Using Pain with Load as a Guide for Tendinopathy
Hey everyone, Dr. E here.
Let's get one thing straight. If you're still telling your patients with tendinopathy to rest, ice, and stretch, you're not just behind the times—you're actively holding them back. The evidence has been screaming at us for years that tendons don't get better with rest; they get better, stronger, and more resilient with the right stress.
The old RICE protocol is dead. It's time to stop being "pain police" and start acting like expert load managers who understand that hurt doesn't equal harm. To help you make that shift immediately, I've distilled the latest clinical commentary from JOSPT into a simple, no-BS playbook. This infographic gives you the modern framework to confidently load tendons, educate your patients, and get them back to performing.
Check it out below.
STILL PRESCRIBING REST FOR TENDONS?
THAT'S OLD SCHOOL.
The evidence is clear: LOAD is the medicine. It's time to kill the outdated RICE protocol and become an expert load manager. Here's your playbook.
The Paradigm Shift
THE OLD WAY
- - Fear of Pain
- - Prolonged Rest & Offloading
- - Passive Modalities
- - Gentle, Low-Load Exercise
THE EVIDENCE-BASED WAY
- ✓ Pain as a Guide
- ✓ Strategic, Therapeutic Loading
- ✓ Building Tendon Capacity
- ✓ Active Patient Education
The Modern PT's Clinical Playbook
PLAY #1: USE PAIN AS YOUR GUIDE
Teach your patient that "hurt doesn't equal harm." Pain is an acceptable, often necessary, part of adaptation. Use a simple traffic light system to empower them.
0-3/10 VAS: GO ZONE. This is the sweet spot for therapeutic loading.
4-5/10 VAS: CAUTION ZONE. Acceptable, but monitor closely. Don't push further.
6+/10 VAS: STOP ZONE. The load is too high. Modify the exercise immediately.
THE GOLDEN RULE: Pain must settle within 24 hours and not worsen day-to-day.
PLAY #2: MASTER THE LOADING CONTINUUM
Tendon rehab is a progression, not a single exercise. Move your patient along the continuum based on their tolerance and goals.
1. ISOMETRICS
For analgesia & initial loading.
2. HEAVY-SLOW RESISTANCE
To build strength & tendon capacity.
3. ENERGY STORAGE
Re-introduce plyometrics for sport.
Learn my full Eval, Reset, and Stabilize system and how to easily assess and treat most conditions from head to toe!
