How to Fix Tendonitis for Triathletes
- Apr 4
- 6 min read
Updated: Apr 14
Tendinopathy, often called tendonitis, is a condition where a tendon cannot properly adapt to physical load, leading to pain and reduced performance. It commonly develops from either doing too much too quickly or not loading the tendon enough over time.
This blog explains how proper load management, progressive strengthening, and targeted rehab strategies can help restore tendon capacity and reduce pain. It also highlights why rest alone is not an effective long-term solution.
A structured approach through physical therapy can help guide recovery, improve tendon resilience, and reduce the risk of recurring pain.
What Tendinitis (Tendinopathy) Is and Why It Happens
If you’ve ever been diagnosed with something like Achilles tendonitis, runner’s knee, tennis elbow, or biceps tendonitis, you likely had a tendon issue.
What was previously called tendonitis or tendinosis is now referred to as tendinopathy, which means “disorder of the tendon”.
Tendon issues used to be called tendonitis because they were thought to be driven by inflammation. That’s why previous methods of treating tendinitis involved rest, ice, and anti-inflammatories.
But in 2009, Dr. Jill Cook proposed a new model that described tendinopathy as the tendon’s inability to adapt to different loads.
According to the paper, tendinopathy can occur when you overload or underload a tendon.
Overloading
Overloading is more commonly described as “doing too much, too soon”. This might look like a sudden increase in running volume or starting a sport with more jumping than you’re used to. The tendon is expected to handle loads it’s not prepared for.
It can also happen when you don’t allow enough recovery between sessions, especially with repetitive activities like running or swimming. This is also commonly described as overuse injuries.
Underloading (Stress Shielding)
Underloading, or stress shielding, is the opposite problem. It occurs when the tendon hasn’t been appropriately challenged for too long. Not challenging the tendon causes it to lose its ability to handle higher loads and makes it more susceptible to overloading.
An example is someone trying to return to the same level of running they did 10 years ago. Their tendon hasn’t been exposed to that level of loading in years, so it’s no longer prepared to handle it.
Common Symptoms to Watch For
Pain is usually felt near a joint and can be described as “sharp” during activity, and “dull” or “achy” during rest.
In the early stages, you’ll probably experience the “warm-up effect”. This is when the tendon is painful at the start of activity but seems to improve as you continue.
As the tendinopathy progresses, you might start having lingering pain that lasts a day or two after stopping the activity. You might also stop experiencing the “warm-up effect” where the pain doesn’t subside even after a warm-up period.
When to Rest and When to Stay Active
If your only strategy is rest, there is a reason why it seems like your tendinopathy never seems to go away. Your tendon might feel better after resting for a few days or weeks, but the pain keeps coming back as soon as you return to your normal training.
That’s because tendons need to be loaded to heal properly.
Resting can decrease pain in the short-term, because you are removing load. But remember, underloading a tendon will cause stress shielding and reduce the tendon’s ability to handle load. This is why the pain comes right back when returning to activity.
So the best thing to do when dealing with tendinopathy is to reduce your training volume a bit, but not completely rest. This allows your tendon to recover while also maintaining its ability to handle load to a certain extent. That way, you don’t have to spend as much time rebuilding capacity.
Effective Home Treatment Options
The main goals with treating tendinopathy are:
Reducing pain
Improving the tendon’s ability to handle load
Strengthening the muscle attached to the tendon
The main components of effective tendon rehab are isometrics, concentric and eccentric loading, and plyometrics (if needed).
Isometrics
Isometric exercises are those that contract the muscle without moving the joint. An example is a wall sit for the quadriceps and patellar tendon.
Isometrics can help to decrease pain in an especially irritable tendon. It is also a good entry point for starting to load the tendon without causing too much pain. Tendinopathy rehab often start with isometric exercises, but it can be skipped if the tendon isn’t too irritated.
Concentric and Eccentric Loading
Concentric exercises are those that contract and shorten the muscle, such as with lifting a dumbbell during bicep curls. Eccentric exercises are those that contract and lengthen the muscle, such as with slowly lowering the dumbbell during the same bicep curl.
These help to build both muscle strength and tendon capacity. But, you might experience some discomfort or pain while doing these exercises, because they are putting more load on the tendon.
It can be difficult to find the right balance between loading the tendon enough and not causing too much pain. The general guideline is to keep pain at or below a 5/10 pain level during exercise.
Plyometrics (If Needed)
If you’re trying to return to a high-impact activity, such as running, plyometrics are a key part of your rehab. Some examples of plyometrics include pogo jumps and drop jumps.
Most people skip this step, because they’ll feel better and have no symptoms by the time they reach this step.
But impact activities demand even more from your tendons than just concentric and eccentric exercises. Plyometrics help to continue building your tendon’s load capacity so that you reduce the risk of the tendinopathy recurring.
If you’re unsure where to start or how to create a treatment plan for yourself, a triathlete physical therapist can help.
How Long Does It Take to Improve?
Tendinopathy rehab takes about 3-6 months on average, because tendons take a while to adapt. Some cases can take a year or more to resolve.
In general, the sooner you start tendinopathy rehab, the less time it will take to get better.
And as a reminder, rehab is almost never linear. You might experience set-backs, and there might be weeks where it feels like nothing’s happening. So it can be more useful to compare where you currently are in rehab to where you came from, instead of focusing on how much you have left to go.
What About Injections, Shockwave, or Dry Needling?
Steroid injections, shockwave therapy, and dry needling can all help address the pain associated with tendinopathy. But they will not help improve the tendon’s ability to handle load and are not a replacement for rehab.
However, they can be useful as part of a comprehensive rehab program, especially for more irritated tendons. By decreasing pain, you are able to better tolerate doing the exercises that will actually improve your tendon.
Also worth noting is that repeated corticosteroid injections can weaken tendon tissue over time. This makes the tendon more susceptible to rupture in the future.
Prevention Strategies for Long Term Relief
The best ways to decrease your risk of developing tendinopathy are:
Managing training load (no sudden increases in training)
Recovering adequately (i.e. sleep, rest days, nutrition)
Regularly strength training to build tendon and muscle capacity
When to See a Professional
There is a small chance that tendinopathy pain will improve after 3-4 months. But if you do not address the tendon’s loading capacity, there is a high chance you will experience tendinopathy pain again.
The vast majority of tendinopathy cases don’t require surgery. Seeing a triathlete physical therapist first for a rehab plan can save you time and money by skipping unnecessary doctors’ visits and referrals. And if your case is one of the few serious enough to warrant a referral to an orthopedic surgeon, the physical therapist can determine that during their assessment.
Most states, including Nevada, allow for direct access, meaning you do not need a referral from a physician to see a physical therapist. However, some insurances may require a physician referral to cover physical therapy services.
Triathlete Physical Therapy in Nevada
If you're located in Nevada, are dealing with tendinopathy, and are dreading having to take time out of your day to go to physical therapy appointments, I offer remote physical therapy for triathletes who want structured rehab without weekly clinic visits.
Fix your tendinopathy without wasting precious time driving to a clinic. Schedule an assessment today to return to training pain-free sooner!
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References
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409–416. https://doi.org/10.1136/bjsm.2008.051193
Cook, J. L., Rio, E., Purdam, C. R., & Docking, S. I. (2016). Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. British journal of sports medicine, 50(19), 1187–1191. https://doi.org/10.1136/bjsports-2015-095422
