Tendonitis Part 2 - How to Stay Strong
In Part 2 of our series on tendonitis, we’re going to discuss how you can keep exercising and stay strong while dealing with a painful tendon. Sometimes the pain of tendonitis isn’t the worst part of the condition, it’s the fact that you have to stop the exercises that you enjoy! Fortunately, there are many ways to adjust your strength training so that pain isn’t as big of an issue, and you can continue to build strength even as you rehab your painful tendon. We’re going to talk through two strategies to adjust exercises, and give some specific examples in the case of someone with pain in their patellar tendon. For those of you who haven’t read Part 1 of this series, I’m going to use the term “tendinopathy” in this article because it applies broadly to tendon pain. To get a more in depth explanation of the different types of tendon pain and the basics of how we manage them differently, see Part 1.
Strategy 1- Change the Movement Pattern
There are some positions that put more strain on a tendon than others. When training around a painful tendon, it’s useful to avoid those positions and work the muscle in a position where there is less strain. This allows us to maintain strength while having a lot less pain. Let’s use patellar tendinopathy as an example. The patellar tendon is the tendon that connects the bottom of your kneecap to the bone of your shin, shown below in between the therapist’s fingers:
People who enjoy exercising are likely familiar with squatting as a staple of most exercise routines. Squats are a fantastic exercise, but unfortunately when someone develops patellar tendinopathy squats are usually painful. Doing a deep squat requires your knee to go forward over your toes. Usually that's a great thing! That stress will usually help the tendon grow strong and tolerate high stresses! However, if the tendon becomes painful, we need to try to take some strain off of it. You do this by sticking to exercises that limit the amount of forward movement of your knee, at least until the tendon starts to feel better. This is done by limiting the range of motion of the exercise (how far you move) or changing the exercise to a different movement pattern that puts less stress through the knee. Here are some examples:
Reverse lunges- this style of lunge takes your bodyweight backward, reducing the amount of forward movement of the knee and therefore reducing the strain on the patellar tendon. There are plenty of ways to add resistance to this exercise, as shown below.
2. Squat Variations- in the video below you’ll see three different adaptations that will allow you to keep a squatting movement in your exercise routine, but reduce the stress placed on the patellar tendon. The first two variations are box squats at different heights. The goal here is to use the box or bench to allow you to shift the weight backwards in the squat without falling over, therefore reducing the strain on the patellar tendon. If you can tolerate doing the squat to a low surface, like the bench, with minimal pain, then you should stick with that variation. But, if squatting to the bench is too low and too painful, a higher surface like a box is better. Finally, the Spanish Squat is a cool variation of the squat where you wrap a thick band around the backs of your knees, which allows you to sit backward into the squat without falling. Make sure you really push your knees backwards into the band at the top of each rep and you’ll feel your thigh muscles burning!
Strategy 2- Change the Speed
This one is easy- if a tendon is sensitive to a movement, try doing it slower! The speed that you move makes a massive difference in the strain that a tendon has to deal with, so slowing down a motion can make a painful movement feel much better. An easy tempo that you can try is: three seconds to lower down, 3 seconds to push up. This can be adapted to all of the above exercises if you’re still having some pain with them. There is an added benefit to a slow tempo too- you’re able to work the muscle really hard without the need for a lot of weight! If lifting heavier weights is painful, try cutting the weight in half and then perform the reps at that 3 second down, 3 second up tempo. In the video below, I’m combining strategies 1 and 2 by using the box to limit my range of motion and allow me to sit back farther into the squat, as well as slowing down the movement.
Conclusion
Tendinopathy can be an incredibly frustrating condition, especially since pain relief is often a very gradual process. These are valuable strategies that can be adapted to any painful tendon, whether it’s in your upper body or lower body. Give them a try in the gym, get creative, and see if you can keep building strength as you recover! Of course, if you’re looking for some more specific management of your condition or need some more guidance, we’d love to help! Please reach out to us with any questions here!
