies
Infraspinatus
- Secure a resistance band around a stable object at elbow height.
- Start with your elbow flexed at 90 degrees in front of you and your hand positioned forward.
- Hold the band and externally rotate your arm, focusing on engaging the infraspinatus muscle.
- Slowly return to the starting position, controlling the movement.
- Repeat for 3 sets of 12 repetitions.
WATCH: Emma's infraspinatus tendinopathy exercise video demonstration
Teres Minor
- Stand on the middle of a low-resistance band
- Abduct your elbows to shoulder height.
- Externally rotate your arms while holding the band, ensuring you feel the engagement in the teres minor muscle.
- Slowly return to the starting position.
- Perform 3 sets of 12 repetitions.
WATCH: Emma's teres minor tendinopathy exercise video demonstration
Supraspinatus
- Secure a resistance band around a stable object at hand height when standing with arms by your side.
- With your outside arm, grab the band and position yourself so that the band runs along your thigh.
- Step away to create tension in the band.
- Raise your arm to your side about 45 degrees, focusing on the supraspinatus muscle.
- Slowly return to the starting position.
- Complete 3 sets of 12 repetitions.
WATCH: Emma's supraspinatus tendinopathy exercise video demonstration
Exercises for Thumb Tendonopathies
Thumb Abductors
- Hold a resistance band in the opposite hand.
- Abduct your thumb against the resistance of the band.
- Slowly return to the starting position, focusing on the eccentric movement.
- Perform 3 sets of 12 repetitions.
WATCH: Emma's thumb abductors tendinopathy exercise video demonstration
Thumb Extensors
- Secure the band under your foot and hold the other end with your thumb.
- Extend your thumb upward against the resistance.
- Slowly return to the starting position.
- Complete 3 sets of 12 repetitions.
WATCH: Emma's thumb extensor tendinopathy exercise video demonstration
Exercises for Foot Tendinopathies
Achilles Tendon
- Sit on the floor with your leg extended and loop the band around the ball of your foot.
- Hold the ends of the band in your hands.
- Point your toes (plantar flexion) and then slowly return to the starting position, focusing on using the Achilles tendon.
- Perform 3 sets of 12 repetitions.
Peroneus Brevis
- Sit with your leg extended and the band looped around the ball of your foot.
- Hold the ends of the band and position your foot inward.
- Evert your foot (move it outward against the resistance of the band).
- Slowly return to the starting position.
- Complete 3 sets of 12 repetitions.
WATCH: Emma's peroneus brevis tendinopathy exercise video demonstration
Why Hasn’t My Tendinopathy Improved After Resistance Training?
Eccentric training is often highly effective and can produce quick results. However, if you're not seeing improvement, it might be because you're not engaging the right muscles. This can happen because of your positioning or because other muscles are compensating.
Muscles work in pairs, one contracting while the other relaxes. Sherington's Law of Inhibition is a principle that states when one muscle is overly tight or dominant, it can prevent its opposing muscle from contracting effectively. For example, if your pectoral muscle is tight, it can inhibit the function of the infraspinatus muscle.
To resolve this, you may need to stretch and lengthen the tight muscle first to allow the target muscle to work as it should.
Including eccentric exercises with resistance bands into your rehab routine can be particularly beneficial for tendinopathy recovery. These exercises effectively target the affected tendons and offer a cost-effective, non-invasive alternative to more traditional treatments. Focusing on the correct movements and using suitable resistance can promote tendon health and restore function with minimal risk.
Always consult a medical professional for correct diagnosis and treatment before beginning any exercise or rehabilitation programme.
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