This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Researchers analysed 110 studies exploring exercise treatment programmes for tendon pain and dysfunction (tendinopathy) of the Achilles, shoulder, elbow, knee and hip. They showed that:
- exercise using weights or a resistance band was more effective than using bodyweight alone
- having rest days was more effective than exercising every day.
The findings will help clinicians (particularly physiotherapists) prescribe exercise regimens for people with tendinopathy.
The issue: how much exercise is best for tendinopathy?
Tendons can become painful, stiff and swollen, and begin to deteriorate; this is called tendinopathy. The exact causes are debated but tendinopathy is not restricted to people who are athletic; the condition affects adults and children in the general population. It usually occurs in the back of the lower leg (Achilles), shoulder, elbow, knee or hip.
Research suggests that exercise is often recommended for most common tendinopathies, but it is unclear exactly how much exercise is most effective and there are no specific guidelines.
The intensity of exercise can be increased by pushing or pulling against a force, for example by using weights or resistance bands. So, using bodyweight alone, you can exercise a tendon in the lower leg (Achilles) by standing on your toes then lowering and raising your heels. Doing the same exercise while wearing a weighted backpack would increase the resistance intensity.
Exercise can also be carried out more frequently (more sessions per week) and at a higher volume (more repetitions per session). It is not known what intensity, frequency and volume of exercise is best for people with tendinopathy.
Researchers therefore analysed existing evidence.
What’s new?
The analysis included 110 studies (both randomised and non-randomised trials) from Europe, Australia and the US. Studies involved almost 4,000 people in all. They evaluated exercise regimens for tendinopathy in the Achilles, shoulder, elbow, knee and hip. Most interventions were delivered or prescribed by physiotherapists.
Researchers assessed how much exercise was needed to improve disability, function, pain, movement, and quality of life.
The team found that people with tendinopathy in the Achilles, shoulder, elbow, knee and hip improved more if they:
- used weights (dumbbells, loaded backpacks or resistance bands, for example) rather than bodyweight-only in resistance exercises
- took rest days between sessions (lower frequency).
The analysis found no consistent trends for exercise volume (the number of repetitions of each exercise per session). The findings were the same for Achilles, shoulder, elbow, knee and hip tendons.
Why is this important?
The findings inform physiotherapists about the frequency of exercise that is most effective for people with tendinopathy. The authors suggest that exercising less frequently than once a day might allow the tendons time to recover. This could explain why people who took rest days improved more than those who exercised every day.
The studies confirmed that higher intensity resistance exercise was more effective than bodyweight-only exercise. The most effective number of repetitions per session remains unclear.
The researchers note a lack of clear reporting in the studies included. They call for future research to follow guidelines to standardise reporting. They stress that this study considered the main exercise prescribed in the studies; other recommended exercise was not considered.
What’s next?
This study is part of a larger project examining the evidence on exercise therapy for tendinopathies. Its goal is to make recommendations for clinical practice and future research.
You may be interested to read
This is a summary of: Pavlova AV, and others. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. British Journal of Sports Medicine 2023; 57: 1327 – 1334.
A blog about the study.
Hospital trusts publish patient information leaflets about tendinopathy and its management: an example from University Hospitals Sussex.
More NIHR Evidence on tendinopathy
Funding: This study was funded by the NIHR Health Technology Assessment.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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