10 points highlight what doesn’t improve tendinopathy of the lower limb.

1️⃣Don’t rest completely.
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Treatment should initially reduce painful, high tendon load movements and introduce beneficial loads (eg, isometrics, heavy-slow resistance).
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2️⃣Don’t prescribe incorrect exercise.
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To be effective tendons must be loaded quickly with spring-like Exs, such as:
Jumping
Changing direction
Sprinting
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3️⃣Don’t rely on passive treatments.
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Passive treatments do not increase the load tolerance of tendon and are not helpful in the long term.
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4️⃣Avoid injection therapies.
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Injections of substances into a tendon have been shown to be no more effective than placebo in good clinical trials.
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5️⃣Don’t ignore tendon pain.
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Pain usually increases 24 hours after excess tendon load.
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An increase in pain of >2/10 on a daily loading test should initiate reduction in aspects overloading the tendon (point 2).
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6️⃣Don’t stretch the tendon.
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Stretching only adds detrimental compressive loads to the tendon.
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7️⃣Don’t use friction massage.
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An effect on local nerves may reduce pain (Short-term), only for it to return with high tendon loads.
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8️⃣Don’t use tendon images for diagnosis, prognosis or as an outcome measure.
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Abnormal tendon images (ultrasound and MRI) in isolation do not support a diagnosis of tendon pain as asymptomatic pathology is prevalent.
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9️⃣Don’t be worried about rupture.
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Pain is protective as it causes unloading of a tendon.
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🔟Don’t rush rehabilitation.
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The muscle-tendon unit requires time to build strength and increase capacity (3 months or more).
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Summary:
The best treatment for tendon pain = Exercise-Based Rehabilitation.
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Starting with a muscle strength program, progressing through to more spring-like exercises, and including endurance aspects will load the tendon correctly and give the best long-term results.
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📚Cook J. Ten treatments to avoid in patients with lower limb tendon pain. BJSM. 2018.