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1) Do not rest completely - While rest can sometimes help pain settle in the short term it will do nothing to help the tendon to repair, as soon as you start moving again the pain will return.
2) Stay away from passive treatments - Passive treatments such as massage, ultrasound and shockwave therapy can have short term affects they are not very affective in the the long term and can even damage the tissue. Exercise is the best way to help treat tendinopathy.
3) Tendinopathy is commonly an overuse injury - Tendinopathy can be caused by many different factors but the main cause is an increase in activity level causing to much load on the tendon. When increasing activity such as the frequency and time of things like fitness sessions or runs, this should be done gradually to allow the tendon to adapt.
4) Exercise is the most effective evidence based treatment for tendinopathy – tendons need to be gradually overloaded so that they can develop greater tolerance to the loads of day-to-day life and sport. Therapists are trained in the best ways in how to safely prescribed exercise and increase load.
5) Avoid injections - There is good evidence showing that injecting substances into your tendon has no long term effects.
6) Do not ignore your pain - A small amount of light Pain is ok when performing your injury rehab, we want to just touch in to that point of discomfort but not massive amounts of pain. Pain in our tendon can mean we are putting too much load through it so don't try and run through this as the pain will not subside and you will end up damaging the tissue.
7) Do not be worried about images or risk of rupture - Most tendinopathies can be treated by a good exercise programme so don't be scared by language such as degeneration and tears. Your pain is a protective mechanism to tell you unload the tendon. Most ruptures actually occur without any pain so having a tendinopathy doesn't mean you are going to rupture the ligament.
8) Avoid stretching - Stretching can put more load on a tendon which can be detrimental and worsen the injury.
9) Be patient - Tendons responds very slowly to exercise. It can take 3 months or even more for your tendon to return to normal but be patient, stick to your rehab programme and avoid taking easy short cuts and you will soon start feeling results.
Please note that these are general principles and there are instances when adjuncts, including injections and surgery are very appropriate in the management of tendinopathy but only as a last resort.
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