Evidence-based tendinopathy care · Edmonton · Canada

Evidence-based tendinopathy care — for people in pain.

Tendons adapt. Load them right, and they heal. Structured, evidence-based recovery programs for Achilles, patellar, rotator cuff, tennis elbow, gluteal, and hamstring tendinopathy.

Built on the evidence
Cook & Purdam continuum model Silbernagel pain-monitoring Heavy Slow Resistance (Kongsgaard) Rio isometric research Malliaras staged loading
The four-stage loading framework

Rest doesn't heal tendons. Progressive loading does.

Modern tendinopathy care moves you through four stages — each with a specific role, dose, and progression criteria. No magic, no passive fixes. Just the right load at the right time.

Irritable / reactive

Isometric

Static holds that quiet pain and restore load tolerance. Used when the tendon is grumpy, in-season, or early in rehab.

5 × 45s holds · 60–70% effort · 2–3×/day
Building capacity

Heavy Slow Resistance

Controlled, heavy loading with a slow tempo. Rebuilds tendon stiffness and strength — the real driver of long-term recovery.

3–4 × 6–15RM · 3s up / 3s down · 3×/week
Sport-ready

Energy Storage

Plyometric and stretch-shortening work. Prepares the tendon for the high-rate loading of running, jumping, cutting.

Low-volume plyos · every 3rd day · paired with HSR
Return & maintain

Return to Sport

Graded reintroduction to training load, then competition. Maintenance loading continues indefinitely — tendons keep what you train.

1–2 HSR sessions/week · ongoing
Conditions

You've been hurting for months. Here's the plan.

Tendinopathy is slow — but predictable. An assessment, a program tailored to your tendon and your life, and regular check-ins to progress or regress the load as you respond. You stay active while you heal.

Tendons we treat

Achilles

Midportion & insertional — they're treated differently. We know the difference.

Patellar

"Jumper's knee" for runners, lifters, and anyone whose knees hurt on stairs.

Rotator Cuff

Shoulder pain with overhead reaching, sleeping on your side, lifting a kettle.

Lateral Elbow

"Tennis elbow" — even if you've never touched a racquet. Grip, type, carry hurts.

Gluteal / GTPS

Pain on the outside of the hip, worse lying on that side or crossing your legs.

Proximal Hamstring

Deep buttock pain that worsens with sitting, driving, or running hills.

Book an assessment Free 15-minute intro call
Why this works

The evidence has moved. So has the protocol.

  • Load is medicine — rest is not.

    Tendons respond to mechanical load. Prolonged rest de-conditions them and extends recovery. You'll train, not avoid.

  • Pain during loading is allowed.

    Using Silbernagel's pain-monitoring model, pain up to 5/10 during exercise is acceptable if it settles by the next morning. We teach you how to read your own tendon.

  • Eccentrics aren't the whole story.

    Heavy Slow Resistance matches or beats eccentric-only programs, with better adherence and better carryover to sport.

  • Imaging rarely changes the plan.

    Tendon changes on ultrasound or MRI don't predict pain or outcome. The program is driven by your function and response, not your scan.

Selected literature anchoring this approach:

Cook & Purdam. BJSM 2009 — continuum model of tendon pathology.

Silbernagel et al. AJSM 2007 — continued sport during rehab with pain-monitoring.

Kongsgaard et al. SJMSS 2009; Beyer et al. AJSM 2015 — Heavy Slow Resistance outcomes.

Rio et al. BJSM 2015 — isometric-induced analgesia.

Malliaras et al. JOSPT 2015 — staged patellar rehabilitation.

Mellor et al. BMJ 2018 (LEAP) — education & exercise for gluteal tendinopathy.

Goom, Malliaras, Reiman. JOSPT 2016 — proximal hamstring tendinopathy.
portrait · Paul Cramer, RMT
About

Paul Cramer, RMT

Registered Massage Therapist with 20+ years in practice and a focused clinical interest in tendinopathy and hypermobility. Founder of MovementSpark and the Integrative Movement Therapy (IMT) framework; currently treating at 4 Points Health in Edmonton.

Tendinopathy.ca is the concentrated version of that work — a structured, evidence-based program for patients who want a plan that actually gets them back to what they love doing.

RMT · 20+ years Tendinopathy & hypermobility IMT founder MovementSpark 4 Points Health
What people ask

The questions that keep coming up.

Will this ever actually heal?

Most tendinopathies resolve with structured loading. Realistic timelines: patellar and Achilles, 3–6 months of consistent work; lateral elbow, often improves in 6–12 months; proximal hamstring, 3–6 months. Think in months, not weeks. Consistency beats intensity.

Do I need a cortisone shot or surgery?

Almost never as a first step. Cortisone relieves pain short-term but is associated with worse long-term outcomes. Surgery is reserved for specific, rare scenarios. Load is the first and best intervention.

Can I keep running / lifting / playing?

In most cases, yes — at a modified dose. We use a pain-monitoring model so you can keep training while the tendon rebuilds. Total rest often makes things worse.

Why didn't rest fix it?

Because tendons need load to remodel. Without mechanical stimulus, they get weaker and more pain-sensitive over time. Rest is a pause, not a plan.

My MRI says the tendon is damaged. Does that change things?

Usually not. Imaging findings correlate poorly with pain or outcome. Plenty of people have tendon changes on scan and no pain. The plan is driven by how the tendon responds to load, not by pixels.

Ready to stop guessing and start loading?

Book an assessment, or start with a free 15-minute intro call to talk through your situation.

Book an assessment Free 15-minute intro call