Understanding Tendon Pain and Load Tolerance
A patient said to me recently:
“Grace, I don’t understand. I’ve been doing everything the same. I haven’t increased my training or changed my equipment. This pain just started one day. I thought it would go away, but it hasn’t.”
This is actually a very common experience with tendon pain.
Many people expect tendon injuries to occur because of one obvious event:
a sudden increase in training
a new shoe
one “bad movement”
one injury
But tendon-related pain often develops more gradually and can appear even when someone feels like nothing has changed.
In reality, tendons respond not only to what we do today, but also to the cumulative effects of loading, recovery, stress, endurance, tissue capacity, and overall life demands over time.
Sometimes the body has been adapting quietly for weeks or months before symptoms finally become noticeable.
What Is Tendinopathy?
Tendon pain is often described clinically as tendinopathy.
Tendinopathy refers to changes involving:
tendon loading tolerance
tissue adaptation
tendon structure and mechanical properties
sensitivity and irritability of the tendon over time
This does not necessarily mean the tendon is “torn” or permanently damaged.
In many cases, tendons become less tolerant to the amount or type of load being placed on them.
This may affect the tendon’s ability to efficiently store and release force during movement.
What Do Tendons Actually Do?
Tendons connect muscle to bone and help transfer force during movement.
They also function somewhat like springs, storing and releasing elastic energy during activities such as:
running
jumping
lifting
climbing stairs
gripping
reaching
playing an instrument
Healthy tendons generally adapt well to physical loading when stress and recovery remain balanced over time.
Problems may develop when the demands placed on the tendon exceed what it is currently prepared to tolerate.
Why Tendon Pain Often Develops Gradually
Many people expect tendon pain to appear suddenly after a specific injury.
However, tendon-related symptoms more commonly develop gradually during periods of:
repetitive loading
cumulative training stress
reduced recovery
poor sleep or increased stress
repetitive occupational or performance demands
changes in movement efficiency or endurance
For example:
runners may develop Achilles or patellar tendon pain while preparing for events such as the BMO Vancouver Marathon or the Vancouver Sun Run
musicians may notice increasing forearm or shoulder discomfort during periods of intensive rehearsal
desk workers may develop elbow or wrist symptoms during prolonged repetitive computer work
active adults may notice shoulder tendon irritation after gradually increasing gym activity
Often, symptoms appear when cumulative loading quietly exceeds current tissue tolerance.
Tendon Properties and the Length-Tension Relationship
Muscles and tendons work together to generate force efficiently across different ranges of movement.
There are certain positions where tissues are able to produce force more effectively and tolerate load more comfortably. This relationship is often described through concepts such as the length-tension relationship.
When muscles or tendons are repeatedly loaded in positions where:
force demands are very high
endurance capacity is limited
tissues are under prolonged tension
recovery is insufficient
symptoms may gradually develop over time.
This is one reason why repetitive postures, sustained gripping, running hills, overhead lifting, or prolonged instrument playing may contribute to tendon irritation in some individuals.
What Is Eccentric Loading?
Tendons are also heavily involved during eccentric loading.
Eccentric loading occurs when a muscle is generating force while lengthening, such as:
lowering down stairs
decelerating during running
lowering a weight at the gym
landing from a jump
controlling movement during repetitive activity
These types of loading patterns place important demands on tendon capacity.
Appropriately prescribed eccentric and progressive loading exercises are often used in rehabilitation to help improve tendon strength, load tolerance, and overall tissue resilience.
However, the goal is usually not simply “doing eccentric exercises,” but finding the appropriate type and amount of loading based on the individual and stage of irritability.
Common Signs of Tendon Pain
Tendon-related symptoms may include:
pain during or after activity
stiffness, particularly in the morning
discomfort with repetitive movement
pain that “warms up” during activity but returns afterward
sensitivity with gripping, lifting, running, or jumping
recurring flare-ups during increases in activity
Symptoms may fluctuate depending on:
activity levels
recovery
sleep and stress
pacing and workload demands
Why Complete Rest Does Not Always Help
When tendon pain develops, many people initially stop activity completely.
While short-term reduction in aggravating activity may sometimes help calm symptoms, tendons generally respond best to gradual and appropriate loading over time.
Too little loading may contribute to:
reduced tendon capacity
decreased strength and endurance
reduced tolerance when activity resumes
This is why symptoms often return quickly when someone suddenly goes back to full activity after prolonged rest.
For many tendon conditions, rehabilitation focuses on progressively rebuilding load tolerance rather than simply avoiding movement altogether.
What Physiotherapy May Focus On
Assessment and rehabilitation may involve:
identifying contributing loading and movement factors
assessing strength, endurance, and movement capacity
improving tolerance to repetitive activity
developing gradual return-to-activity strategies
pacing training, work, or performance demands more effectively
Treatment may also incorporate:
progressive exercise-based rehabilitation
eccentric and tendon-loading strategies where appropriate
movement retraining
education around load management and recovery
manual therapy
intramuscular stimulation (IMS) where clinically appropriate
These approaches are integrated when clinically appropriate as part of an individualized rehabilitation plan.
Tendon Pain and Long-Term Movement Confidence
For many people, recovery is not only about reducing pain.
It is also about:
returning to meaningful activity
maintaining sport and exercise participation
supporting work and repetitive demands
reducing recurrence risk
improving confidence with movement and loading
With appropriate rehabilitation and gradual progression, many people are able to improve tendon capacity and return successfully to activity.
Practical Strategies That May Help
For many individuals, symptoms improve with:
gradual progression of activity
avoiding sudden spikes in workload or training
improving recovery and sleep habits
balancing repetitive demands more effectively
building strength and endurance progressively
pacing activity during flare-ups rather than stopping completely
Small consistent changes over time are often more effective than searching for a single quick fix.
Related Articles
Learn more:
Related Conditions
This topic commonly relates to:
gluteal tendinopathy
Achilles tendon pain
patellar tendon pain
repetitive strain injuries
running-related overuse injuries
musician and performance-related injuries
What To Do Next
If tendon pain is persistent, recurring, or affecting work, exercise, sport, music, or everyday activity, a structured assessment can help identify contributing factors and guide rehabilitation strategies.
