BPC-157 for tendonitis: what the gym crowd gets wrong

What did @thenattyengineer actually say?

With 17 years of lifting behind him, the creator argues that the only path to healing tendonitis without taking time off is "reducing the inflammation." His prescription: ice and "take ends said" (ibuprofen or a leave-on NSAID, based on context) several times a day for multiple weeks. He also dismisses elbow pads, knee sleeves, and warmups as tools that help you train through pain but do nothing for actual healing.

To be fair, he's talking from real experience, and the frustration behind the advice is relatable. But lived experience in the gym and evidence-based rehab science are not always the same thing, and this video is a good example of where they diverge pretty sharply.

Does the science back this up?

Not really, and in some ways, the advice runs counter to what the research has been saying for well over a decade. The idea that tendonitis is primarily an inflammatory condition that you treat with anti-inflammatory tools has been largely revised in modern sports medicine.

The term most clinicians now use is tendinopathy, not tendonitis, because histological studies have repeatedly found that chronic tendon pain involves a degenerative process, not an acute inflammatory one. A landmark paper by Khan et al. (2002, JAMA) noted that biopsies of painful tendons often show little to no inflammatory cell infiltrate. Purdam et al. (2004, British Journal of Sports Medicine) demonstrated that heavy slow resistance training, specifically loaded eccentric exercise, produced meaningful structural and symptomatic improvements in patellar tendinopathy. And a 2015 Cochrane review on NSAIDs for tendinopathy found only short-term pain relief with no evidence of long-term structural benefit. Ice follows a similar pattern: useful for acute pain management, but not a healing mechanism.

What did they get wrong (or right)?

The creator gets partial credit for one thing: he's right that warmups and sleeves are primarily comfort and performance tools, not structural healers. That's broadly consistent with how rehab clinicians think about passive supports.

Where he goes wrong is the framing that reducing inflammation is the core task. For acute tendon injuries in the first 24-72 hours, ice and NSAIDs have legitimate short-term roles in pain management. But for chronic tendinopathy, which is what most gym-goers are dealing with after weeks or months of overuse, the evidence points toward loading, not resting or medicating inflammation away.

Specifically, the advice to take ibuprofen multiple times a day for multiple weeks is where things get clinically problematic. Cook and Purdam (2009, British Journal of Sports Medicine) published the "tendon continuum" model showing that reactive tendinopathy responds differently to load than degenerative tendinopathy. Blanket NSAID use over weeks doesn't address the mechanical adaptation the tendon needs, and chronic NSAID use carries real risks including gastrointestinal damage and potential impairment of tendon healing at the cellular level (Tsai et al., 2004, Journal of Orthopaedic Research).

What should you actually know?

If you're dealing with tendon pain that has lasted more than a few weeks, the evidence-based approach is not rest-and-ice, and it is not training through it with sleeves either. It is structured, progressive loading of the tendon under the guidance of a sports medicine clinician or physiotherapist.

Eccentric and isometric loading protocols have the strongest evidence base for tendinopathy. Isometric holds in particular have shown rapid pain-relief effects in patellar tendinopathy (Rio et al., 2015, British Journal of Sports Medicine), which makes them useful for athletes who want to keep training. NSAIDs and ice can play a supporting role in managing pain acutely, but they should not be the treatment strategy.

• Tendonitis (acute inflammation) and tendinopathy (chronic degeneration) are not the same condition and do not respond identically to the same treatments.
• Weeks of daily NSAID use carries documented health risks and has not been shown to accelerate tendon healing in clinical trials.
• A sports medicine doctor or physiotherapist can differentiate your stage of tendon injury and tailor loading accordingly.
• Peptide-based approaches for tendon recovery, including BPC-157, remain under active research and have not received regulatory approval for this use.