02
January 17, 2024•52 min
Tendon Triage: Loading Before Needling
The order-of-operations for achy tendons—irritability screen, loading progressions, and when advanced tools add value.
Episode player coming soon
💡Key takeaways
- 1Irritability dictates the starting load, not imaging.
- 2Tendon care is about dose control more than modality shopping.
- 3Expensive injectables belong after a legitimate loading sprint.
✓Order-of-operations checklist
- Score AM pain and 24-hour response for one week.
- Start with isometric holds if pain >5/10 with mid-range work.
- Progress to isotonic reps, then plyometrics as morning pain drops.
Show notes
Irritability screen
We flag sleep debt and sudden volume spikes before assuming structural failure.
Symptom diaries guide whether to start with isometrics or immediately load heavy slow resistance.
Dose the rehab like training
Three-stage loading (iso → isotonic → plyo) sets guardrails for athletes and clinicians.
We drop cost-aware notes on when imaging or injectables help.