If you’ve ever dealt with tennis elbow or golfer’s elbow, you know the drill. It starts as a bit of niggling soreness — maybe after a long day on the tools, a heavy gym session, or yes, a few too many sets on the court. You rest it. It feels better. You go back to what you love. And then it comes roaring back, sometimes worse than before.
So you ice it. You take some anti-inflammatories. You maybe see someone who gives you a stretch and tells you to take it easy. Weeks pass. Months, sometimes. And still it lingers — that sharp, nagging pain on the inside or outside of your elbow that just won’t quit.
Here’s the thing: it’s not your fault it’s not getting better. The most commonly repeated advice about tendon pain is, at best, incomplete — and at worst, actively working against your recovery. The research has moved on. The clinical approach has changed. But that information hasn’t quite filtered through to the advice most people are getting.
Let’s fix that.
First, a Quick Reality Check on What’s Actually Going On
Tennis elbow (pain on the outside of the elbow) and golfer’s elbow (pain on the inside) both come down to the same underlying problem: the tendons that attach your forearm muscles to the bone aren’t coping with the demands being placed on them.
For years, these conditions were called “tendinitis” — the “itis” meaning inflammation. But modern imaging and research have shown that in most cases of persistent tendon pain, there’s actually very little inflammation happening at all. What’s there instead is a kind of structural breakdown — the tendon fibres become disorganised and the tissue quality deteriorates over time.
This distinction matters enormously, because if there’s no real inflammation driving your pain, then treatments aimed at reducing inflammation aren’t going to get to the root of the problem.
What your tendon actually needs is something quite different — and perhaps counterintuitive.
5 Things I Wish Everyone With Tendon Pain Knew
1. Rest Is Not the Answer — Load Is
This is probably the most important shift in thinking, and the one most at odds with what people are told.
When a tendon is painful, the natural instinct — and the standard advice — is to rest it. And while there’s certainly a place for reducing the specific activities causing the most aggravation, complete rest is one of the worst things you can do for a struggling tendon.
Tendons respond to load. They are living tissue that literally remodel and strengthen themselves in response to mechanical stress. When you take that stimulus away entirely, the tendon doesn’t recover — it actually becomes weaker and less able to handle the demands you’ll eventually put it through again.
The goal isn’t to do nothing. The goal is to find the right kind of load — carefully calibrated, progressive, and structured — and use it as medicine.
2. Stretching Alone Won’t Get You There
Stretching feels productive, and a good stretch can provide temporary relief. But if you’ve been diligently stretching your forearm for weeks and wondering why nothing’s changing, here’s why: stretching doesn’t do enough to drive the structural changes the tendon needs.
Passive stretching places relatively little force through tendon tissue. It’s simply not enough of a stimulus to prompt the tendon to rebuild and reorganise. It can be a useful adjunct — and there’s nothing wrong with including it — but if stretching is your primary strategy, you’re missing the most important piece.
3. Ice and Anti-Inflammatories May Actually Be Working Against You
This one surprises people. Ice packs and ibuprofen have become almost reflexive responses to any musculoskeletal pain, and for acute injuries like a sprained ankle, they have their place. But tendon pain is a different beast.
Because the underlying issue in persistent tendon pain is degeneration rather than active inflammation, suppressing the body’s inflammatory response — which is actually part of the healing process — can interfere with recovery. Some research suggests that regular use of anti-inflammatories may actually impair the tendon’s ability to heal itself over time.
Does this mean you can never take a painkiller? Of course not. But relying on them as your primary management strategy is treating the symptom while ignoring the cause.
4. A Little Pain During Exercise Is Not a Warning Sign — It’s Part of the Process
This one genuinely surprises people. When it comes to tendon rehabilitation, a small amount of pain during or after exercise (typically rated up to a 4 or 5 out of 10) is not only acceptable — it’s expected, and in some protocols, deliberately monitored as a guide to how hard to push.
The old model said: pain means stop. But for tendons, this rule doesn’t hold. The research is clear that carefully loaded exercise performed within acceptable pain limits is both safe and necessary for recovery. Learning to distinguish between productive discomfort and genuine warning signs is part of what a good rehabilitation programme teaches you.
5. How Quickly It Got Better Before Doesn’t Predict Whether It’s Actually Fixed
Most people with tendon pain notice that if they rest long enough, it improves. They return to their activities, and for a while everything seems fine. Then it comes back — often at the slightest provocation, and sometimes with a vengeance.
This cycle of apparent recovery and relapse is incredibly common, and it’s what leads people to believe their elbow is just a “bad elbow” or that they’re stuck with it. But what’s actually happening is that the underlying tendon hasn’t been rehabilitated — it’s just been rested. The capacity of the tendon hasn’t improved, so the moment meaningful load is applied again, it fails.
True recovery means building the tendon’s capacity up so that it can comfortably handle your life and activities again. That takes targeted work — not just time.
So Why Are We Confident This Is the Right Approach?
The way we treat tendon pain today isn’t guesswork or trend-chasing. It’s built on decades of clinical research that has fundamentally changed how sports medicine, physiotherapy, and rehabilitation science understand these conditions.
The field has been shaped by researchers like Jill Cook, Craig Purdam, and Hakan Alfredson — clinicians and scientists who have studied tendons extensively and whose work has driven a global shift in treatment guidelines. What emerged from this research is a graduated loading model: a structured, progressive approach to rehabilitating tendon tissue using exercise as the primary therapeutic tool.
From this body of evidence, clinical protocols have been developed that take people through carefully sequenced stages — from initial pain management, through isometric (static) and isotonic (moving) loading exercises, and progressively toward the kind of dynamic, high-demand activity that reflects real life and sport. These aren’t generic exercises plucked from a pamphlet. They are specifically designed to target the tendon, delivered in a way that matches where the tissue is in its recovery at each point in time.
The results, when the protocol is followed properly, are genuinely good. People who have struggled for months or years frequently make meaningful, lasting recoveries — not because anything revolutionary was done, but because the right approach was applied consistently and intelligently.
The Path Forward Is Clearer Than It’s Ever Been
If you’re stuck in the rest-flare-rest cycle with your elbow, the good news is that there is a way through. It requires effort and consistency, and it asks you to trust a process that might feel counterintuitive at first. But it is grounded in the best available evidence, and it works.
The first step is understanding what’s actually going on — which you now do. The second is getting an assessment that confirms the diagnosis and rules out anything else that might be contributing. And the third is committing to a properly structured rehabilitation programme rather than hoping that time alone will do the job.
Your tendon isn’t broken beyond repair. It just hasn’t had the right stimulus to rebuild. Let’s give it that.
At MovementSpark, we use a research-backed clinical protocol to guide people through tendon rehabilitation — from that first painful flare-up through to full return to the activities they love. If you’re ready to stop guessing and start recovering, get in touch.
