Do I Need to Rest a Tendon Injury, or Keep Moving?
By Toby Sullivan, MCSP - Chartered Physiotherapist
This is probably the question I get asked most about tendon pain, and it's a fair one, because the two most common instincts, stopping completely or pushing through it, both tend to make things worse rather than better.
Why complete rest doesn't fix it
A tendon that's struggling isn't like a cut that heals better if you leave it alone. Tendons need load to stay strong and to recover properly. Stop all activity for a few weeks and the pain often does settle, which feels like progress, but the tendon usually hasn't actually got any stronger or more resilient. Go back to normal activity and it flares straight back up, because the underlying problem was never addressed, only avoided.
Why pushing through it doesn't work either
The opposite approach, carrying on exactly as before and hoping it settles down on its own, tends to keep the tendon irritated without ever giving it a chance to adapt. This is the pattern I see most in keen runners and padel or tennis players: the pain becomes background noise, tolerated rather than dealt with, until it's been going on for months.
What actually helps: the right amount of load
The tendon needs load, just the right amount, building gradually. Too little and it never gets stronger. Too much, too soon, and it stays irritated. In practice, this usually means a staged exercise programme, starting at a level the tendon can currently cope with and building up steadily, alongside some short-term adjustments to the activity that's aggravating it, rather than stopping it altogether.
A useful rule of thumb
A common guide, though not a hard rule, is that some discomfort during activity is often acceptable if it settles down within a day, and isn't getting worse week on week. Pain that lingers well beyond the activity, or that's trending upward over time, is a sign the load needs adjusting, either up or down, rather than a sign to stop entirely.
When it's worth getting help
Tendon pain that's been hanging around for more than a few weeks, or that keeps coming back every time you return to normal activity, is usually a sign the loading balance needs proper input rather than trial and error. For pain that's been longstanding, focused shockwave therapy alongside a loading programme can help move things along faster than loading alone.