When should exercise be initiated in the treatment of tendinitis?

From the Guidelines

Exercise for tendinitis should begin after the acute inflammatory phase has subsided, typically 2-3 days after injury when pain and swelling have decreased. This approach is supported by the American Family Physician journal, which suggests that relative rest and reduced activity prevent further damage and promote healing and pain relief 1. The duration of rest is not clearly defined, but most physicians allow patients to continue activities that do not worsen pain 1.

Key Considerations for Exercise

• Start with gentle, pain-free range of motion exercises, gradually progressing to light resistance training over 1-2 weeks
• Initially, perform exercises daily for 5-10 minutes, increasing to 15-20 minutes as tolerated
• Begin with isometric exercises (contracting muscles without movement) before advancing to eccentric exercises (lengthening the tendon under tension), which are particularly effective for tendon healing 1
• Always stay below pain threshold—mild discomfort is acceptable, but sharp pain indicates you should reduce intensity

Additional Recommendations

• Apply ice for 15-20 minutes after exercise to manage inflammation, as cryotherapy provides acute relief of tendinopathy pain 1
• Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for short-term pain relief, but have no effect on long-term outcomes 1

Importance of Early Exercise

Early, appropriate exercise promotes proper collagen alignment during healing, increases blood flow to the affected area, and prevents muscle atrophy, ultimately leading to faster recovery and reduced risk of recurrence. If pain persists or worsens with gentle exercise, consult a healthcare provider before continuing.

From the Research

Timing of Exercise in Tendinitis Treatment

• The optimal timing for starting exercise in the treatment of tendinitis is not explicitly stated in the provided studies, but it can be inferred that exercise should be started as soon as possible, as part of a nonoperative therapy approach 2, 3.
• Eccentric exercises are considered the mainstay of treatment for patellar tendinopathy and should be started early in the treatment process 2, 3.
• A study on patellar tendinopathy patients treated with platelet-rich plasma injection combined with a physical therapy program showed promising results, with exercises started after the injection 4.
• The intensity and difficulty of exercises should be gradually increased to improve the load capacity of the affected tendon 4.

Factors Influencing Exercise Timing

• The severity of tendinopathy may influence the timing of exercise, with more severe cases potentially requiring a more gradual introduction to exercise 5.
• The type of tendinopathy, such as gluteal tendinopathy, may also require a stage-adjusted treatment approach, with exercise being introduced at different stages of treatment 5.
• The combination of exercise with other treatments, such as platelet-rich plasma injections or physical therapy, may also impact the timing of exercise 6, 4.

Key Considerations

• There is no consensus on the optimal method of treatment for tendinitis, and the timing of exercise may vary depending on the specific condition and treatment approach 2, 6.
• Further research is needed to determine the most effective treatment strategies for tendinitis, including the optimal timing of exercise 6, 3.