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Blog, Physiotherapy, Posture

Tendinopathy Pain Management: Breaking the Boom-Bust Cycle

Person holding painful knees illustrating tendinopathy pain management and tendon overload symptoms

Pain during exercise can be confusing, especially when advice seems to conflict.

One day you are told to push through it, the next day you are warned to stop immediately.

In tendinopathy pain management, understanding when pain is acceptable and when it signals overload is crucial.

Learning this balance helps prevent the common boom-bust cycle and is one of the most important skills for successful rehabilitation.

Why I’m Talking About This

My name is Kevin, and I am a physiotherapist with a strong interest in musculoskeletal injuries and exercise-based rehabilitation.

I work closely with people dealing with persistent pain, and sporting injuries, where this exact question comes up every day.

Getting this balance right is often the difference between progress and repeated setbacks.

Pain, Tendons, and the Reality of Rehab

Tendinopathy is one of the most common causes of ongoing pain in active people. It can affect the Achilles, patellar tendon, rotator cuff, elbow, and more.

Some key facts:

  • Tendinopathy accounts for up to 30 percent of sports-related injuries
  • Tendons respond best to gradual, progressive loading, not rest alone
  • Complete pain avoidance often leads to deconditioning and prolonged recovery

Importantly, some pain during rehab is normal and often necessary, particularly with tendon loading and tendinopathy pain management. However, this does not mean all pain is safe.

The Real Problem: The Boom-Bust Cycle

One of the biggest mistakes I see is the boom-bust cycle.

This looks like:

  • You feel good and do too much (the boom)Athlete performing strengthening exercise as part of tendinopathy pain management rehabilitation
  • Pain flares up significantly
  • You stop everything and rest (the bust)
  • Symptoms settle, confidence returns, and the cycle repeats

This pattern is especially common in tendinopathy. Tendons dislike sudden spikes in load and hate long periods of underloading. This creates a situation where pain keeps returning despite good intentions.

So… When Should You Push Through Pain?

Pushing through pain may be appropriate when:

  • Pain is mild to moderate and settles within 24 hours
  • Symptoms do not progressively worsen week to week
  • Strength and function are gradually improving
  • Pain feels local and predictable, not sharp or unstable

This is often acceptable and expected in tendon rehab.

When Pain Is Telling You to Pull Back

Pain is a red flag when:

  • Pain continues to worsen beyond 24 to 48 hours
  • You lose strength, confidence, or movement quality
  • Pain becomes sharp, catching, or feels unsafe
  • You are repeatedly flaring after activity

This usually means the load is too high or progressing too quickly.

The Solution: Smart Loading, Not Guesswork

Successful rehab is about:

  • Gradual increases in load
  • Consistency over intensity
  • Monitoring symptom response, not chasing zero pain
  • Avoiding long rest periods followed by big spikes in activity

This approach breaks the boom-bust cycle and allows tissues to adapt safely.

What You Can Do Next

If you are unsure whether you should push or pull back, don’t guess.

You can:

  • Book a physiotherapy session to get a tailored loading plan
  • Learn how much pain is acceptable for your injury
  • Get guidance on progressing exercises without flare-ups

Call us on 1800 992 999 or book online to start your recovery with confidence. The right plan makes all the difference.

Written By:

Kevin Go (Physiotherapist)

Bachelor of Physiotherapy

References

Ackermann, P.W. and Renström, P. (2012) ‘Tendinopathy in sport’, Sports Health: A Multidisciplinary Approach, 4(3), pp. 193–201. doi:10.1177/1941738112440957.

Antcliff, D. et al. (2021) ‘“Pacing does help you get your life back”: The acceptability of a newly developed activity pacing framework for chronic pain/fatigue’, Musculoskeletal Care, 20(1), pp. 99–110. doi:10.1002/msc.1557.

Maffulli, N., Wong, J. and Almekinders, L.C. (2003) ‘Types and epidemiology of tendinopathy’, Clinics in Sports Medicine, 22(4), pp. 675–692. doi:10.1016/s0278-5919(03)00004-8.

Millar, N.L. et al. (2021) ‘Tendinopathy’, Nature Reviews Disease Primers, 7(1). doi:10.1038/s41572-020-00234-1.

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