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Avoiding Tendinopathies by Reallocating Stress

Written on April 16, 2009 at 6:10 am, by Eric Cressey

Avoiding Tendinopathies by Reallocating Stress

In a previous newsletter, I wrote about how people become symptomatic for some musculoskeletal problem because numerous issues have collectively brought them to the threshold where pain kicks in.  If you haven’t read it, definitely check it out now HERE.

Basically, the gist is that injury prevention and rehabilitation programs that only address single factors aren’t sufficient.  You shouldn’t fix a shoulder problem with just rotator cuff strengthening exercises and rest.  You can’t just get a massage and take some rest to get your lower back pain to go away.

In this newsletter, I highlighted how poor exercise technique – or even just faulty movement patterns in daily life – is something that can push someone to threshold.  It’s one of the reasons why we go to such great lengths on our Building the Efficient Athlete DVD set to outline common technique mistakes and how to correct them with over 30 common resistance-training exercises.


One quick example of how this can push an athlete over the symptom threshold (or pull that athlete back under it) is kinesiotaping.  In the past two years – and particularly at the Beijing Olympics – this modality spread rapidly in the world of athletics, treating everything from the ankles up to the shoulders.


While the creators of this tape assert that it has effects on the lymphatic and circulatory systems, it’s my impression that the most marked changes occur with respect to the reallocation of stress on particular tissues.  I’ve perused all their reading materials, and nowhere do I see any claims that it reduces inflammation.

Here, then, we get support for the new (and correct) era of thinking that tendinitis is very uncommon.  The -itis ending indicates an inflammatory condition, and if that was the case, some anti-inflammatories would quickly and easily take care of the overuse pain folks so commonly feel in the athletic world.  Anyone who has struggled with an achilles, patellar, or supraspinatus tendinopathy will tell you that it really isn’t that simple, so what gives?

The truth is that most folks are dealing with a tendinosis.  The -osis ending tells us that we’re dealing with a degenerative – not inflammatory – problem.  Essentially, tissue loading exceeds tissue tolerance – and that means that we need to find a way to reallocate stress to ease the burden on that tissue both acutely (kinesiotaping) and chronically (appropriate movement patterns).

The difference between tendinitis and tendinosis has been highlighted at-length in the research world.  Unfortunately, the correct terminology has been slow to catch on both in the medical community and lay population.  As a result, many individuals underestimate the chronic nature of these problems.

In the photo above, a tape-job might help at the shoulder acutely by posteriorly tilting the scapula or altering the degree of humeral rotation to allow for safe overhead movements (less mechanical impingement of the rotator cuff on the undersurface of the acromion process of the scapula).  Long-term, though, an athlete with this type of shoulder problem would need to work on scapular stability, glenohumeral range-of-motion, rotator cuff strength, and thoracic spine range-of-motion.  And, of course, he’d need to ingrain these appropriate movement patterns with a resistance training program with perfect form.

Oh, and speaking of tendinopathies, it is only somewhat coincidental that I’m publishing this newsletter today: the day of the Boston Marathon.  Thousands and thousands of runners who are at the brink of threshold are going to be piling 26.2 miles of volume on top of their glaring dysfunctions.  I’m headed out to watch the best reality TV show in the world: the hip replacement docs in Boston are going to be busy for the rest of the week!

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5 Responses to “Avoiding Tendinopathies by Reallocating Stress”

  1. Dave Farrell Says:

    Hi Eric,

    I bought your book Maximum Strength, and have loved it. I was well into phase three when I was stopped in my tracks by forearm/wrist tendonitis (tendonosis?). I’ve had this issue in the past, and can’t seem to prevent it from happening whenever I train seriously. Any suggestions?

    Dave Farrell
    Louisville, Colorado

  2. Gene Zeitler Says:

    Hi Eric,

    As a Kinesio Taping provider I can say that KT does claim to reduce inflammation b/c the taping has a lifting quality on the skin. This decreases the pressure under the skin allowing the tape to direct exudate to lymph nodes. I have to say that I was skeptical until I put the tape on some pts and where I applied the tape the bruising was either gone or decreased. Also placing the tape over inflamed bursas has been effective. I have had good response with the tape so I have to believe that it is more than just placebo. Some of my athletes won’t leave the office until I put it on.

    With regards to the tendonitis/tendonosis/tendonopathy discussion it appears that inflammation may occur in the first 7 to 10 days, but from there it is degeneration, pitting and disease that occurs in the tendon. Often there is an accumulation of GAGs. For these injuries ART, SASTM, and Graston work well to breakdown abnormal tissue growth and help remodel the tissue. Ultimately, however, correcting muscle imbalances, and improving biomechanics is vital to prevent recurrence. In some athletes, however, it is very difficult b/c of the volume of training preventing complete muscular balance. Also, in several cases the exercises aren’t always effective in alleviating the injury b/c they don’t necessarily completely breakdown the damaged tissue and stimulate fibroblasts and collagen fibers to be layed down in an appropriate direction. This is where the manual therapy techniques become usefull (ART, SASTM, Graston etc…). Ultimately, a combination of education, manual therapy and exercise is the only way to completely rehabilitate a patient and prevent recurrence.

    By the way, I really enjoyed your book about unstable surface training (this has definately influenced the design of my rehab programs) and The Art of Deload.

    Thanks for your forum!


  3. Bob Parr Says:

    Hi Eric (and congrats, again!),

    I realize this doesn’t qualify as Kinesio Taping, but what do you make of the idea of using athletic tape down one’s back to reinforce good posture? I first read about this in a T-nation article by TC a few years back, and have since come across it again in other articles about postural corrections.

    Good or bad idea, in your estimation?


  4. Mike T Nelson Says:

    Hi there EC.

    You stated, “my impression that the most marked changes occur with respect to the reallocation of stress on particular tissues”

    I assume (you know what happens you assume) that this is from changing the input, probably from the skin tension created by the tape, to the brain to alter the motor pattern. I don’t think you can ever really tape a normal muscle in any new position.

    I have used KT for the former and it can work quite well, but be sure to test it as everything as you would normally.
    Rock on
    Mike N

  5. Justin Brantley Says:

    I recently broke my collarbone cycling. I was about to start the Peak phase of Maximum Strength and have worked hard and got some great gains in all lifts. Is there any suggestions or past articles I can read on training around this injury especialy in the firts 3-4 weeks. I don’t want to lose what I just worked so hard for!

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