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Pull harder! The “key” to tendinitis?

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

“Once again high-loading interventions are the key to managing tendinopathies,” a sports doc wrote, inspired by a 2022 trial, Radovanović et al. The idea is that pulling hard on sick tendons is good for them (by lifting heavy weights, for instance). It’s a bit counter-intuitive! A tendon is struggling to adapt to load, so … just add load? But it’s not as bass-ackwards as it sounds, if the dosage is right.

Are they “the key,” though? Does that hyperbole fit here? Does high load unlock the solution to tendinitis?

Not based on that trial. That trial actually convinces me of the opposite: lotsa loading was no better for pain than low load or passive therapy … and none of them did much of anything. It’s hardly surprising that loading can make a tendon tougher in various ways, but it didn’t actually translate into reduced pain as measured here. Sure, the “overall clinical picture” improved, and that is not nothing — it’s why I do high loading for my own gnarly Achilles tendons. It’s probably better than not doing it. Maybe. I’d like to think I’m reducing my risk of rupture, and I might actually be.

But I am not comfortable saying that high loading is “key” for Achilles tendon — not while the pain marches on.

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