Why Your Tendon Pain Won’t Go Away (and How Progressive Loading Fixes It)

So your elbow hurts, your finger feels like it’s made of glass, or your Achilles is screaming every time you hike to the crag. Congratulations, you’ve joined the tendinopathy club — population: half the climbing community. At Rock Rehab in Santa Fe, NM, we loooove treating tendon pain. It’s a weird passion of ours.

Here’s the deal: tendons don’t magically heal with rest, stretching, or praying to the climbing gods. Proper tendon treatment is extremely effective. An improper treatment plan will cause pain to linger for months or even years. No joke.

Tendinopathy is caused by the disorganization of the collagen fibers within the tendon. If your pain has been going on longer than 3 days, IT’S NOT AN INFLAMMATORY PROBLEM. So stop icing and resting. The goal of tendon treatment is to realign and reorganize those fibers. This is achieved by one thing above all else: progressive loading.

What your tendon looks like when it’s in pain

Here you can see on the left, a normal healthy tendon (looks like a fresh climbing rope). On the right you can see a degenerative tendon with rounded fibroblasts, increased ground substance, capillary ingrowth, and disorganized type I and III collagen fibrils (looks like the rope your buddy leaves at the crag all winter so he doesn’t have to hike with it). Learn more about classifying tendon problems here.

Phase 1: Calm shit down, start with isometrics

In the early stage of rehab, your tendon is basically a frayed rope. It’s weak, the fibers are disorganized, and pissed off. Jumping straight back onto your project is like whipping on that rope until it snaps. Not smart.

Instead, PTs start with isometric exercises — static holds where the tendon is under tension, but not moving. Think of it as teaching your rope to hold bodyweight again before you ever fall on it.

Examples for Climbers:

• Finger flexor tendinopathy: Half crimping on a 22+mm edge with less than 50% of body weight for 30–45 seconds, 4–6 reps, 1-2 times per day. No max hangs yet, just steady pressure. Do this every other day and progress by 5 lbs per time as long as symptoms stay the same or get better.

• Medial elbow pain: Hold a wrist flexion isometric with a light dumbbell or resistance band for 30–45 seconds, 4–6 reps, 1-2 times per day. 9 times out of 9, the climbers we see at Rock Rehab are using too light of a weight for this exercise. Try a heavier weight as this will cause more tendon reorganization.

• Lateral elbow pain: Hold a wrist extension isometric with a light dumbbell or resistance band for 30–45 seconds, 4–6 reps, 1-2 times per day (seeing a pattern here).

These isometrics reduce pain by calming down the tendon’s pain response, while sneaking in a little load to start rebuilding tissue tolerance.

Phase 2: Build shit up, progress to isotonics

Once pain calms down, you graduate to isotonic exercises — controlled movements through range. Now you’re re-training the tendon to tolerate lengthening and shortening under load, which is what climbing constantly demands.

Examples for Climbers:

• Finger flexor tendinopathy: Half crimping on a 20+mm edge with 50-80% of body weight for 8 seconds, 2-3 sets of 6-8 reps, only 1 time per day. Do this every other day and progress by 5 lbs per time as long as symptoms stay the same or get better.

• Medial elbow pain: Full range wrist flexion curls with a dumbbell or resistance band. 2-3 sets of 8-12 reps, only 1 time per day. Do this every other day and progress by 5 lbs per time as long as symptoms stay the same or get better.

• Lateral elbow pain: Full range wrist extension curls with a dumbbell or resistance band. 2-3 sets of 8-12 reps, only 1 time per day. Do this every other day and progress by 5 lbs per time as long as symptoms stay the same or get better.
  

The key here? Tempo and control. Climbers love to cheat with momentum. Stop it. Slow eccentrics (lengthening phase) are tendon gold. Research is mixed on whether eccentric loading alone is better than the combination of eccentric and concentric loading. At Rock Rehab we recommend using the combination of eccentric and concentric loading because it’s easier to achieve the right amount of load.

Phase 3: Heavy and Specific

Here’s where most climbers tap out. You feel 60–70% better, you start climbing harder, then the pain comes roaring back. Why? Because you never got to the heavy loading phase which should start at 4-6 weeks.

Tendons need high tension to truly remodel — think heavier weights, lower reps, longer timelines. Research shows that tendons remodel when you push them hard enough to stimulate collagen realignment.

Examples for Climbers:

• Finger flexor tendinopathy: Half crimping on a 20mm edge with 80-120% of body weight for 6 seconds, 3 sets of 4-6 reps, only 1 time per day. Do this every other day and progress by 5 lbs per time as long as symptoms stay the same or get better.

• Medial elbow pain: Full range wrist flexion curls with a dumbbell or resistance band (you better be upping the weight!). 2-3 sets of 6-8 reps, 3 times per week.

• Lateral elbow pain: Full range wrist extension curls with a dumbbell or resistance band (again, you better be upping the weight!). 2-3 sets of 6-8 reps, 3 times per week.

This is tendon boot camp — if you never train here, your rope stays frayed.

Phase 4: Sport-Specific and Chaos Training

Finally, once the tendon is handling heavy, slow loads without pain, you add back the chaos: dynamic movements, plyometrics, and climbing-specific stress. Tendons need to know how to handle fast, unpredictable loads — just like that sketchy dyno or desperate deadpoint.

Examples for Climbers:

• Campus board (low rung, submaximal intensity, build slowly)

• Plyometric pull ups

• Mooboading (start slow, bro)

This is where you bulletproof your tendon for real climbing stress — the unpredictable, chaotic stuff that causes injuries in the first place.

Why Your Current Plan Isn’t Working

If you have tendon pain that is lasting longer than 8 weeks or if your progress has plateaued, it’s time to change things up. There’s a good chance you’ve generally taken the right steps and maybe it’s helped to an extent. But we need more. At Rock Rehab, we pride ourselves on solving complex tendon pain, often after the climber has been to multiple other providers. The most common reason these tendons are not healing is: right medicine, but wrong dosage of medicine:

1. You’re not loading hard enough.
   Sorry, but red bands and 5-lb dumbbells forever aren’t fixing your elbow. If you’re climbing and training hard, you need a tendon loading program that matches that level of challenge. Tendons need real tension to adapt.

2. You’re not loading long enough.
   Tendon remodeling takes months, not weeks. Most climbers bail once pain goes down, then act shocked when it comes back.

3. You skipped phases.
   Jumped back into climbing after a week of rest? That’s like using your shredded rope without checking the core. Of course it failed.

4. You’re chasing symptoms, not fixing capacity.
   Ice, massage guns, and voodoo floss may feel good, but they don’t build tendon strength. Only loading does.
   

What Happens If You Don’t Do Progressive Loading

Short answer: you stay stuck. Pain flares every time you push, you waste money on gadgets that don’t work, and eventually you risk a partial or full tendon tear. That means surgery, months off the wall, and a whole lot of Netflix you didn’t plan on.

Progressive loading isn’t optional. It’s the medicine to get you out of pain and back onto your project. Skipping it is like trying to send without chalk — messy, slippery, and bound to fail.

The Bottom Line

Tendons heal when you teach them to handle stress again — progressively, intelligently, and over time. That’s what physical therapists are trained to do: walk you through each phase, keep you from skipping steps, and make sure you’re actually pushing hard enough to get results.

If your elbow, finger, or shoulder pain won’t quit, chances are you’re stuck in rehab purgatory: not enough load, not enough time, and not enough progression. Let’s fix that.

👉 Book a session with Rock Rehab, and let’s get your tendons climbing-ready again — stronger, tougher, and way less whiny than they are right now.

About the author:

Evan Ingerson is a Santa Fe, NM–based physical therapist and climbing lifer with over 25 years of experience on the wall and 9 years helping climbers get out of pain and back to crushing. He specializes in climbing injuries, return to climbing plans, and calling out bad beta—on routes and in training plans. Whether you’re tweaked, gassed, or just trying to climb smarter, Evan’s here to keep you sending.