Tendonitis and Training: How to Keep Progressing Without Making It Worse

Tendonitis (technically, tendinopathy) is the toll of the consistent: the elbow on bench day, the shoulder on press day, the knee on squats, the classic elbow of those who pull too much. And it punishes the two most common instincts — "train through it" worsens the injury; "stop everything" weakens the tendon and postpones the problem. The tendon doesn't want rest: it wants load at the right dose.

Disclaimer: persistent pain deserves professional evaluation. This is the general map; the physical therapist is the local guide.

Why total rest fails

Tendons remodel in response to load — without stimulus, the disorganized tissue stays disorganized, just rested. Modern literature treats tendinopathy with progressive exercise, not immobility. Acceptable rehab pain: up to 3-4/10 during the exercise, returning to baseline within 24h.

The general loading protocol

1. Phase 1 — Isometrics (high pain): 30-45s sustained holds in a pain-free position, 4-5 sets. Natural analgesia + remodeling stimulus. E.g.: bar hang hold for elbows, wall sit for the knee.
2. Phase 2 — Slow heavy eccentrics: 3-4s negatives, 3x8-12. The gold standard of tendon remodeling.
3. Phase 3 — Progressive return: back to full movements with double progression, starting 30-40% below the usual.

Tactical adjustments by region (while rehabbing)

• Elbow (epicondylitis): neutral grip on pulls and curls; straps to take the forearm off the limit; less close-grip volume.
• Shoulder: daily light face pulls and cuff work; swap the barbell press for lower-pain landscapes (dumbbells, neutral grip, lower angles).
• Knee (patellar): isometrics + legs without deep squatting temporarily; return to depth with the pain.

The mistakes that make it chronic

Ignoring six months of a "little ache"; returning to full load in the first pain-free week; aggressively stretching an irritated tendon (load > stretch); and hunting passive solutions — ice, creams, gadgets — while fleeing the only active one: progressive load. The tendon is patient, vengeful tissue: treat it early and well, and it forgets; late and badly, and it remembers for years.