At some point in their lives, nearly everyone will encounter tendonitis, that annoying and often debilitating condition of inflamed and damaged tendons. Frequent culprits are the rotator cuff in the shoulder, the forearm muscle tendons in the elbows, the patellar tendon in the knee and the Achilles heel in the ankles. Tendonitis (or more accurately, tendinopathy, as tendons are often not particularly inflamed, just structurally disrupted) can often linger for years, settling down periodically, and then returning with a vengeance when an activity aggravates it. Interestingly enough, inactivity can also bring on tendon damage, as the lack of physical stress (and often bad posture) can damage tendons through neglect and atrophy.
One thing is clear from the research, and that is that the best way to fix tendon issues is through exercise. Rest simply decreases pain over time, but unlike muscle, tendons don't fix themselves with the elapse of time. Treatments such as acupuncture, Active Release Technique, ultrasound, Shockwave therapy, and countless others are useful to some extent, but only when combined with a good exercise program. The treatment modalities improve the quality of the tissue, making exercise more effective.
Image showing the parallel fibre structure of tendons. When the structures tear, they get replaced by a jumbled mass of tissue, unless exercise is used to provide strain
Why does exercise work for fixing tendons? Because as living tissue, a tendon needs movement and strain to remodel itself into a functioning unit again. Without strain, fresh material for the tendon that is supplied by the blood stream and synovial fluid gets deposited into a dysfunctional heap, and over time forms useless scar tissue. Exercise remodels the new material into parallel lines of tissue that is similar to the original tendon material.
What kind of exercises program to follow? Each injury and tendon requires its own program, but the most important thing is finding the appropriate amount of loading. With too little loading, the tendon tissue will not respond appropriately. With too much loading, the excessive stress will further damage the tendon, making healing impossible. I can't really go into individual routines here, since each tendon requires different exercises, but if you have a recent tendon injury, or a long-standing, nagging issue that won't go away, email me at firstname.lastname@example.org and I can offer you some useful advice. Often, just 5 minutes of specific exercise a day will make a tremendous lasting impact on your injury!