Firstly tendon pain is probably not tendinitis.
Research has firmly established that tendon pain in most cases is the result of tendon degradation rather than inflammation as previously thought. Hence most practitioners now refer to the condition as a tendinopathy rather than a tendonitis.
Whatever occured to bring about the original injury is past history it seems and in most cases the problematic tendon requires load to bring about a lasting solution.
In a study comparing corticosteroid injections with eccentric loading and heavy resistance training, heavy resistance training produced the best outcomes for subjects suffering from patellar tendon pain.
Here is the problem, which most of you with tendon pain will probably know, exercise with tendon pain hurts.
In most cases it really hurts.
Previously I had mixed results loading problematic tendons. The research at the time was biased towards eccentric loading but with some clients this was intolerable.
So what do you do when the medicine causes more pain than the problem itself?
There are two things that can influence this.
1) Are the muscles that attach to the target tendon contracting appropriately?
2) Is there a biomechanical issue which could be influencing the outcome?
In most cases the answer to those two questions is no and yes.
So for example, with a patellar tendinopathy, are the quadriceps contracting appropriately? Probably not if there is or has been pain at the knee.
If you inject just 20 ml of saline fluid into the knee to mimic the effects of a trauma, you will likely cause inhibition of the quadriceps.
If load is being placed through the muscular system to target the tendon and the muscles involved are not contracting particularly well, the exercise will feel horrible.
Secondly and perhaps more importantly, it is futile working on the tendon if a larger biomechanical issue has been missed.
If for example your hip doesn’t internally rotate on the symptomatic side, your knee will be absorbing more force than is ideal and the tendon may struggle to heal.
Address the biomechanical factors first before working on the symptomatic tissue.