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Tendinitis is an inflammation or irritation of a tendon, a thick cord that attaches bone to muscle. So, you’ve hundreds of them. But the most common tendons that tend to get irritated in the lower limb are:
- Achilles (above your heel)
- Patella (below your kneecap)
- Gluteal (on the outside of your hip)
- Hamstring (the bony bit at the base of your bum)
Tendon pain follows a sudden increase of activity volume that your body isn’t used to, such as: getting back into training after stopping for a while, going for a long walk that you are not used to, or increasing your running distance rapidly, or even changing your training style (i.e. from weight lifting to Crossfit)
Think of it as if your muscles have a certain capacity and when they can’t work any harder, the tendon attached to it will get irritated.
In the short-term, resting for a few days or weeks will allow the pain to disappear or reduce at least. But returning to activity will aggravate the symptoms again. And, if anything, those symptoms are likely to return sooner because with rest, our muscles start losing capacity. Lower capacity means the tendons are more likely to get irritated sooner.
Keeping you running or walking, with a relatively small amount of pain (discomfort zone), is what we will try to do. If the pain is severe, a short period of rest may help but ideally modifying your activity in the short-term (reducing your speed, intensity, distance, or volume) can help keep you moving. This will also mean you can maintain your current muscle capacity. but what is the benchmark here for people who cannot differentiate between discomfort and pain during training on irritated tendon? According to research, 2-4 hrs of minimal pain after training is acceptable. If the pain persists more than that period, you must reduce the load on the irritated segment (speed, intensity, distance, or volume).
The best evidence we have available for treating tendon pain is to strengthen the muscles they attach to. An individually designed program, that is a progressed on a regular basis, will allow you gradually increase your muscle capacity and help you achieve your goals.
We’re looking for the right fix, not a quick fix. Massage, orthotics, taping and injections can absolutely give temporary relief. But those treatments alone just deal with the symptoms and not the cause of the problem – very likely the symptoms will return. Loading your muscles and getting them stronger will typically take time; it varies person to person but typically it is months rather than weeks.
Load it, don’t rest it completely.
Load it, within your pain limit (to the discomfort zone only).
Load it, in different directions.