OK, now how long does it take for tendinopathy to improve?
Complete resolution of tendinopathy is more predictable within months rather than within days of seeking care. Strong or specific time-based opinions about complete tendon pain improvement should be considered sceptically. Most of the time, you should expect improvement in pain and function within 2-3 months when completing a high-quality tendinopathy management program.
However, in some cases, in individuals with multiple associated risk factors, as described already, complete resolution of tendinopathy can last for longer than 12 months. However, that does not mean people with a longer duration of tendon pain are less likely to improve with high-quality management. Many research papers have described improvements in people with persistent tendon pain for longer than 2 years who have had great improvement following progressive tendon loading strategies. Length of pain does not seem to predict delayed recovery. Rather, unhelpful pain behavior can predict prolonged tendon pain and is associated with delayed recovery. Common reasons tendon pain does not resolve are listed below.
Tendinopathy can reoccur after years of resolution, which shouldn't be interpreted as being back to square one. You should reflect on the above recommendations for gaps missing in your weekly tendon pain management habits.
Most health professionals would not like to admit to this, but it is honest to say that although rare, despite the best care, some people might never have resolved tendon pain. However, this does not mean they have to suffer with tendon pain. Properly guided physiotherapy and education can reduce the suffering and confusion inherent in persistent pain and decrease the medical cost associated with desperate treatment-seeking behavior aimed at “fixing” pain.
Common reasons tendon pain does not improve?
When regular exercise is stopped too early due to common barriers to physical activity (not prioritising exercise time, access, lack of perceived benefit) or the short-term resolution of previous tendon pain. Sometimes, we expect recovery too soon and stop valued activities or exercise because we're not improving. Maintain enjoyable habitual physical activity.
Exercise might have needed to be more progressive, especially with strength training or plyometric jumping activities.
Pain behavior and pain beliefs that aren’t helpful long term. This might include fear avoidance or not exposing your tendons to movement out of concern of making your pain worse.
Depression and anxiety, as well as other conditions such as diabetes, being overweight and cardiovascular disease.
Not having a tendon flare-up plan or believing a flare-up is causing rapid damage and, therefore, changing management plans prematurely.
Relying only on pain relief methods such as braces, medication, or manual therapy.
Health-care providers offer unhelpful advice. Ironically, healthcare professional advice, including Physios and Doctors, can be unhelpful and contribute to unhelpful behavior. Examples include exaggerating imaging or assessment findings, prompting outdated advice, or not explaining your condition fully and how your life context has led to potentially persistent tendon pain. Speak to your Physio or Exercise Physiologist as much as possible about what other healthcare professionals have shared with you that has been contradicted by the information shared.
Common concerns surrounding tendon pain.
Painful tendinopathy does not increase the risk of tendon ruptures. Pain probably protects you from that.
“Physiotherapists will stop me from doing the aggravating activity that I love.” Stopping all valued activity of any dosage that causes tendon pain is very old school and only necessary when any dosage of that activity cannot be tolerated. These aggravating activities are the foundations of the recovery process, and we want you to return to these in a realistic timeframe. You just might not be able to tolerate the same amount of these activities as usual, and we might encourage a reduction, but never for more than a couple of weeks. Finding the progressive weekly dose of this activity is one of the key strategies we will discuss during a physiotherapy consult.
Like the strength of a tendon and associated muscle, flexibility is not a strong risk factor for developing tendon pain. At the level of the tendon, muscle, or joint, stretching is simply a low-intensity strength exercise and shares the same benefits as strength training without increasing tissue strength. Prioritising full range of motion strength training will improve flexibility if desired while having more secondary health benefits than stretching alone. We are still unsure of why participation in strength training is helpful for tendon pain, but “just getting stronger” does not need to occur for some people's tendons to become less painful.
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