Struggling With a Tendinopathy That Just Won’t Heal?

By Nicole Lynch, NLtherapies at The Osteopathic Care Clinic, Douglas

BSc Ost Med, DO Osteopath

Are you stuck in the rest–ice–repeat cycle? Do your symptoms ease with a few weeks’ rest, only to flare again as soon as you return to training? You’re not alone—and there is a better way forward.

What Actually Causes Tendinopathy?

Tendinopathy (previously known as tendonitis) develops when a tendon is overloaded too quickly. The sudden spike in stress causes the tendon’s collagen fibres to become disorganised, reducing its ability to absorb and distribute load. This leads to pain, stiffness, and reduced performance.

Why Rest Alone Doesn’t Work

Unlike muscles or skin, tendons don’t heal well with rest.If you’ve rested for weeks, felt better, and then flared again the moment you resumed activity—this is the classic tendinopathy cycle.

Tendons dislike prolonged rest.They need controlled LOAD to recover.

Stretching: Why It Can Make Things Worse

Most irritated tendons become even more aggravated when stretched. Stretching can compress the tendon against bone, which healthy tendons tolerate—but unhappy tendons do not.Early stretching can slow healing, increase irritation, and delay your return to sport or training.

What About Ice?

Many people still rely on the old RICE method (Rest, Ice, Compression, Elevation). But even Dr. Mirkin, who created the RICE protocol in 1962, reversed his recommendation in 2015.

Ice can give short-term pain relief, but when combined with rest alone it does not promote long-term tendon healing.Movement and progressive loading are what truly drive recovery.

The Power of Isometrics for Tendon Pain

Isometrics—holding a muscle contraction without moving the joint—are one of the most effective early-stage treatments.

They apply controlled load to the tendon without stretching it, helping reduce pain and improve strength.

A common protocol is:

• 4–6 sets

• 30–45 second holds

• At about 70% of your maximum effort

Research shows this can reduce pain by up to 87% for around 45 minutes, making it ideal before training or as part of your daily routine.

Pain During Rehab: What’s Normal?

Some pain is expected.A 4–5/10 pain during prescribed exercises that settles within 24 hours is considered safe and tolerable.

If pain spikes or lingers, it’s a sign to adjust load, frequency, or volume.Just like medication, exercise needs the correct dosage.

Healing Takes Time—And That’s Okay

Tendon rehabilitation takes weeks to months, not days. Progress isn’t always linear.

Be patient.Be kind to yourself.And remember—comparison is the thief of joy. Every body heals at its own pace.

How Manual Therapy Fits In

Hands-on osteopathic treatment can help reduce pain, improve mobility, and support the tendon as it adapts to load.But manual therapy is most effective when combined with a structured strengthening programme designed specifically for your injury.

Your Recovery Starts With the Right Plan

Working closely with your rehab team at the osteopathic care clinic ensures you progress safely, stay motivated, and avoid slipping back into the rest–flare–rest cycle.

If you’re ready to finally break free from persistent tendon pain, NLtherapies at The Osteopathic Care Clinic in Douglas can help guide you through a personalised, evidence-based rehab plan.