How to Prevent Tendonitis
Written by: Dr. Justin Kirk
Training-related injuries are common, but not unavoidable. If you’ve been training long enough, you have likely experienced aches and pains associated with working out. Tendonitis is one of the most common training injuries people experience, but just because injuries are common doesn’t mean you have to accept them as a part of training. Here’s what you need to know about tendonitis, how to prevent it using Angles90 grips, and what to do if you experience it.
Why Tendonitis Is So Common
Tendons are the thick, strong ropes that connect your muscles to the bone. Biomechanically, tendons are built to be efficient at transferring force from your muscles to your bones to move your joints. Tendonitis is an overuse injury of the tendon - so active people are inherently more likely to develop it. To put it another way, you don’t develop tendonitis from relaxing on the couch.
Lifting and training introduce microtrauma to your muscles and tendons. If your body recovers from the microtrauma and repairs the muscle/tendon tissue, you gain muscle size and strength. That’s the goal, right? But if your body doesn’t respond and recover from the microtrauma, you may find yourself wrestling with tendonitis.
The 2 Main Causes of Tendonitis
The two main causes of tendonitis—repetitive overuse and/or excessive overload—are both related to unsuccessful recovery from the otherwise normal microtrauma from muscle use.
Repetitive overuse refers to the repetitive process of performing the same motions without variety over and over until the muscle/tendon can’t repair itself in time to keep up. Risk for overuse injury also goes up exponentially if you're working in awkward positions.
Excessive overload refers to forcefully exerting a muscle/tendon past what it is capable of. Both repetitive overuse and excessive overload cause more muscular microtrauma than you would experience during daily life, or even with normal training volumes.
Your body might be able to recover from a certain amount of overexertion or overuse (especially if you optimize all aspects of your recovery), and some competitive athletes even use “overreaching” as a way to break plateaus and set high-level PRs.
Even though this is an elite-level strategy, it’s simply not sustainable because it leads to nagging pains or injuries like tendonitis if you do it for too long. That's one reason why the top lifting coaches program de-loads for their athletes. At the end of the day, both primary causes of tendonitis come down to the same thing - the body wasn’t able to complete the 3 steps of the inflammatory healing process after the stimulus of training. The 3 steps are: inflammation of the tissue, proliferation of new cells, and remodeling the repair
The body uses the inflammatory process as its innate healing mechanism to recover from training. Believe it or not, training stimulates inflammation. Before you get too worried, inflammation from training is a natural, internal response that is normal and actually good for the first few daysfollowing the stimulus/stress that triggered the process.
When the body fails to complete the inflammatory process, healing is delayed, which leaves dead cells, cellular debris, inflammatory markers, swelling, and unrepaired tissue where our normal muscle and tendon cells should be. If healing is delayed for too long, tendinosis (tendon narrowing) might develop - which is something you definitely want to avoid.
How to Use Angles90 Grips to Prevent Tendonitis
An ounce of prevention is worth a pound of cure. So since we know why tendonitis develops, let's put it into practice to train smarter, not harder.This is where using moveable grips like Angles90 grips are a natural fit to fix the root cause of repetitive overuse or excessive overload.
Training with grips that allow variations in movement, grip, and position reduces the risk of your joints getting force-fed the repetitive motions that predispose you for tendonitis. When you vary the angles in your workouts with varying grips, you allow the body to accumulate stress evenly, as opposed to excessively loading the same motion over and over.
Since the Angles90 grips attach to all major machines, bars, handles, cables, and more, the number of setups are almost limitless. The ergonomic handle also fits the shape of your hand to optimize grip function without excessive stress on the wrist and elbow. Optimal handle shape and better grip prevents awkward positioning when exercising. The grips also allow for slight rotation while lifting, which allows your body to move with more freedom compared to the locked-in position of most immoveable bars and handles. More freedom of motion reduces unnecessary friction and stress.
So what happens if you suspect you have tendonitis? Here’s what you should do next.
Quick Action Steps on How to Deal with Tendonitis
The faster you can get evaluated by a medical professional, the faster you can get out of pain and begin the healing process. Don’t delay seeking treatment if you are in pain or suspect injury because you may develop complications (i.e. muscle atrophy, tendinosis, etc.) if the pain is severe and doesn’t settle within 2-3 days post-workout, listen to your body and get it checked out. If the pain is not severe and settles within 2-3 days, modifying the aggravating exercise can allow you to continue training.
My goal when rehabbing athletes is always to keep them in the gym, training around the injury. Afterall, what you do in the gym should make you better outside of the gym if done correctly - not worse! But, if you can’t find an exercise modification that significantly reduces or eliminates the pain, remove that exercise. The goal is to minimize the amount of time spent training with an injury (or around the injury), not to continue to push through the pain.
The traditional model for tendonitis involves icing the injury, but personally, I tend to not use ice on most injuries because it’s a known vasoconstrictor. Vasoconstrictors reduce the diameter of your blood vessels, which in turn limits blood flow and leaves the area congested. Blood flow is what brings healing mediators, white blood cells, and nutrients to the injured site. However, if ice feels good to you, it’s fine for pain management.
As you go throughout your workout, play with the angles and variations to see if you can find a modification that is less painful. Pay attention to when you feel the pain set in. If you know your technique, flexibility, strength, or joint stability are contributing to the issue, take this time to address your weak link. Then once you’ve fixed the underlying issue, gradually re-load the previously painful tissue to re-strengthen it.
How to Program Your Training to Reduce Risk for Tendonitis
From an exercise physiology perspective, the way I like to write training programs to reduce the risk for tendonitis is using alternating training blocks. Training blocks run 4-6 weeks with the goal of gradual progression towards the block goal. This method allows you to develop strength and lift proficiency, but without running the same program until you fall apart.
To set up a training block, select the exercises you want to work on for4-6 weeks, set the plan for how you plan to progress the exercises, gradually progress one metric (i.e. reps, sets, or weight) of your training each week, de-load after week 6 is over, and then change variations of the selected exercises for the next 4-6 weeks. You can and should still train the movement patterns you’re working on progressing when you change training blocks.
An example for deadlifts would be rotating between lifting from the floor, RDLs, neutral grip deadlift (you can use a trap bar or Angles90 grips), pause deadlifts, dynamic effort deadlift with bands, rack pulls, etc. If you have questions about programming, feel free to reach out and I’d love to help you.
About the author:
Dr. Justin Kirk, PT, DPT is a Physical Therapist in the USA. He has a Bachelor’s degree in Exercise Science and a Doctorate degree in Physical Therapy from The University of Alabama at Birmingham. Justin is passionate about treating athletes of all levels from weekend warriors to collegiate athletes. He writes and shares content on injury prevention, training smarter, running, and athletics on Instagram @theliftingPT.