Why tendons are the stubbornest tissue in the body
Tendon problems — Achilles, patellar, rotator cuff, tennis elbow — share a frustrating profile: they develop slowly, hang around for months, and resist quick fixes. The biology explains why: tendons have poor blood supply, so their repair metabolism is slow, and their pathology is degenerative more than inflammatory (Cook and Purdam, 2009) — the collagen matrix becomes disorganised.
Two consequences follow:
- Rest doesn't heal them. Unloaded tendon doesn't remodel; it weakens.
- Anti-inflammatories barely touch them. There is often little classic inflammation to suppress in chronic cases.
What tendons need is stimulated repair + graded load. That's exactly the combination our protocol delivers.
Where MLS laser fits in
Photobiomodulation stimulates mitochondrial activity in tendon cells (tenocytes), increasing ATP production, collagen synthesis and local microcirculation — precisely the resources the tendon lacks. Meta-analysis evidence (Tumilty et al., 2010) supports low-level laser for tendinopathy when correct doses are used, and Bjordal et al. (2006) measured direct reduction of inflammatory mediators around the Achilles after laser treatment.
Our MLS® Mphi 75 delivers synchronised 808nm + 905nm wavelengths, which lets us treat both the pain and the tissue metabolism in the same session.
The protocol, phase by phase
Phase 1 — Reactive phase (typically weeks 1–2, sessions 1–4)
- MLS laser 2–3× per week over the tendon and paratendon
- Load reduced, not removed: isometric holds (e.g. heavy isometric calf holds for Achilles) — evidence shows isometrics reduce tendon pain acutely
- Identify and correct the load error that started it: training spike, footwear change, technique
Phase 2 — Remodelling begins (weeks 2–6, sessions ~4–10)
- MLS laser reduced to 1–2× per week
- Heavy slow resistance loading enters: slow, heavy, progressive — the strongest evidence base for tendon remodelling (Malliaras et al., 2013)
- Pain monitoring rule: ≤3/10 during exercise, settled by next morning
Phase 3 — Capacity and return (weeks 6–12)
- Laser only as needed for flare management
- Energy-storage loading for athletes: hopping, jumping, sprinting progressions
- Objective re-testing before full return: strength symmetry and pain-free loaded range
What results to expect
Most patients feel meaningful pain reduction within 4–6 laser sessions. But — and this is the honest part — pain relief is not tissue repair. The collagen remodelling that makes the tendon robust takes 8–12 weeks of progressive loading. The laser opens the door; the loading programme walks you through it. Skip the second part and the pain returns with the first training spike.
Struggling with a tendon that won't settle? Book a tendinopathy assessment at Bruno Physical Rehabilitation, Ipswich.
References
- Tumilty, S., Munn, J., McDonough, S. et al. (2010) 'Low level laser treatment of tendinopathy: a systematic review with meta-analysis', Photomedicine and Laser Surgery, 28(1), pp. 3–16.
- Cook, J.L. and Purdam, C.R. (2009) 'Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy', British Journal of Sports Medicine, 43(6), pp. 409–416.
- Hamblin, M.R. (2017) 'Mechanisms and applications of the anti-inflammatory effects of photobiomodulation', AIMS Biophysics, 4(3), pp. 337–361.
- Malliaras, P., Barton, C.J., Reeves, N.D. and Langberg, H. (2013) 'Achilles and patellar tendinopathy loading programmes: a systematic review', Sports Medicine, 43(4), pp. 267–286.
- Bjordal, J.M., Lopes-Martins, R.A. and Iversen, V.V. (2006) 'A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations', British Journal of Sports Medicine, 40(1), pp. 76–80.