Your kid has been complaining about knee pain for three weeks. Right below the kneecap. It hurts when they jump, when they land, sometimes even when they walk up the stairs. So you did what you were supposed to do. Rest. Ice after every practice. Compression sleeve. And for a few days, it seemed to calm down.

Then they went back to practice, and within one session, the pain was back.

So you ice it again. You tell them to take another week off. And the cycle repeats.

I see this all the time with young athletes. Patellar tendon pain. Achilles issues. Elbow pain from throwing. The default advice is almost always rest and ice. And for a lot of families, it feels like the responsible thing to do. If it hurts, you stop. If it’s inflamed, you ice it.

But tendons don’t work that way. And the longer you rest and ice without addressing what the tendon actually needs, the harder it becomes to get back.

Tendons Need Load, Not Rest

Tendons are built to handle force. That’s their job. They transmit load between your muscles and your bones. And they adapt to the demands you place on them.

When you load a tendon consistently, it gets stronger. When you stop loading it, it loses capacity. It becomes more sensitive. And when you eventually go back to the activity that was bothering it, the tendon isn’t ready.

That’s why rest alone doesn’t fix tendon pain. It might reduce the symptoms for a while, but it doesn’t rebuild what the tendon lost.

I had a high school volleyball player come in a few months ago with patellar tendon pain. She’d been dealing with it for over a month. Her parents had her rest for two weeks. Iced religiously. She felt better, went back to playing, and within three days the pain was back.

The tendon wasn’t torn. It wasn’t damaged. It was irritated because it had lost some of its capacity to handle the load she was asking it to carry. The pain wasn’t telling her to stop forever. It was telling her the tendon needed to be gradually rebuilt.

We didn’t tell her to rest more. We started loading the tendon in a controlled way. Within a few weeks, she was back to playing without pain. Not because the tendon “healed” on its own, but because we gave it what it actually needed.

Ice Feels Good, But It Doesn’t Help Tendons Heal

Ice is tempting because it works in the moment. It numbs the area. It reduces the sensation of pain. But when it comes to tendon pain, especially pain that’s been lingering for weeks, ice isn’t doing what you think it’s doing.

Tendons heal through a process that requires blood flow. They need nutrients and oxygen. When you ice aggressively, you’re shutting that down. You’re numbing the pain, but you’re not giving the tendon the environment it needs to rebuild.

And here’s the other issue. Ice doesn’t improve the tendon’s ability to handle load. It doesn’t make it stronger. So when the athlete goes back to their sport, the tendon is in the same state it was before. Maybe even weaker.

I’m not saying ice is never useful. If you roll your ankle and it swells immediately, ice can help in the first day or two. But for chronic tendon pain that keeps coming back, ice is not the answer.

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What We Actually Do

When someone comes into our clinic in Westerville with tendon pain, we’re not reaching for ice packs. We’re looking at how we can calm the pain down quickly and then start rebuilding capacity.

For tendons that are really irritated, we’ll often use focused shockwave therapy. It’s not a magic bullet, but it’s one of the most effective tools we have for reducing sensitivity in a tendon that’s been stuck in a pain loop. Shockwave helps reset the tissue and creates a window where we can start loading without flaring things up.

But shockwave alone doesn’t fix the problem. Once the pain is calmed down, we start loading. Controlled, progressive loading. That’s what actually rebuilds the tendon.

In the early stages, that might look like isometric exercises. Holding a position under load without movement. As the tendon adapts, we progress to eccentric loading. Slow, controlled movements where the tendon lengthens under tension. For patellar tendon pain, that might be step-downs or squats. For Achilles issues, heel drops off a step.

Eventually, we add back sport-specific movements. Jumping. Cutting. Throwing. But we do it in a way that respects where the tendon is in its recovery.

This isn’t a one-week process. Tendons adapt slowly. But when you give them the right stimulus, they do adapt. They get stronger. And the pain goes away, not because you avoided the activity, but because you prepared the tendon to handle it.

The Goal Is Durability

The goal isn’t just to get rid of the pain. The goal is to make the tendon more durable. To build a buffer so that when the athlete goes back to practice, the tendon can handle it. So that when they have a tough game or a long tournament weekend, the pain doesn’t come roaring back.

That’s what gets missed when the only plan is rest and ice. You might feel better temporarily, but you haven’t built anything. You haven’t increased capacity.

I understand the instinct to protect. To rest. To ice. Especially with a young athlete who’s in pain. But tendons don’t get stronger by avoiding load. They get stronger by being challenged in the right way, at the right time, with the right progression.

If your kid has been dealing with tendon pain for weeks and the rest-and-ice approach isn’t working, that’s not a sign that something is seriously wrong. It’s a sign that the tendon needs a different strategy.

Moving Forward

Tendon pain is frustrating. It’s stubborn. It doesn’t respond to quick fixes. But it does respond to the right kind of load, applied consistently over time.

If you or your athlete has been stuck in the cycle of resting, icing, and returning to pain, it’s worth asking a different question. Not “how do I make the pain go away,” but “how do I rebuild the capacity that the tendon lost?”

That’s the question we ask at Central Ohio Spine and Joint. And that’s the framework we use to help young athletes get back to their sport, not just pain-free, but stronger and more resilient than before.

Your body isn’t fragile. Your tendon isn’t broken. It just needs the right plan.

Building better with you,
Dr. Blake Richard, DC

See it in action: For a deeper look at how we utilize this 3-phase process to get you better results, you can watch our breakdown video here: The COSJ 3-Phase Process

Central Ohio Spine & Joint
768 Park Meadow Rd
Westerville, OH 43081

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Always seek the advice of a qualified healthcare provider for diagnosis and treatment of medical conditions.