Did I heal my tendonitis?
Learn the science and practice of healing tendonitis, and see if it worked for me
There were times I feared door knobs. Every handshake made me wince. Tendonitis - more specifically epicondylitis in my case - sucks. It makes everything painful, much worse - it makes everything feel dangerous.
But now I’m better. I can do pull ups with an extra 55 kilograms attached at my waist. And tomorrow, I want to try my first one arm pull up on my injured side. I’ll post a video at the end, and let you know how it went.
As a movement professional, knowing simple protocols for treating common injuries is one of the best ways to help people.
This article shares science, practical advice and my personal story on how to heal tendonitis.
How I got my tendonitis
I used to do a lot of hard swings. It feels amazing to swing big, because you’re barely affected by gravity. It’s like swimming in a different kind of physics. Looking back, I see that I wasn’t strong enough for the amount of force that I could handle. In the end, I had to stop swinging because my elbows became so painful. I felt that if I became stronger, the pain would go away or become more manageable. But every time I would get on the bar to do pull ups, my elbow would scream. It sucked!
How I lost my tendonitis
It must be about two years ago now. I had had enough. I was so absolutely bored of the cycle. I’d read Jake Tuura’s Jumper’s Knee Protocol a while back. It’s a series of rehab phases beginning with low intensity isometric holds. Things like wall squats and glute bridges. It worked well on my knee injury; I knew it had some key ingredients. I flipped the exercises upside down and designed pull up and push up isometrics to target my elbow. It took me about a month of doing it almost everyday, sometimes twice per day - but then it was gone. And I could load my tendon again. And it’s been basically fine ever since! Cool, huh? And there’s thousands of cases just like this: People recovering from long term and even career-ending tendon injuries in a matter of weeks.
Four prescriptions for healing tendonitis
1) To fully recover, avoid impact for 24-48 hours after heavy training. Light isometrics and later on strength training can be done as they are not significant stressors to the tendon.
2) Make the tendon healthier with 30 second isometric holds. Perform four times with 90-120 second rests in between.
3) Do the isometrics 1-2 times daily. Tendons stop adapting after ten minutes and continue adapting after 6-8 hours, so you can do these frequently.
4) Take 15-20 grams of collagen peptides in your morning coffee or tea. Take daily // with Vitamin C an hour before strain to improve collagen synthesis and recovery.
A more detailed look at tendonitis rehabilitation
Tendons are like tiny ropes stuck together with glue. Those ropes are mostly made out of tough collagen, and the glue is made out of squidgy proteoglycans. Both the ropes and glue help distribute stress in different ways; with collagen distributing force lengthways between bone and muscle, and proteoglycans distributing force laterally, like brake fluid.
Overuse injuries cause the internal structure of tendons to change and become disordered; limiting capacity to transmit force. As a result, ranges of motion that correspond with disordered tissue become inhibited, and are therefore difficult to load. The revolution in tendon rehab is that long duration isometric holds give the disordered tissue an opportunity to be loaded and to reorganise.
When you hold an isometric of sufficient intensity for 30+ seconds, healthy tendon tissue starts to relax under the relatively low load. This gives the inhibited tendon a chance in the sun. Tension is passed down the chain, towards the injured tissue. Upon receiving that information, cells in the inhibited tendon are stimulated and begin producing more collagen and proteoglycans. Speculatively, this new tissue is built according to the trail map of ions left by the strain of the isometric holds1; like a dog following a scent.
This tissue producing cell response shuts off after about ten minutes. That means after ten minutes of stimulating exercise, your tendons are not adapting anymore. The shop is closed, for about 6-8 hours. This is actually good news, if you want to recover quickly. Because these long duration isometrics are generally not intense enough to be fatiguing, you can do up to two rehabilitation sessions per day; each lasting around ten minutes.
One arm pull up test
Somewhat successful! No pain. At all. I didn’t get beyond 90°, but with better coordination, I think I could. I do weighted pull ups twice per week, and that gives me the strength, but the coordination is specific to the movement; and obviously needs work! My right side felt good - and I got a decent one and a half repetitions in. Again, improved coordination would make the movement more efficient.
You’ll also see my weighted pull up training and heavy bicep curls. These are staples in my training. Patiently loading these movements over the last two years has supported my tendons by teaching me to distribute stress around multiple structures. It’s also made my arms chunkier, which is fun.
I’m still fairly conservative around my elbow; favouring lower volumes of work, but I’m so glad to be out of the woods of tendonitis (epicondylitis…). I’m proud of myself for putting the work in and getting over a major source of discomfort and frustration. I’m happy to get back to doing things I love - when the opportunity arises:
Recommended resources
1) Tim Ferriss x Dr. Keith Baar — Simple Exercises That Can Repair Tendons
Bioelectrical controls of morphogenesis: from ancient mechanisms of cell coordination to biomedical opportunities, Michael Levin
I’ve had a small tear in my quadriceps tendon for 7 years now. Not the patellar tendon, which is the primary problem in jumper’s knee. Do you have any thoughts on how the jumper’s knee protocol can be adapted to heal the quad tendon? Many thanks!
Thank you so much for this