Question explored with the scientific record
Best way to look after your tendons
The short version: for healthy tendons, progressive loading is the one thing with real support. Most of the rest is unproven or worse.
The evidence here is mostly about treating existing tendinopathy, not preventing it in healthy tendons. That is a real gap. What it does show is consistent: heavy, progressive loading is the most effective option across tendon sites [5], and eccentric exercise beat wait-and-see in two randomized trials for chronic Achilles problems [4]. A runner with hamstring tendinopathy improved from pain 7/10 to 1/10 and function from 23 to 80 over 12 weeks of progressive loading [2]. A case report of Achilles tendinopathy after an antibiotic (levofloxacin) improved with a two-phase program of protection then progressive loading, pain 3/10 to 0/10 by week 14 [1]. These are single cases, not proof, but the direction matches the larger reviews.
| Approach | What the evidence shows |
|---|---|
| Heavy eccentric loading | Most consistent benefit across sites [5] |
| "Do as tolerated" loading | Similar results to strict protocol at 6 weeks [3] |
| Shockwave therapy | Moderate evidence, helps some Achilles cases [4][5] |
| Corticosteroid injection | Short-term relief, tendon atrophy risk [4][5] |
| PRP injection | No better than placebo at 6 or 24 weeks [4] |
| Kinesio tape | Little to no meaningful benefit [6] |
The honest caveats matter. The loading studies are small, often uncontrolled, and improvement can reflect natural recovery [1]. The corticosteroid record found tendon atrophy risk was far higher than placebo [4], and long-term efficacy is limited [5]. PRP did not beat placebo [4]. Kinesio taping showed little to no benefit across most outcomes [6]. None of these records test prevention in healthy tendons, so I cannot tell you a specific loading dose prevents injury.
My call: load your tendons progressively and consistently, skip injections and tape as first-line, and treat any single study as a hint, not a verdict. Confidence: moderate for treating tendinopathy, low for prevention.
Sources used 6
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Physical Therapist Management of Fluoroquinolone-Induced Achilles Tendinopathy
In a 41-year-old man with levofloxacin-induced bilateral Achilles tendinopathy, an overlapping two-phase physical therapy program was followed by reduced pain and improved lower-extremity function.
DOI: 10.1093/ptj/82.12.1224 -
Clinical Progression and Load Management For Proximal Hamstring Tendinopathy In A Long-Distance Runner: A Case Report
In a 30-year-old male long-distance runner with proximal hamstring tendinopathy, a 12-week progressive loading exercise program was followed by reduced pain, improved VISA-H function, and return to running.
DOI: 10.26603/001c.116578 -
Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial
This study compares the effectiveness of the Alfredson eccentric heel-drop protocol with a 'do-as-tolerated' protocol for nonathletic individuals with midportion Achilles tendinopathy, finding no significant difference in outcomes between the two approaches after six weeks.
DOI: 10.2519/jospt.2014.4720 -
Management of chronic Achilles tendinopathy
This review finds limited evidence for most chronic Achilles tendinopathy treatments, supports eccentric exercise as first-line, and reports some favorable ESWT trials but inconsistent benefit for other conservative options.
DOI: 10.1136/dtb.2012.08.0124 -
Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments
This study systematicly reviews systematic reviews of randomized controlled trials evaluating tendinopathy treatments across sites, finding heavy eccentric exercises as the most consistently effective option for reducing pain and improving function, with moderate evidence for ES…
DOI: 10.1111/sms.13734 -
Kinesio taping does not improve ankle functional or performance in people with or without ankle injuries: Systematic review and meta-analysis
A comprehensive systematic review and meta-analysis assessing Kinesio taping applied to the ankle in healthy individuals and those with ankle injuries, finding little to no robust evidence of clinically meaningful benefits across most outcomes, with only sporadic, very-low to lo…
DOI: 10.1177/0269215520963846