By: Ryan Bibeau, DPT, CSCS, CCPC
Tendon pain can sideline your lifts—and your progress. But what if the key to hitting your next PR wasn’t just muscles, mobility, or your recovery routine, but the strength and resilience of your tendons?
At FX Physical Therapy, we help athletes reclaim pain-free movement and build stronger, more resilient tissue through evidence-based rehab and performance strategies. Here’s what you need to know about tendon health—and what to do if your elbows, knees, or shoulders are holding you back.
What Are Tendons and Why Do They Hurt?
Tendons are the dense connective tissues that attach muscles to bone. They’re strong but not invincible. Unlike muscles, tendons don’t have a rich blood supply, which means they heal slowly and are prone to overuse injuries—especially when training volume spikes or movement mechanics break down.
Common signs of tendon dysfunction include:
- Pain during or after lifting (especially pressing or pulling)
- Stiffness in the morning or after rest
- A dull ache that worsens with repetitive movement
Top 3 Causes of Tendon Overload in Lifters
1. Too Much Too Soon
Tendons adapt to load gradually. If your training program suddenly increases in intensity, volume, or frequency (looking at you, New Year PR goals), you could overload the tendon faster than it can repair.
2. Not Enough Load
It’s not just about rest—tendons need load to stay healthy. Total rest may relieve pain in the short term, but it also makes tendons weaker over time, leaving them more vulnerable to reinjury.
3. Compressive Stress
Tendons don’t just respond to how much you load them, but how. Poor joint position during lifting (think elbow flare during bench press or excessive wrist extension during overhead lifts) can lead to friction and compression that irritates the tendon.
Understanding Tendinopathy: A Continuum, Not a Tear
Tendon injuries don’t happen overnight. They develop over time—often without any noticeable trauma. The Tendon Pathology Continuum, developed by Dr. Jill Cook, describes three stages:
- Reactive Tendinopathy – The tendon becomes painful and swollen from sudden overload.
- Tendon Dysrepair – Continued stress causes structural changes in the tendon.
- Degenerative Tendinopathy – Chronic overuse and poor load management lead to breakdown and long-term dysfunction.
The good news? Tendinopathy is reversible, especially when caught early and treated with progressive loading.
Why Rest Alone Won’t Solve Your Tendon Pain
Rest might make you feel better temporarily, but it doesn’t address the underlying issue: load tolerance. In fact, complete rest can weaken the tendon further, setting you up for a rebound injury when you return to training.
What you need instead is a structured plan that:
- Decreases pain and reactivity
- Reintroduces load gradually
- Targets tendon-specific adaptations
- Transitions back to sport-specific movement
The Solution: Load, Progression, and Targeted Exercise
Rehabbing a tendon takes more than stretching or foam rolling. At FX Physical Therapy, we use evidence-based protocols rooted in the latest sports science to help athletes restore tendon health and performance.
Your plan may include:
- Isometric loading to reduce pain and promote tendon healing
- Heavy slow resistance (HSR) training to rebuild capacity
- Tempo and range manipulation to challenge the tendon through different phases of movement
- Gradual return-to-lift progression tailored to your goals
This isn’t a one-size-fits-all program. It’s customized rehab designed to get you back to pressing, pulling, and performing at your peak—without pain.
Final Takeaway: Don’t Ignore Tendon Pain
Tendon pain is your body asking for help—not for rest, but for smart intervention.
If you’re a lifter struggling with nagging elbow, shoulder, or knee pain, don’t settle for endless ice and Advil. Get evaluated by a physical therapist who understands strength athletes—and knows how to get you back under the bar.
Ready to lift pain-free?
Book an evaluation with FX Physical Therapy today.
Let’s build stronger tendons—and even stronger lifts.
Resources:📖 FXPT Tendon Workshop Slides
