Why tendons don't need (lots of) rest

We see lots of tendon injuries here at the clinic. These include tendon problems such as achilles, patella, and gluteal tendinopathies, as well as tennis elbow and plantar fasciitis (plantar fasciitis is not technically a tendon injury but the principles of treatment are the same).

Often a patient will come in for a second opinion, being understandably frustrated at being told to rest for several months as a way of 'healing' their tendon problem and removing their pain.  Unfortunately we know that prolonged rest (beyond several weeks) for tendons is unhelpful and in many cases detrimental.

The following table is one of my favourite ever for tendons. It's from the NFL and looking at achilles rupture rates. The top part of the table shows the achilles injuries in a 'typical' season with 3-4 weeks of off season. There were roughly 5 achilles ruptures per year.

The bottom half of the table shows what happened when the players had a force 5 month off season due to a pay dispute. Disaster! TWELVE achilles ruptures in the space of one month once games started up again.  Although this observational study doesn't prove it, it displays a concerning trend that long periods of rest really don't help.  Other research shows that the ability of the tendon to cope with 'work' (e.g. running, jumping) is dramatically reduced with long period of rest.

                        reference: http://www.jospt.org/doi/pdf/10.2519/jospt.2011.0107

                       reference: http://www.jospt.org/doi/pdf/10.2519/jospt.2011.0107

So while 'not resting' doesn't always mean continue running, jumping or playing tennis as normal, it also doesn't mean to put your feet up on the couch for 3 months either! Our physiotherapists have experience in how to grade rehabilitation for all of your common and uncommon tendon injuries!


Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare in Boronia. He has a particular interest in Sports Medicine conditions, especially hip, groin and tendon pathologies.  The clinic serves the local area including Bayswater, Ringwood East and Ferntree Gully with Sports Physiotherapy Services