Why Every Pilates Instructor Should Understand Tendon Loading
- theziblingsalipoon
- Jul 16
- 6 min read
One of the most common things Pilates instructors hear from clients is:
"My physio said I've got tendinitis."
Or perhaps:
"I've been told my rotator cuff is inflamed."
"My Achilles has been sore for months."
"I've got gluteal tendinopathy."
For many instructors, these conversations immediately create uncertainty.
Should they remove certain exercises?
Should they avoid loading the tendon altogether?
Should the client rest until the pain disappears?
Fortunately, our understanding of tendon injuries has changed dramatically over the past twenty years.
Modern research has shown that tendons are not fragile structures that simply need rest.
In fact, complete rest is often one of the least effective treatments for long-term tendon pain.
Instead, tendons respond remarkably well to one thing:
Appropriately prescribed load.
As Pilates instructors, understanding the basic principles of tendon loading doesn't mean diagnosing injuries or replacing physiotherapy. It means making more informed programming decisions, recognising when a client needs referral, and understanding why certain exercises help while others aggravate symptoms.
What Is a Tendon?
A tendon is the strong connective tissue that attaches muscle to bone.
When a muscle contracts, the tendon transfers that force into movement.
Think about how many tendons are loaded during a typical Pilates class.
Every time a client performs:
Footwork
Scooter
Lunges
Bridging
Planks
Arms in straps
Standing balance work
Multiple tendons are working to transfer force throughout the body.
Healthy tendons are incredibly strong.
They are designed to tolerate substantial load repeatedly throughout life.
However, like muscles, bones and ligaments, tendons adapt according to how they are loaded.
Tendinitis vs Tendinopathy
One of the biggest changes in sports medicine has been our understanding of tendon pain.
For many years, painful tendons were labelled tendinitis, implying inflammation.
We now know that most long-standing tendon pain involves very little inflammation.
Instead, the tendon undergoes changes in its structure and its ability to tolerate load.
This is why the preferred term today is tendinopathy.
Tendinopathy simply describes a tendon that has become painful and has reduced
capacity to tolerate mechanical load.
This distinction matters because treatments aimed purely at reducing inflammation often fail to address the real issue.
The tendon usually doesn't need complete rest.
It needs carefully managed loading.
Why Do Tendons Become Painful?
Tendons generally become symptomatic when the load placed upon them exceeds their current capacity.
This can happen in many ways.
Sometimes the increase is sudden.
For example:
returning to running after several months off
starting a new gym programme
increasing Pilates classes from one to five per week
Other times, it develops gradually.
Small increases in repetitive loading accumulate over weeks until the tendon becomes irritated.
Importantly, pain doesn't necessarily mean damage.
Often it simply means the tendon's current capacity has temporarily been exceeded.
Tendons Adapt Slowly
One of the most important things Pilates instructors should understand is that tendons adapt much more slowly than muscles.
A client may feel noticeably stronger within several weeks of beginning resistance training.
The tendon, however, continues adapting over a much longer period.
This explains why clients often feel capable of doing much more before the tendon is actually ready.
Programming that progresses too quickly may overload the tendon even though the muscles appear strong enough.
Patience is essential.
Compression vs Tensile Load
One concept that is becoming increasingly important in tendon rehabilitation is understanding the difference between tensile load and compressive load.
Tensile Load
Tensile loading occurs when a tendon is pulled by the muscle attached to it.
This is the type of loading tendons generally respond very well to.
Examples include:
calf raises
bridging
controlled shoulder strengthening
hamstring loading
progressive squats
Appropriately prescribed tensile loading stimulates tendon adaptation and increases capacity over time.
Compressive Load
Compression occurs when the tendon is pressed firmly against a nearby bone while also being loaded.
This combination can become provocative for certain tendons.
Examples include:
The gluteal tendons being compressed against the greater trochanter during excessive hip adduction.
The rotator cuff tendons being compressed beneath the acromion during certain overhead positions.
The Achilles tendon being compressed where it wraps around the heel during excessive dorsiflexion.
Understanding compression explains why two exercises loading the same muscle can feel completely different for someone with tendinopathy.
Common Tendinopathies Pilates Instructors Encounter
Gluteal Tendinopathy
Often presents as pain on the outside of the hip.
Clients frequently report discomfort:
lying on one side
crossing their legs
prolonged standing
climbing stairs
Programming considerations include reducing excessive hip adduction while maintaining progressive gluteal strengthening.
Achilles Tendinopathy
Typically presents with pain or stiffness around the Achilles tendon, especially first thing in the morning.
Many clients notice symptoms improve once they begin moving.
Progressive calf strengthening is one of the most evidence-supported treatments available.
Complete avoidance of loading generally delays recovery.
Patellar Tendinopathy
Often called "jumper's knee."
Pain usually develops at the lower portion of the kneecap during activities involving jumping, stairs or repeated squatting.
Controlled quadriceps strengthening forms the foundation of rehabilitation.
Rotator Cuff Tendinopathy
Commonly presents with shoulder pain during lifting, reaching or sleeping on the affected side.
Programming focuses on gradually restoring shoulder capacity while avoiding excessive compression in painful ranges.
Again, complete avoidance of shoulder movement rarely leads to long-term improvement.
Why Rest Isn't Usually the Answer
One of the biggest myths surrounding tendon pain is that complete rest allows tendons to heal.
Rest certainly has a role when symptoms are highly irritable.
However, prolonged unloading creates another problem.
The tendon gradually loses capacity.
Then, when activity resumes, it becomes overloaded again.
This cycle often explains why tendon pain becomes persistent.
Modern rehabilitation instead focuses on maintaining appropriate loading throughout recovery.
Movement is medicine.
The dosage simply needs to be appropriate.
Pain Doesn't Always Mean Stop
This is one area that often worries Pilates instructors.
Clients may experience mild discomfort during tendon rehabilitation.
Current research supports using pain monitoring rather than complete pain avoidance.
Many physiotherapists use a simple guide:
Mild discomfort during exercise that settles reasonably quickly afterwards is often acceptable.
Pain that continues increasing during exercise or remains significantly worse for the following day suggests the tendon has probably been overloaded.
As Pilates instructors, we don't prescribe rehabilitation protocols.
But understanding that tendons tolerate gradual loading helps explain why physiotherapists often encourage continued movement rather than complete rest.
Programming Principles for Pilates Instructors
You don't need to become a tendon rehabilitation expert.
However, several principles can immediately improve your programming.
Progress Gradually
Avoid sudden increases in:
repetitions
spring resistance
class frequency
complexity
Small, progressive increases are generally better tolerated than large jumps.
Respect Recovery
Unlike muscles, tendons often require more recovery between heavier loading sessions.
Programming high-load calf strengthening every day, for example, may exceed tendon capacity in some clients.
Modify Load Before Removing Movement
If an exercise aggravates symptoms, consider adjusting:
spring resistance
range of motion
body position
tempo
repetition volume
rather than removing the exercise entirely.
Understand the Goal
The goal is rarely pain elimination during the session.
The goal is gradually increasing the tendon's ability to tolerate everyday life.
When Should You Refer?
Pilates instructors should always refer clients for physiotherapy assessment when:
pain develops suddenly following trauma
swelling is significant
weakness develops rapidly
symptoms continue worsening despite modification
diagnosis is uncertain
pain is limiting normal daily function
Working collaboratively with physiotherapists provides the best outcomes for clients.
Professional Reflection
Perhaps the biggest lesson tendon research has taught us is that tissues are incredibly adaptable.
Tendons become stronger when appropriately loaded.
They become less tolerant when they are underloaded.
As Pilates instructors, understanding this changes the questions we ask.
Instead of:
"Should this client stop exercising?"
We begin asking:
"How can this tendon continue loading safely today?"
That shift from avoidance to intelligent progression is one of the defining characteristics of evidence-based Pilates instruction.
Continue Your Professional Development
Understanding tendon loading is an essential part of working confidently with real clients.
Our Advanced Injury Modification Certification explores common tendon presentations, pain monitoring, exercise progression, load management and evidence-based modification strategies for the conditions instructors encounter most frequently in the studio.
For instructors wanting to go even deeper into why tendons behave the way they do, our Applied Anatomy & Biomechanics Certification explains how anatomy, biomechanics and tissue loading influence movement, compensation and programming decisions across both Mat and Reformer Pilates.
Together, these certifications provide the clinical reasoning skills that bridge the gap between foundational Pilates education and working confidently with clients experiencing musculoskeletal conditions.
Key Teaching Points
Most persistent tendon pain is better described as tendinopathy rather than tendinitis.
Tendons respond positively to progressive loading and generally do not improve with prolonged rest alone.
Understanding tensile and compressive loading helps explain why certain exercises aggravate symptoms while others assist recovery.
Tendons adapt more slowly than muscles, making gradual progression essential.
Pilates instructors should modify load thoughtfully while recognising when referral is appropriate.
Evidence-based programming focuses on building tissue capacity rather than avoiding movement.
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