The biggest mistake athletes make with tendon pain

Your knee starts hurting gradually. Before you know it, it’s affecting every squat session.

You stop training for a week or 2, resume training because it feels better, but after 3 sessions your back to where you started.

‘Tendon issues? Take rest and use ice.’

‘Tendon issues respond well to 90 degrees isometrics eccentrics’

‘You’re simply getting older, it’s part of the deal.’

While these held up for a longer period of time, our understanding has moved on. Of course, complete rest rarely solves tendon issues. It’s about finding the right amount of loading.

Function creates form

Like most body tissues, it needs to know what to do. In the case of injury, collagen will make it’s way in and repair any possible damage. Thing is, it simply doesn’t know what the tissue needs to be able to do.

In the example of muscles, it needs to be able to contract and relax. Tendons need to be able to withstand and transfer those forces to move.  In other words, appropriately dosed loading is often the most important part of recovery.

Another way to think about this: tendons don’t adapt because time passes, it adapts because it receives information. The information being the load you put on it.

Taking it too easy, unnecessarily.

There can be a lot of factors that can influence the onset and maintaining tendon issues. Ankle mobility, hip mobility, foot pressure, programming and a lot more. I’ll cover a few in this blog.

A client of mine, who is a pretty strong squatter, has dealt with recurrent knee issues. It’s mostly anteriorly, improves with warming up and gets severe after the session and the days after. Having tried multiple physios who’ve all approached it too carefully - doctors who’ve only prescribed painkillers, ice and rest. Everytime, after a short period of rest, the pain was better. So logically, back to training which immediately elicits the pain again, paired with frustration.

The main question here was: how can we make the tendon capable of tolerating heavy squats again and not how we could eliminate pain.

Knowing he just wants to train seriously, the first challenge was getting the reactivity down. After that, we had phases of 4-6 weeks. Within a few months, his knee issue that took almost years to get fixed, was solved.

Applying what’s needed, not just what books say

This client had difficulty opening his left hip and with that, struggles with proper foot pressure. Even though he’s strong, the pain was seriously hindering. Important note here: these factors do not necessarily cause the pain, but improving them reduces unnecessary stress on the affected tendon, allowing for better training.

Let’s go over what needs to be done first:

The first step wasn’t chasing big numbers or strength, it was reintroducing mechanical tension in a way the tendon could tolerate. Heavy isometrics reduced pain and started exposing the tendon to meaningful load.

The exercises that elicit complaints will not be eliminated. Lighter loads and working within the relatively pain-free range will allow the tissue to heal whilst maintaining the skill, in this case the back squat.

Addressing any possible technical deficits, in this case the hip mobility. Although the changes are relatively small, it does contribute very well to awareness during the movement.

This is just a small piece of the pie, but this will greatly help starting up the recovery process.

What’s in it for you

Don’t be too afraid to train, but also don’t overshoot to temper the ego. Ask yourself: what gives the most training satisfaction without having to pay for it with pain afterwards.

Final thoughts

Tendons are sturdy structures, but they are not indestructible. They do respond well to proper and smart loading. Chill the ego, relax on the ramping up, address any less optimal compensation mechanisms and, perhaps the most important one, have fun with getting stronger.

Athletes simply want to train and don’t want to spend too much time doing fancy ‘rehab exercises’. With tendon issues, a few small adjustments will work wonders.

People who are serious about their training are dedicated to get their work done, without too much fluff. If anything from this blog feels like it resonates with you and looking to break that cycle, you need a plan that matches your tendon’s capacity to the demands of your sport. The goal isn’t to get you out of pain. It’s getting you back to training with confidence without wondering whether the next heavy session will set you back again.