Running with Tendonitis: Guided by an Expert Physical Therapist

If you’ve ever spent time resting from an injury, only to find that it appears again within weeks of restarting activity this article is for you. Our interview with tendinonpathy expert Dr Alex Nelson, is an important discussion of running with tendonitis and dispels common misconceptions.

Here you’ll find a summary of the Tread Lightly episode interviewing Dr Nelson. We recommend listening to the full episode, which is embedded at the end of the article, for additional details.

What is Tendonitis vs Tendinopathy?

Amongst athletes you’ll hear the term tendinitis tossed around. And if not, you probably have heard things like jumper’s knee or runner’s heel.

Terminology is really important and we’ll talk about that here in a second because tendinitis is often the diagnosis given to people who are battling tendon pain. And the suffix on the end with itis kind of leads people to believe that inflammation is kind of the hallmark sign of this injury and that the inflammation is the primary driver of their symptoms.

Which leads us down a path of trying to reduce inflammation through NSAIDS or ice or rest.

But that isn’t actually going to resolve the issue.

And now, the better term is actually tendionpathy. That way we aren’t confusing maybe an acute injury inflammation with what is really happening to the tendon and surrounding muscles.

Will Rest Resolve Tendon Issues?

No.

As with any injury, you obviously need to stop the things that are causing massive amounts of pain. But you can’t stop doing everything.

“actually resting too long and complete rest to the tendon and to the surrounding muscle groups can lead to some of these maladaptive changes to the tendon. So rest is actually harmful and especially if we completely rest for too long.“ running tendonitis

What are the Warning Signs of Tendinosis?

Unfortunately, the answer here sucks because there may not be any! But there are in fact, risk factors and things we can look at both for the inactive an active population.

As with so many running injuries, once again doing too much ,too fast, too soon or overworking an area is a common cause of patellar tendonitis, achilles tendonitis, jumper’s knee, plantar fasciitis.

A few things Dr Nelson mentions to look at:

Muscle weaknesses
Overtraining
Poor footwear selection
Poor sleep, poor nutrition, all the things that are overtaxing the body

Running with Tendonitis

All right, great news we don’t need to rest completely, but what does that mean for our training?

It actually means that we might need to train with a little bit of pain. This is the part that throws a lot of us off because assume that all pain means stop, but with tendon recovery we are likely going to be slowly increasing the load it can tolerate and that may mean discomfort.

On a pain scale of 1-10, we want to make sure sessions aren’t pushing us past the occasional 3, possibly 4. If the pain is higher, then we need to back things down a bit.

And it’s not just about being able to get in your run, you absolutely must train the load under weights. This is more than some mini band exercises or mobility work, we need to work on an actual strength training program.

Running with tendonitis

Why Strength Training is Key For Tendonitis Recovery

One of the reasons that Coach Amanda Brooks was so interested in working with Dr Nelson is his focus on strength.

“But really for tendon pain and tendinopathy, working towards heavier strength training is part of the process and a key part of the process, because it is really those heavier loads that not only help the muscle adapt, because as I talked about, there are weakness to the surrounding musculature, but also the tendon itself. And it’s shown in the research that higher loads with strength training and during those exercises produce more adaptive and healing effects to the tendon.”

Here is a fantastic example of how this might look as discussed further in the podcast:

“we’ll just keep using runners as our example here, but if someone has Achilles teninopathy and they get to the point where they’re doing plyometrics and they get back to the return to run phase, that person may have two out of ten pain when they run a half a mile. And then they may have two out of ten pain when they run two miles.

And then they may have two out of ten pain when they run three miles. And then they may have two out of ten pain when they run five miles, whatever the distance is. But that can be frustrating because people look at that and they’re like, oh my gosh, I have not gotten any better.

Pain has not gone away. But in reality, they have improved quite a bit because their load tolerance, their capacity, they can do more with the same amount of pain…”

How Long Does Tendinitis Last?

First it’s important to know that this is something you can work through and not just live with forever. Also, I keep referring to it as tendinitis because that’s the term you’re used to, but remember tendinopathy is the more accurate description now.

The timeline isn’t going to be as speedy as many of us would like.

While we should be making consistent progress in begin able to tolerate more and more load (running and strength), it may still be 3- 6 months before we are doing all of these things completely pain free.

And for folks who have being doing the complete rest route for weeks on end…sorry it may be a longer journey. Because now we understand that that loss of strength is going to need to be rebuilt and then expanded upon.

A massive reminder as well, that if you get a cortisone shot, the rehab process doesn’t actually change. Your pain is reduced, but your body is not healed, so you still need to go through the gradual build up.

Who is Dr Nelson?

He graduated from the University of Illinois in Chicago in 2018 with Doctor of Physical Therapy degree, then he worked in the outpatient orthopedic clinic for five years, with a wide variety of populations of athletes, all individuals from young to old.

This all lead him to an interest in specializing in tendionpathy and starting his business Training with Tendinopathy. You can connect with him there for guidance on your recovery!

Was this discussion of running with tendonitis helpful? Are you enjoying the podcast?

We’re always always happy to hear about other topics or guests you’d like to see on the shoe!