Paul Cramer -MovementSpark

02/18/2026

Why Your Tendon Pain Isn’t Just "Inflammation": 5 Surprising Truths from Modern Science

1. The "Rest and Ice" Trap

If you have struggled with chronic pain in your Achilles, rotator cuff, or knee, you have likely followed the traditional script: rest it, ice it, and wait for the "inflammation" to subside. It is a frustrating cycle. You do everything right, the pain fades slightly, but the moment you return to your sport, the burning ache or stiffness returns.

The reason this approach fails is because of the "Inactivity Trap." Modern clinical science has revealed that inactivity markedly decreases collagen turnover. When you stop moving, you aren't just resting; you are sending a biological signal to your body that the tendon tissue is no longer needed. This causes a decline in tissue quality and capacity. Our understanding of tendon health has undergone a massive shift, moving away from the old "tendinitis" (inflammation) myth toward the evidence-based reality of tendinopathy.

2. Takeaway #1: It’s Not Tendinitis—It’s Tendinopathy

For decades, we blamed "tendinitis," a term implying that simple swelling was the culprit. However, the structural reality of a painful tendon is much more complex than a bit of heat and redness. Research shows that a diseased tendon is in a state of matrix disrepair rather than acute inflammation.

In a healthy tendon, the extracellular matrix is a well-organized network of Type I collagen fibrils, which are strong and aligned to handle force. In a tendinopathic tendon, these fibers become fragmented and disorganized. The body attempts to fix the damage by laying down Type III collagen, which acts as a haphazard, inferior "patch." This Type III collagen lacks the biomechanical strength of the original tissue, leading to a tendon that is thick, disorganized, and less capable of handling load.

"Tendinopathy describes a spectrum of changes that occur in damaged and diseased tendons, leading to pain and reduced function. Tendinopathy is characterized by abnormalities in the microstructure, composition and cellularity of tendon."

3. Takeaway #2: Your Scans Don't Always Match Your Pain

One of the most confusing aspects of tendon health is the "Imaging Paradox." Ultrasound or MRI scans often show "tendinosis" (degeneration) in people who feel zero pain. Conversely, you can have significant pain with a relatively "normal" scan.

We now know that by the time you feel that first "twinge" of pain, structural changes have likely been occurring silently for years. Research using the carbon-14 bomb pulse method suggests that up to 50% of the collagen in a diseased matrix has undergone continuous, slow turnover long before clinical symptoms appear. Pain often represents the late phase of a prolonged disease process.

Because of this, recovery is a marathon, not a sprint. While your pain might subside in a few weeks, the structural recovery of the collagen matrix can take 24 weeks or more to show meaningful change.

4. Takeaway #3: It’s Not Just Overuse—Genetics, Meds, and Metabolism Matter

We often blame a sudden increase in running or lifting for our injuries. While "overuse" is a major trigger, your tendon’s ability to repair itself is influenced by your systemic health. If your "mechanic" only looks at your running shoes and ignores your internal biology, you may never fully recover.

The source material identifies several surprising non-mechanical risk factors:

* Genetics: Specific variations in genes, such as polymorphisms in COL5A1, significantly modify your risk of Achilles tendon pathology.
* Medications: Certain drugs are toxic to tendons. Fluoroquinolone antibiotics are associated with a 2–15% increased risk of tendinopathy and rupture, while excess corticosteroid use can impair physiological healing.

* Metabolic Factors: Conditions like diabetes mellitus, obesity, and hypercholesterolemia (high cholesterol) don't just increase your risk of injury; they actively impair your body’s response to physical therapy.

Reflection: If you have high cholesterol or metabolic issues, your rehab might take longer. Tendon health isn't just about how much you move; it is about your body’s systemic capacity to manage tissue repair and homeostasis.

5. Takeaway #4: Rest is Rarely the Cure (Loading is the Medicine)

The most counter-intuitive truth in modern sports medicine is that inactivity is a signal for weakness. To rebuild a tendon, you must use it. The gold standard of care is now "Tendon Loading Programs," with a specific focus on Heavy Slow Resistance (HSR) training. HSR has been shown to produce high patient satisfaction and, crucially, can actually shift fibril morphology back toward a near-normal appearance.

* The Pain Monitoring Model: Unlike other injuries where pain is a "stop" sign, successful tendon rehab often allows for some discomfort. Clinicians use a "pain monitoring model" where manageable pain (often up to a 4 or 5 out of 10) is allowed during exercise, provided it settles within 24 hours. This discomfort is often necessary to stimulate the tenocytes to produce new, healthy Type I collagen.

"Currently, exercise regimens, referred to as tendon loading programs, remain the most effective conservative approach in the treatment of tendinopathy."

6. Takeaway #5: The Truth About "Quick Fixes" (Injections and Surgery)

When pain persists, many patients look for a "fix" through injections or surgery. However, the modern clinical specialist views these with extreme caution:

* Corticosteroid Injections: These are often a trap. While they may provide transient pain relief (under 6 weeks), they can worsen the condition over 9–12 months. More alarmingly, evidence shows they increase the risk of re-tear rates and even spontaneous tendon rupture in the long term.
* Surgery: For many common issues, such as the shoulder, the mainstay procedure known as Arthroscopic Subacromial Decompression (ASAD) has been put to the test. Multiple multi-centre trials found that ASAD was no better than "sham surgery" (placebo) or structured physiotherapy.

Tendon healing is a slow biological process, not a mechanical "repair." Because tendons have a naturally slow turnover rate, full recovery typically requires 6 to 12 months of consistent, progressive loading.

Conclusion: A New Path Forward

Recovery requires moving away from the "passive" approach of waiting for the pain to stop or seeking a quick shot. Instead, you must adopt an "active" approach that views the tendon as a living, responsive structure that requires specific signals to grow stronger.

Closing Thought: If your tendon is a living structure that adapts to the demands you place on it, are you giving it the right signals to grow stronger, or just waiting for a ‘fix’ that may never come?

If you'd like to learn more about a tendon loading program that would work for you, please reach out. I'd be happy to help.

02/16/2026

**Isometrics: Not Just for the 70’s 🕺**

When you hear “isometrics,” what comes to mind?

Wood-paneled basements. Tube socks. S**g carpet.
Someone pushing against a wall like it’s a serious workout.

It feels outdated.

But here’s the interesting part…

Modern research has quietly brought isometrics back — not because they’re trendy — but because they’re effective.

An interesting fact: Isometrics are probably one of the best and most often used rehab exercise for people with tendon pain!

So what *is* an isometric?

It’s when a muscle produces force without moving.
No lifting. No lowering. Just tension.

You’re holding.
Resisting.
Building strength in stillness.

And that stillness turns out to be powerful.

Here’s why they deserve another look:

1️⃣ They can calm down sensitive tissue
When a tendon or joint is irritated, movement can feel threatening. Isometrics let you load tissue without repetitive motion. It’s not about avoiding load — it’s about introducing it intelligently.

2️⃣ They build strength at specific angles
Strength is joint-angle specific. If you’re weak or painful at a certain position, holding there builds capacity exactly where you need it.

3️⃣ They improve tendon tolerance
Tendons respond well to controlled, sustained tension. Isometrics give them that signal in a very clean, simple way.

4️⃣ They may help lower blood pressure
Research on sustained grip holds and wall sits shows promising effects on resting blood pressure over time. Simple tool. Big potential upside.

5️⃣ They build mental resilience
Holding tension is uncomfortable — but safe. Learning to stay steady in that discomfort builds confidence. And confidence changes pain.

---

If you want to try them today, start here:

• Wall Sit – 20–45 seconds
• Calf Raise Hold – 20–45 seconds
• Split Squat Hold – 20–40 seconds each side
• Plank – 20–60 seconds
• Grip Squeeze (ball or towel) – 30–45 seconds

Do 3–5 rounds.

Start moderate. You don’t need to shake violently for it to “count.”

And here’s the key:

Isometrics aren’t magic.
They’re a tool.

For tendon pain especially, they’re often the bridge between “I’m scared to move” and “I’m rebuilding capacity.”

In a world obsessed with speed and intensity, there’s something powerful about getting stronger without moving at all.

Have you used isometrics before — or do they still feel stuck in the s**g carpet era?

02/16/2026

Achilles Tendinopathy Treatment

MovementSpark Health – Paul Cramer, RMT
Edmonton, Alberta

If your Achilles tendon has been stiff in the morning, sore after runs, or limiting your workouts, it’s not “broken.”

It’s asking for capacity.

At MovementSpark, Achilles tendinopathy treatment focuses on rebuilding the tendon’s strength and tolerance — not just calming pain temporarily.

Understanding Achilles Tendinopathy

Achilles tendinopathy is not primarily an inflammatory condition.

It’s a capacity problem.

Your tendon has been asked to handle more load than it’s currently prepared for — whether that’s:

Increased running volume

Hill training

Court sports

Sudden return to activity

Prolonged standing

Age-related changes in tendon stiffness

The result?

Pain, stiffness, and a reactive tendon that feels fragile — even when it isn’t structurally torn.

Common Symptoms

Morning stiffness in the Achilles

Pain at the back of the heel or mid-tendon

Tenderness with squeezing

Pain during push-off, stairs, or running

Symptoms that warm up… then return later

The tendon is not trying to tell you it’s damaged.

It’s telling you it needs to get stronger.

The MovementSpark Approach to Achilles Tendon Health

My approach is simple, but not simplistic.

We build tendon capacity in phases.

1️⃣ Clear Assessment

We determine:

Irritability level (how reactive is it?)

Load tolerance

Strength deficits

Training errors

Lifestyle stressors (sleep, recovery, total load)

Because tendon health doesn’t live in isolation.

2️⃣ Strategic Loading

Tendons respond to load — not rest alone.

Your program may include:

Isometric holds to reduce pain sensitivity

Slow heavy resistance work

Eccentric or tempo loading

Plyometrics (when appropriate)

Return-to-run or sport progressions

Load is medicine.
Dose matters.

3️⃣ Hands-On Support

As a Registered Massage Therapist, I integrate:

Targeted soft tissue work

Tendon unloading strategies

Shockwave therapy when indicated

Recovery guidance

These support the process — but exercise drives change.

4️⃣ Education & Self-Management

You’ll understand:

Why pain doesn’t always equal damage

How to monitor load

When to push and when to pull back

How to prevent recurrence

This is not passive care.
It’s guided tendon coaching.

How Long Does Achilles Tendinopathy Take to Improve?

Most people notice improvement within a few weeks when loading is consistent.

Full tendon remodeling takes time — often 8–16+ weeks depending on severity.

Tendons adapt slowly.
But they adapt reliably.

Consistency beats intensity.

Can Achilles Tendinopathy Heal on Its Own?

Mild cases may calm down with temporary rest.

But without progressive loading, the tendon’s capacity doesn’t change — and symptoms often return once activity resumes.

The goal isn’t just to reduce pain.

It’s to build resilience.

When to Seek Help

If you have:

Persistent pain beyond a few weeks

Recurring flare-ups

Reduced performance

Fear of pushing off or loading

It’s time to shift from “managing symptoms” to building tendon health.

Start Building Stronger Tendons

If you’re in Edmonton and dealing with Achilles tendon pain, I’d be happy to help.

MovementSpark Health
Paul Cramer, RMT
Tendon-Focused Care

Book an assessment and begin rebuilding capacity.

02/13/2026

5 Things I Would Do If I Had Tendinopathy

(As a 64-Year-Old Active Male — Who Also Happens to Be a Clinician)

If I woke up tomorrow with Achilles pain… or that familiar ache at the outside of my elbow… I’d like to think I’d handle it perfectly.

But I know myself.

I’d probably ignore it for a week.
Tell myself it’s “just tight.”
Maybe stretch it a bit.
Maybe hope it settles.

Because even clinicians are human.

But once I recognized it for what it was — tendinopathy — here’s what I would actually do.

1️⃣ I’d Stop Waiting for It to “Just Go Away”

This is the biggest mistake I see — and yes, I’ve done it too.

Tendon pain often starts subtly. A little stiffness in the morning. A mild ache after activity.

It doesn’t feel serious.

But I now understand that tendons don’t usually fix themselves with passive rest. They adapt to load.

So instead of waiting 6–8 weeks hoping it disappears, I’d begin structured loading early.

Not aggressively.

Just intentionally.

2️⃣ I’d Start Progressive Loading Right Away

For Achilles tendinopathy, that might mean:

Isometric calf holds to calm pain

Slow, controlled calf raises

Gradual increases in volume

For elbow tendinopathy:

Controlled wrist extension loading

Slow tempo strengthening

Grip work progressed carefully

As a 64-year-old, I’d respect recovery.

But I wouldn’t fear load.

Because I know this:
Strength changes tissue.
Confidence changes pain.

3️⃣ I’d Look Honestly at My Recovery

This is where being older (and hopefully wiser) matters.

Am I sleeping enough?
Am I layering stress on top of stress?
Am I trying to train hard while under-recovered?

Tendons don’t just respond to exercise.

They respond to the whole system.

Too intense.
Too heavy.
Too often.
Not enough recovery.

That combination — especially in Edmonton winters when activity patterns shift — can tip the balance.

If my tendon was talking to me, I’d listen.

4️⃣ I’d Probably Get Shockwave

Yes — I would.

Not because it’s magic.

But because I’ve seen radial shockwave therapy help stubborn tendons become more responsive to loading.

For me, it would be part of a plan — not the plan.

Manual therapy to settle sensitivity.
Shockwave to stimulate change.
Progressive strength to rebuild capacity.

If I were honest?
I’d want someone guiding the progression.

Even as a clinician.

5️⃣ I’d Respect the Timeline

This one is humbling.

At 64, I don’t recover like I did at 30.

And tendons don’t remodel overnight at any age.

So I’d give it 12–16 weeks of consistent, intelligent loading.

Not perfection.

Consistency.

And when flare-ups happened — because they probably would — I wouldn’t panic.

I’d adjust load.
I’d zoom out.
I’d remind myself: this is capacity-building, not catastrophe-management.

The Truth

If I had tendinopathy, I wouldn’t treat it like damage.

I’d treat it like a training problem.

Because most persistent tendon pain isn’t about tearing.

It’s about being underprepared for the demands placed on it.

As we get older — and stay active — the solution isn’t to do less.

It’s to train smarter.

02/07/2026

Capacity, not Catastrophe.

If you have tendon pain, your first thought is often:
“Something must be torn.” or "It must be inflamed."

But most of the time, tendon pain isn’t a disaster—it’s a capacity issue.

Your tendon is doing more work than it’s currently trained for.

That’s why:
• Rest alone often doesn’t solve it
• Pain comes back when activity resumes
• Strength-based rehab makes such a difference

Resolving your tendon pain needs a bit of work within tollerable limits. Tendons adapt when we train them gradually and intelligently.

Pain isn’t always a warning of damage—it’s often feedback.
The best way forward is to think about how to build it up, not how to "fix" it.

Capacity, not catastrophe.
Build what the tendon needs.

02/06/2026

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01/30/2026

In Star Trek, the Borg said: “Resistance is futile.”
In real life — especially as we get older — the opposite is true.

Resistance is optimal.

Not extreme.
Not punishing.
Not about grinding harder.
Not about “pushing through pain.”

Just intentional, appropriate challenge.

Your body adapts to what you ask of it.
If you ask for less, it gives you less.
If you ask for strength, resilience, and capacity — it builds them.

Resistance isn’t harm.
It’s information.
It’s how the body learns what it needs to tolerate in real life.

Carrying groceries.
Climbing stairs.
Getting up from the floor.
Walking farther.
Living with more confidence in your body.

So no — resistance isn’t something to avoid.

Used well, it’s how we age better, move better, and live stronger.

Resistance isn’t futile. It’s optimal.

01/14/2026

01/13/2026

Most persistent tendon pain isn’t what we were taught it was.

For years, people have been told their tendon pain is due to “inflammation,” that they should rest, stretch, or wait it out. For many, that advice leads to frustration—not resolution.

We now understand that most long-standing tendon pain is better described as tendinopathy.
That means the tendon isn’t broken—but it is struggling to meet the demands placed on it.

Tendons are built to handle load.
They adapt slowly, but reliably, when the right kind of progressive loading is paired with clear education and reassurance.

My goal is to help reduce confusion around tendon pain and movement.
The focus here is education first—helping people understand what’s going on, rebuild confidence in movement, and move forward with a strength-forward approach.

If you’re dealing with Achilles pain or other stubborn tendon issues, I’ve written a clear, evidence-informed guide that explains:
• why tendon pain behaves the way it does
• why pain doesn’t always mean damage
• what actually helps tendons recover long term

👉 movementspark.com/tendon

In-person care is available through 4 Points Health & Wellness in Edmonton.
Educational programs and courses are currently in development.

You’re not broken.
And tendon pain is rarely a dead end.

01/10/2026

Do you have "long term" Achilles Tendon Pain? Please read this -it will be worth while... This changes everything!

Most people with Achilles pain are told they have tendonitis.

But here’s the important shift:

Most long-lasting Achilles pain isn’t tendonitis.
It’s tendinopathy.

Tendonitis suggests inflammation.
Tendinopathy describes a tendon that’s struggling with pain and the demands we put on it.

That difference matters!

When pain lasts weeks or months, research shows inflammation is often not the main driver anymore. What? you mean it's not an inflamed tendon?

Yes, that's what I mean...
Instead, the tendon’s structure, nervous system sensitivity, and capacity all play a role.

This changes everything.

Because if the problem isn’t just inflammation,
then rest, ice, and “taking it easy” won’t rebuild what’s missing.

Achilles recovery becomes more about progressively restoring strength and trust in the tendon.

It becomes -a strength forward approach -realizing that your tendon is actually pretty amazing and with a little organized help, can be retrained to meet the demands you are putting on it.

You can still be active.

We will use pain as a guide to help us along the way, not as a signal to stop what we're doing.

-Tolerable pain that does not get significantly worse = a green light for continued activity.
-Tolerable pain that might get a bit worse with activity= a yellow light for continued activity with caution -perhaps a bit of extra recovery time between activity.
-Higher pain that is worse and worse the next day = a red light for our activity. we have to step back and really look at what is going on.

09/26/2025

Pricing: Early bird: $445.00 + tax (30 days BEFORE the course date). Includes practice tape at the course, a course manual, and a certificat

09/23/2025

Beyond Tendonitis: A New Path to Lasting Relief

If you’ve been living with tendonitis for months—or even years—you know how discouraging it can feel. Rest, ice, stretches… maybe they helped a little, but the pain always came back. It’s easy to think you’ve run out of options.

The truth? We now know so much more about how to heal tendons than we did even a few years ago. With the right plan, real recovery is possible—even if you’ve been stuck for a long time.

Why Old Approaches Didn’t Work

Traditional treatments focused on short rest periods or generic rehab plans. But tendons heal slowly and need the right kind of load over time—not just weeks, but months. Without that, the pain cycle repeats.

A Smarter Approach

Our program combines the best of today’s tendon science:

Proper assessment with a whole person perspective.

Strategic loading exercises that strengthen tendons instead of irritating them

Alignment and movement coaching so you reduce strain and move with confidence

A realistic 3–5 month plan that gives your body the time it needs to truly rebuild

Why This Brings Hope

You don’t need to settle for managing pain. With the right guidance, tendons can remodel and get stronger—even after years of discomfort.

A better way forward: a step-by-step plan built to restore strength, reduce pain, and help you get back to the activities you love.