Tendinopathy treatments: what physio TikTok gets right and wrong

What did @kratosphysio actually say?

The creator laid out three directives for people dealing with tendinopathy: stop aggressive stretching, stop doing random pain-free exercises without structure, and stop complete rest. The core argument is that tendons need "progressive targeted loading" rather than avoidance or unstructured movement. That is a reasonable summary of where rehabilitation science has moved over the past two decades, and it is worth taking seriously rather than dismissing as TikTok noise.

The framing is blunt and direct, which works for short-form video but strips out some important nuance. Saying "stop stretching it" without qualification, for instance, is the kind of instruction that lands differently depending on which tendon someone has, how irritated it is, and what phase of the condition they are in. More on that below.

Does the science back this up?

Largely, yes. The shift away from complete rest and passive treatment toward active loading programs is well-supported. Alfredson et al. (1998, Clinical Orthopaedics and Related Research) established heavy eccentric loading for Achilles tendinopathy as a landmark rehabilitation approach. Since then, Beyer et al. (2015, American Journal of Sports Medicine) compared heavy slow resistance training to eccentric protocols and found both produced clinically meaningful improvements in pain and function.

The caution around aggressive stretching for irritated tendons also has backing. Cook and Purdam (2009, British Journal of Sports Medicine) introduced the tendon continuum model, which describes how compressive loads at insertional sites can drive tendon pathology. End-range stretching in particular increases compressive stress at insertional tendons like the Achilles and rotator cuff, which is a real mechanism, not physio mythology.

The recommendation to find a tolerable load and build from there reflects isometric and isotonic loading research. Rio et al. (2015, British Journal of Sports Medicine) showed isometric contractions can produce immediate pain relief in patellar tendinopathy, suggesting even low-level loading beats doing nothing.

What did they get wrong (or right)?

They got the big picture right. The three claims collectively push against two of the most common mistakes people make: over-resting and panicking about pain during movement. That is genuinely useful public health information.

The stretching claim is where the advice needs a caveat. For mid-portion Achilles tendinopathy, aggressive stretching is indeed problematic. But for some shoulder and hip tendinopathies, light range-of-motion work is not automatically harmful, and context matters. Saying "stop stretching" as a universal rule for all tendons oversimplifies the literature.

The phrase "random bodyweight movements won't rebuild tendon strength" is accurate but slightly misleading. Bodyweight loading can be entirely appropriate early in rehab, particularly for deconditioned individuals or in acute flare phases. The issue is lack of progression and structure, not the bodyweight nature of the exercise itself. That distinction matters if someone avoids all bodyweight work because of this video.

• Stretching advice: mostly right for insertional tendons, oversimplified for all tendons
• Progressive loading recommendation: well-supported by evidence
• Anti-rest stance: accurate and aligned with current clinical guidelines

What should you actually know?

Tendinopathy is not one condition. The same "Achilles tendon pain" label can describe mid-portion degeneration, insertional pathology, or paratenonitis, and each responds differently to loading parameters. A blanket three-step protocol delivered in under a minute cannot replace a clinical assessment. If you have been dealing with tendon pain for more than six weeks without improvement, you need a physio or sports medicine physician doing load testing and imaging, not another TikTok video.

The loading principle the creator describes is real. Tendons adapt to mechanical stress through mechanotransduction, a process where tenocytes respond to load by synthesizing collagen. But that adaptation requires appropriate dosage, adequate recovery time, and progression over weeks to months, not days. Most people underestimate how slowly tendons remodel compared to muscle.

One thing this video does not address is the role of systemic factors. Sleep quality, metabolic health, and hormonal status all influence tendon healing capacity. That is not a criticism of a short video, but it is worth knowing when self-managing.