Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study

Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J · The American Journal of Sports Medicine

Continuing to train within defined pain limits produced no worse outcomes than rest at any timepoint over 12 months — moderate, monitored pain during loading is tolerable; the harm signal belongs to sharp/escalating pain, not all pain.

Population

38 patients with Achilles tendinopathy

Intervention

Continued tendon-loading sport within a pain-monitoring model (pain allowed up to 5/10, no worsening next day)

Comparator

Active rest with training restriction

Limitations

Tendon, not cartilage; small trial; defines a pain ceiling rather than testing 'loading through sharp pain' directly.