KIRSTIN WEIBLE, PT, COMT
The Kennedy Stages of Tendinopathy provide a useful gauge on when and how to grade activity in cases of soft tissue pain (muscles, tendons, etc.). It is not always necessary to stop activity completely, but it is not always a good idea to just push through the pain either. The stages suggest the following:
Stage 1: Pain after activity
No need to lessen activity.
Add specific exercises to your routine to address deficits creating your pain. If you have quadriceps weakness, it makes sense to do exercises to strengthen that muscle specifically. These can also be expected to have changes in the tendons, ligaments, and bones of the joint.
Stage 2: Pain at the beginning and after activity
Decrease painful activity by 50%. For example, decrease your cycling distance from 40 to 20 miles.
Add specific exercises. Again, this is still an important step.
Stage 3: Pain at the beginning, during, and after activity, but performance not affected
Decrease painful activity by 75%. Now you’re doing a very little bit of your activity. It’s important to make changes at this phase.
Add specific exercises (someone is beginning to sound like a broken record).
Stage 4: Pain at the beginning, during, and after activity, and performance affected
Stop painful activity…until 25% better. This is important, as the activity has a very clear relationship to your pain. Not temporarily stopping such an activity can lead to continued symptoms regardless of whatever else you do.
Focus on specific exercises to improve to higher stage
The above stages can seem straightforward at first glance, but may be confusing to navigate most effectively on your own. Intervention with a physical therapist can be best to guide you through these stages and get you back to your prior level of performance. And these stages aren’t just for cyclists, they’re for activities of all kinds. If you’re having trouble with any recreational or competitive activities, we are here to guide you through to the other side.