Understanding Why Tendinopathy Does Not Respond To Stretching

Tendinopathy does not typically respond well to stretching alone because the underlying pathology is primarily due to altered tendon structure, impaired load tolerance, and failed healing responses—rather than mere shortness or tightness of the muscle-tendon unit.

Pathophysiology and Load Response

• Tendinopathy involves degenerative or failed repair changes within tendon collagen and extracellular matrix, resulting in pain, stiffness, and loss of resilience.

• Stretching applies a low-magnitude, static load to the tendon. This does not provide the stimulus needed for tendon adaptation or healing, as tendons require higher mechanical loading (e.g., resistance or eccentric exercises) to initiate synthesis of new collagen and restructure tissue.

• Static stretching does not generate sufficient load magnitude, volume, or frequency to promote tendon remodelling or increase tendon’s load tolerance, which are necessary for recovery from tendinopathy.

Clinical and Evidence-Based Insights

• Eccentric and heavy slow resistance exercises, which place significant tension through the tendon, are far more effective in reducing symptoms and restoring function compared to stretching alone.

• Studies comparing stretching versus loading exercises show that stretching may provide some temporary relief but does not produce consistent or long-lasting improvements in pain, function, or tendon structure.

• The most effective exercise regimens are those that challenge the tendon and muscle through progressive, high-intensity loading combined with rest days to allow adequate recovery and adaptation.

Summary Table: Stretching Versus Loading for Tendinopathy

Treatment Type	Mechanism	Outcomes
Stretching	Low load, static tension	Mostly short-term relief
Eccentric Loading	High load, controlled motion	Tissue remodelling, pain relief
Heavy Resistance	High load, with progressive overload	Restoration of function

In summary, tendinopathy does not improve with stretching because that approach fails to provide the specific mechanical stimulus required for tendon repair and restoration of strength, while loading-based exercises do address these needs and remain the most evidence-based intervention.