Elbow or Achilles Pain? Here’s Why It’s So Stubborn and What Really Works!

Kelsie Mazur, DPT 

If you have ever dealt with Achilles pain, tennis elbow, or any of those nagging overuse issues, you may have noticed that many clinicians now call these conditions tendinopathies rather than tendinitis. That shift in terminology matters. The old term tendinitis implies acute inflammation, but most of these problems are not primarily inflammatory. Instead, they result from degenerative and maladaptive changes within the tendon. The tissue becomes overloaded, irritated, and structurally weakened over time. Because this process is more about failed healing and disrupted collagen than about true inflammation, the more accurate term is tendinopathy, which simply means a disorder of the tendon. This distinction helps explain why these injuries are often stubborn, why rest alone does not solve them, and why the right kind of loading is essential for real healing.

Tendinopathies are slow to resolve because tendons dislike sudden changes in the amount of load placed on them. They are built to handle tension and repetitive force, but only when the body has been given time to adapt. When someone jumps into a new workout routine, increases running mileage or speed,  returns to tennis after a few months away, or spends a weekend doing heavy home projects with tools their forearm is not conditioned for, the tendon fibers may become irritated faster than they can repair. This creates a cycle of stiffness, pain, and reduced load tolerance. Tendons also have a limited blood supply, so they do not remodel quickly. Real progress happens gradually over many weeks or even months.

One of my patients, a recreational tennis player, is a perfect example. He came in with elbow pain that had lingered for nearly a year. He had tried everything from resting from tennis to stretching the forearm, using a brace, and even switching racket styles. Each time he rested, the pain improved, but as soon as he started hitting serves and forehands again, the symptoms returned within minutes. What he did not realize was that although rest made his elbow feel better, it also decreased the tendons ability to handle load. His symptoms persisted because the tissue was not being trained to tolerate the demands of the sport. Once we shifted his rehab toward progressive strengthening, starting with isometric holds, moving into slow controlled exercises, and eventually adding grip and rotational strength work, his symptoms steadily improved. It was not a quick fix, but consistency made all the difference.

This story highlights a key point that I feel like a broken record when saying: Rest does not fix tendon issues. Hot take: rest still doesn’t work even when a doctor or PA tells you to rest. While it may briefly decrease symptoms, it does nothing to rebuild the tendons capacity. Stretching alone is also not enough. Although it can provide temporary relief, it does not strengthen the tissue or improve resilience. What tendons truly respond to is progressive and intentional strengthening that stimulates collagen remodeling (strong sticky stuff that makes our muscles bulletproof) and gradually restores durability.

The challenge is that tendon rehab only works with consistency. I cannot stress this enough!!!! These tissues adapt slowly and depend on regular repeated stimulus to change. I often compare tendinopathy rehab to brushing your teeth. It is not exciting and it is not glamorous, but it is absolutely essential. We focus on modifying activity rather than stopping everything, following the twenty four hour rule to monitor symptoms, and progressing exercises based on how the tendon responds rather than expecting a completely pain free process.

In the end, tendinopathies are not mysterious and they are not something you have to live with forever. They simply require time, progressive loading, and steady work to remodel the tissue and restore its strength. When you give tendons what they need, they often become stronger and more resilient than before the injury ever started. 

Let’s chat! Book an assessment and let’s get you back to feeling good in your body.
No referrals, no waiting, just answers. Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.