Ordinary Loads: Tendons and Ligaments in Everyday Life

You do not have to play tennis to develop tennis elbow. Sometimes the most demanding loads are hidden inside the ordinary things we do every day.

A spell of carrying a growing child. A weekend spent gardening. Decorating a room, moving house or returning to long walks after a quiet winter. None of these activities sounds particularly dangerous, yet each can be followed by a painful elbow, shoulder, wrist, knee or ankle.

The interesting question is not simply what the person did, but why that familiar activity became uncomfortable when it did.

Our bodies do not divide movement into exercise and everyday life. A tendon does not know whether it is being loaded by a dumbbell or a heavy shopping bag. A ligament does not know whether an ankle turned during sport or while stepping off a kerb. Tissues encounter force, speed, repetition, duration and recovery—not the name we give to the activity.

Most of the time, these ordinary loads are helpful. They give our tissues a reason to remain capable. Occasionally, however, the demands of life begin to exceed what a tendon or ligament is currently prepared to manage.

That does not necessarily mean the body is damaged, weak or wearing out. It means that load and capacity have temporarily fallen out of step.

Your body is working even when you appear still

Tendons connect muscles to bones. They transmit the force produced by a muscle so that we can move a joint, control it or hold it steady. Some tendons, including the Achilles, also store and release elastic energy as we walk and run.

This means that tendons are working even when there is no obvious movement.

When you carry a child, for example, the arm may appear relatively still. Beneath the surface, however, muscles are continuously producing force. The fingers maintain their grip, the wrist muscles prevent the hand from collapsing forwards, the forearm adjusts as the child moves and the shoulder and trunk prevent the combined weight of adult and child from pulling the body off balance.

A static hold is therefore not an absence of work. In some circumstances, sustained work can be more tiring than repeatedly lifting and lowering an object, because the muscles and tendons are given fewer opportunities to relax.

Ligaments perform a different role. They connect one bone to another and help guide and restrain the movement of a joint. During ordinary movement, they contribute to stability. When a joint is suddenly forced too far or too quickly, some of their fibres may be stretched or torn, producing a sprain.

This distinction is important. Tennis elbow is a tendon problem, not a ligament injury. A typical ankle sprain is a ligament injury. Both may hurt during movement, but they do not represent the same process and should not automatically be managed in the same way.

An ordinary task can contain a surprising amount of load

The weight of an object tells us only part of the story.

A child held close to your chest generally places less demand on the arm and shoulder than the same child held farther away. The child has not become heavier, but the longer lever increases the muscular force needed to support them. If they wriggle, lean or suddenly throw their weight backwards, the direction and speed of the load change as well.

Duration matters too. Picking up a child once is different from carrying them around a supermarket. Holding a shopping bag for ten minutes is not simply one lift; it is a prolonged gripping task. Painting a ceiling is not one overhead reach but hundreds of repeated movements performed with the arm elevated.

Even a relatively light task may become demanding when it is prolonged, repeated, performed at speed or introduced suddenly. A weekend of gardening after several inactive months may expose the hands, wrists, elbows and shoulders to more work than they have recently experienced. A walking holiday may ask more of the Achilles tendon in three days than the previous three months combined.

The problem is not necessarily that the activity is harmful. The difficulty may be that the increase happened more quickly than the body could adapt to it.

Load is not only something the body survives

It is easy to imagine tendons and ligaments as pieces of rope that gradually fray with use. Living tissue is

much more responsive than this analogy suggests.

Cells within a tendon sense mechanical force and alter their activity in response. This process, known as mechanotransduction, influences how the surrounding collagen-rich matrix is maintained and reorganised. As Chatterjee, Muljadi and Andarawis-Puri explain, these exchanges between tendon cells and their mechanical environment contribute both to healthy adaptation and to the disrupted repair response seen following excessive or poorly tolerated loading.

Appropriately dosed resistance can make tendons more capable. A systematic review by Lazarczuk and colleagues found that mechanical-loading programmes could increase the stiffness and material properties of healthy lower-limb tendons. In other words, tendons do not simply lose something each time they are used. Loading also gives them the stimulus to adapt.

Too little load can allow capacity to decline. Too much, too soon, may provoke pain. Between those extremes lies the gradual, repeated challenge through which the body becomes more capable.

This is why the same activity can have different effects at different times. A long walk may help prepare one person for a walking holiday while provoking another person who has recently been unwell, injured or inactive. The difference is not necessarily determination, age or “good” and “bad” movement. It is the relationship between the task and the capacity available on that particular day.

Why tendons become painful

Persistent tendon pain is usually described as tendinopathy. It commonly affects the Achilles tendon, the patellar tendon at the knee, the rotator-cuff tendons of the shoulder, the gluteal tendons around the hip and the tendon attachment involved in tennis elbow. The older term tendinitis implies that inflammation is the defining problem. Inflammatory processes can be involved, but they do not fully explain the condition. Similarly, describing every tendinopathy as degeneration or a collection of tiny tears makes a complex process sound deceptively simple.

An international clinical consensus recommends tendinopathy as the most appropriate general term for persistent tendon pain associated with reduced function or tolerance of loading (Scott et al., 2020).

Research has identified changes in collagen organisation, tendon cells, blood vessels, sensory nerves and the material surrounding the cells. Importantly, these changes do not always correspond neatly with pain. Millar and colleagues therefore describe tendinopathy as a complex, multifactorial condition rather than a simple inflammatory or wear-and-tear disorder.

This helps explain why a painful tendon does not always improve through rest alone. Rest may reduce the immediate irritation, but it does not necessarily rebuild the tendon’s ability to manage the task that caused the difficulty. It also explains why pain during a movement does not automatically mean that more fibres are tearing. Pain deserves attention, but it is not a running total of structural damage.

So, can carrying a child cause tennis elbow?

It can certainly contribute. Tennis elbow, or lateral elbow tendinopathy, affects the common attachment of several wrist-extensor muscles on the outside of the elbow. These muscles do more than move the wrist backwards. They also stabilise the wrist while the fingers grip. When you lift and carry a child, the fingers hold, the wrist stabilises and the forearm repeatedly rotates as the child is picked up, put down and repositioned. If the child is held on the same side for long periods, the exposure becomes both sustained and asymmetrical.

It is therefore entirely plausible that a period of prolonged child-carrying could provoke an elbow that was already approaching the limit of its capacity. That is not quite the same as saying that carrying the child single-handedly “caused damage”. Tendon pain rarely provides such a tidy chain of cause and effect.

A systematic review of occupational evidence found associations between lateral elbow tendinopathy and combinations of mechanical exposure, including forceful work and forearm rotation. Interestingly, repetition or gripping considered in isolation was not consistently associated with the condition (Bretschneider et al., 2022). The whole pattern of exposure appears to matter more than any single movement.

The most accurate explanation may therefore be that carrying the child was one contributor within a wider picture. The child may have become heavier. Carrying time may have increased. Sleep and recovery may have changed. The tendon’s previous conditioning, work demands and other daily activities may also have influenced how much load it could tolerate.

Small changes can sometimes make the activity more manageable: holding the child closer to the body, changing sides, using both arms, sharing longer periods of carrying or breaking a task into shorter intervals. These are ways of adjusting the dose while symptoms settle. They are not an admission that the person has been carrying “incorrectly”.

The parent’s wrist tells a similar story

De Quervain’s syndrome affects tendons and their surrounding sheath on the thumb side of the wrist. It can make lifting a baby, opening containers, gripping and moving the thumb particularly painful.

The condition is sufficiently common among new mothers that it is sometimes called “mother’s wrist”.

That nickname can make repeated lifting sound like the entire explanation. The reality is less certain.

The British Society for Surgery of the Hand notes that mothers of young babies are particularly susceptible, but also acknowledges that it is unclear how much this reflects repeated lifting and how much it relates to pregnancy and postpartum biological changes.

This distinction matters because it avoids blame. A parent has not necessarily injured their wrist through poor technique. Childcare demands, tissue sensitivity, altered recovery and biological changes may all be present at the same time. Changing how a baby is lifted may reduce symptoms, but it does not prove that the original movement was faulty or that one perfect lifting method exists.

Ligaments usually tell a different story

Where tendinopathy often develops gradually, a ligament sprain is more likely to follow a recognisable event. The ankle rolls while walking on uneven ground. A knee twists while turning. A thumb or wrist is forced backwards during a fall.

A mild sprain involves stretching and limited fibre damage without obvious instability. A moderate sprain includes a partial tear and greater loss of function. A severe sprain may involve complete rupture and marked instability. The American Academy of Orthopaedic Surgeons provides a useful clinical description of these grades, although an individual injury may not fit neatly into one category without examination.

The pain of a sprain is only one part of the problem. Swelling, reduced movement and temporary loss of confidence in the joint can alter how a person walks or uses the limb. Even after the pain has largely settled, balance and rapid protective responses may remain impaired.

This is why rehabilitation after an ankle sprain often includes balance, strength and movement-control exercises rather than waiting for discomfort to disappear. Clinical guidance supports progressive exercise and a graded return to normal activity, particularly because incomplete recovery can contribute to repeated sprains and chronic ankle instability (Martin et al., 2021).

The return of load is part of recovery, but its timing and amount depend on the ligament involved and the severity of the injury. Evidence from animal studies suggests that mechanically loaded healing ligaments may eventually become stronger and stiffer than completely unloaded ligaments, although the research is limited and cannot tell us the ideal dose for an individual person (Bleakley and Netterström-Wedin, 2023). Protection and loading are not opposing ideas. Early protection may be appropriate after an injury; progressively restored movement becomes important as healing advances.

Pain and damage are related, but they are not the same thing

Pain is real, but it is not a precise measurement of structural damage.

A tendon can be very painful without being close to rupture. Another tendon can display visible structural changes on a scan while causing no symptoms at all. How the tissue looks, how it functions and how it feels are connected, but they are not interchangeable.

A striking example comes from a 2026 MRI study of 602 adults aged between 41 and 76. Almost every participant had at least one rotator-cuff finding, including many people whose shoulders were not painful. Tendon abnormalities were only slightly more common in painful shoulders than in symptom-free ones (Ibounig et al., 2026).

This does not mean scans are useless. A scan may be extremely important when a significant tear, rupture or other pathology is suspected. It means that an image must be interpreted alongside the person’s symptoms, strength, movement, history and function.

A scan showing age-related or tendon changes is not a prediction of inevitable decline. Equally, a normal scan does not make someone’s pain imaginary.

The person attached to the image remains the most important part of the assessment.

Why one person develops pain and another does not

Two people can perform the same task and have very different experiences. This is partly because no two people arrive at that task with the same history.

Recent activity is important. A tendon accustomed to regular loading will generally have a different capacity from one that has had several months of reduced use. Previous injury may alter strength, movement or confidence. Age can influence tissue properties, but it does not remove the capacity to adapt.

General health can also affect connective tissue. Diabetes, for example, can alter tendon structure, collagen behaviour, cellular function and healing (Vaidya, Lake and Zellers, 2023). A wider systematic review has found associations between tendinopathy and metabolic factors including diabetes, altered blood lipids and higher body mass index, although much of this evidence is observational and cannot demonstrate simple cause and effect (De Luca et al., 2025).

Pregnancy, the postpartum period and menopause may also influence tendon symptoms and capacity. Hormonal explanations remain tempting, but biological change rarely occurs in isolation. Sleep, recovery, activity, childcare, work and previous conditioning may all change at the same time.

Medication occasionally matters as well. Fluoroquinolone antibiotics can, very rarely, cause serious tendon problems. The UK Medicines and Healthcare products Regulatory Agency advises people who develop tendon pain or swelling during or after one of these medicines to seek prompt medical advice, particularly where other risk factors are present (MHRA, 2024).

None of these factors means that a person is fragile. They explain why treatment and recovery need to be shaped around the individual rather than around the name of the condition alone.

Recovery is usually about rebuilding, not simply resting

When an activity hurts, stopping it can bring short-term relief. Sometimes a brief period of protection or reduced activity is exactly what is needed. The difficulty comes when rest becomes the entire plan.

If a tendon is never asked to work, it is given little reason to become better at working.

Recovery from tendinopathy often begins by adjusting the most provocative part of the load. A person might temporarily reduce the length of a walk, divide a gardening job over several days, carry for shorter periods or change the position in which a task is performed. The aim is not to avoid movement indefinitely, but to create enough breathing space for capacity to be rebuilt.

Progressive resistance exercise can then help the tendon tolerate increasing force. A systematic review by Pavlova and colleagues found that externally loaded exercise, sufficient intensity and adequate recovery between sessions may be important, although the evidence does not support one ideal programme for every tendon and every person.

Eventually, rehabilitation must resemble real life. A parent needs more than the ability to perform a controlled exercise; they need to lift a tired child from an awkward position. A gardener needs grip endurance. A runner needs the Achilles tendon to accept force quickly. A person recovering from an ankle sprain needs to cope when the ground is less predictable than a clinic floor.

Exercises are not the destination. They are preparation for the life the person wants to resume.

Where massage therapy can help

Massage cannot knit a torn ligament together or manually rearrange the collagen inside a tendon. It cannot determine from touch alone whether a tendon is inflamed, degenerative or partially torn.

Fortunately, massage does not need an implausible structural explanation in order to be useful.

Treatment may ease pain, reduce protective muscular tension and help an area feel safer to move. It may provide a period of respite when persistent discomfort has made the whole limb feel guarded or overworked. It can also create space to discuss how symptoms behave, which activities appear to provoke them and where manageable changes could be made.

The evidence for manual therapy in tendon conditions remains mixed. A Cochrane review found little or no clinically important advantage from manual therapy and exercise over placebo in the principal high-quality trial concerning rotator-cuff disease, while the wider evidence was limited (Page et al., 2016). An overview of treatments for lateral elbow tendinopathy similarly found low or very low certainty around several manual approaches (Ariie et al., 2023).

This does not mean that someone who feels better after massage is mistaken. It means that immediate comfort should not be confused with proof that tissue has been structurally repaired.

Massage is most defensible as part of a wider process: helping to settle symptoms, supporting comfortable movement and reducing unnecessary fear while the person rebuilds capacity. When a significant tear, rupture or unstable joint is suspected, appropriate assessment takes priority.

When ordinary pain may need further assessment

Many aches related to changes in activity settle with sensible adjustments and gradual recovery. Some presentations deserve more urgent attention.

A sudden snap or pop followed by marked weakness or loss of function may indicate a tendon rupture. A rapidly swelling or visibly unstable joint, inability to bear weight after an injury, obvious deformity, increasing numbness or a limb becoming unusually pale or cold should also be assessed promptly.

Redness, heat, fever or feeling systemically unwell cannot safely be assumed to be an ordinary tendon or ligament problem. New tendon pain associated with fluoroquinolone antibiotics should be discussed promptly with a doctor or pharmacist.

Pain that steadily worsens, repeated joint giving-way, progressive weakness or failure to regain normal function also warrants further assessment, even if the original activity appeared harmless.

Ordinary movement is not the enemy

Everyday life is full of load. We carry, grip, reach, climb, balance and occasionally react to the unexpected. These forces are not simply hazards to be avoided. They are part of the conversation through which the body maintains and develops capacity.

Sometimes the conversation becomes unbalanced. The child becomes heavier. The walk becomes longer. The gardening becomes more intensive. Recovery becomes shorter. A tissue that was comfortably managing yesterday’s demands begins to struggle with today’s.

The answer is rarely to fear the movement forever. More often, it is to understand the load, make it temporarily more manageable and gradually prepare the body to meet it again.

Carrying a child can contribute to tennis elbow. A long walk can provoke the Achilles. A misplaced step can sprain an ankle. But these experiences do not reveal a badly designed or irreversibly damaged body.

They reveal a living body responding to what has recently been asked of it—and, in most circumstances, retaining the ability to adapt to what it will be asked to do next.

This article is intended for general education and does not provide an individual diagnosis or treatment programme.

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