Tendon Pain and Strength Training: Why Rest Isn’t Always the Answer
Ground to Overhead Physical Therapy | Durham, Cary & Chapel Hill, NC
If you’re a CrossFit athlete dealing with knee pain during squats, a runner experiencing Achilles discomfort, or a weightlifter struggling with persistent tendon pain, you’ve probably been told to rest until the pain disappears.
But what does the research actually say?
For many cases of tendinopathy, appropriately dosed resistance training—not complete rest—is a key component of recovery.
What Does the Research Show?
A 2023 systematic review published in the British Journal of Sports Medicine analyzed 110 studies involving 3,953 participants with various tendon conditions.
Researchers found that rehabilitation programs incorporating external resistance, such as dumbbells, barbells, or machines, generally produced better outcomes than bodyweight-only programs.
Interestingly, programs allowing more recovery between loading sessions also tended to produce better results than very frequent training.
The takeaway? Progressive loading and adequate recovery are both important for tendon rehabilitation.
Heavy Slow Resistance vs. Eccentric Training
Eccentric exercises have traditionally been a cornerstone of tendon rehabilitation. However, they’re not the only effective approach.
A 2015 randomized controlled trial compared heavy slow resistance (HSR) with eccentric training in 58 individuals with chronic midportion Achilles tendinopathy.
After 12 weeks, both groups demonstrated significant improvements in pain and function, maintained at one year.
However, adherence differed:
Heavy slow resistance: 92%
Eccentric training: 78%
Neither approach produced superior clinical outcomes, suggesting that multiple loading strategies can be effective.
What Does This Mean for CrossFitters, Runners, and Weightlifters?
Reducing pain is important, but rehabilitation shouldn’t stop there.
Your tendon needs to tolerate the demands of your sport.
For example:
CrossFit athletes: Progress from controlled strengthening toward squats, jumping, and high-repetition movements.
Olympic weightlifters: Rebuild tolerance to heavy squatting, pulling, and explosive lifting.
Runners and triathletes: Develop strength before progressively restoring running volume, speed, and repetitive impact.
These progressions should be individualized rather than based on a universal timeline.
Should You Train Through Tendon Pain?
Some discomfort during rehabilitation may be acceptable, but that doesn’t mean ignoring symptoms.
Pain during activity, symptoms afterward, and next-day stiffness can help determine whether your current workload is appropriate.
A successful rehabilitation program generally progresses through:
Load management: Modify aggravating activities without unnecessarily eliminating exercise.
Progressive strengthening: Increase resistance as tolerated.
Dynamic loading: Reintroduce faster movements, plyometrics, or running when appropriate.
Return to performance: Build tolerance to the actual demands of training and competition.
The 2024 Achilles tendinopathy clinical practice guideline supports tendon-loading exercise as a first-line treatment for appropriate cases of midportion Achilles tendinopathy.
The Bottom Line
Tendons need appropriate loading to improve their capacity—not simply prolonged rest.
The goal of rehabilitation isn’t just reducing pain. It’s restoring the strength, capacity, and confidence needed to train consistently and perform at your best.
At Ground to Overhead Physical Therapy, we help CrossFit athletes, weightlifters, runners, and active individuals throughout Durham, Cary, Chapel Hill, and the surrounding Triangle area return to the activities they love.
Don’t just return to activity. Build the capacity to perform.
Peer-Reviewed References
Pavlova AV, et al. (2023). Effect of resistance exercise dose components for tendinopathy management: A systematic review with meta-analysis. British Journal of Sports Medicine.
DOI: 10.1136/bjsports-2022-105754
Beyer R, et al. (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. American Journal of Sports Medicine.
DOI: 10.1177/0363546515584760
Chimenti RL, et al. (2024). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision. Journal of Orthopaedic & Sports Physical Therapy.
DOI: 10.2519/jospt.2024.0302
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