Tendon pain is a very common reason people seek physiotherapy. Whether it’s a sore Achilles after running, persistent elbow pain from work, or shoulder discomfort when lifting your arm, the underlying cause is often tendinopathy.
Despite how common it is, tendinopathy is frequently misunderstood. Many people think it is simply “inflammation of a tendon,” but modern research shows it is more complex than that.
In this blog, we’ll explain what tendinopathy is, why it develops, who is at risk, and how physiotherapy can help you recover safely and effectively.
What Is Tendinopathy?
A tendon is the strong connective tissue that attaches muscle to bone. When a muscle contracts, the tendon transfers that force to move the joint.
Tendinopathy refers to a condition where the tendon becomes irritated and painful, usually due to repeated overload over time.
Inside a healthy tendon, collagen fibres are arranged in strong, parallel lines that allow the tendon to handle significant forces. However, when tendons are repeatedly overloaded without enough recovery, these collagen fibres may start to react and become first irritated and if the overload persists they may start to degenerate.
Normally, the body lets us know the tendon is at risk through a pain and we adjust our activities accordingly and the reactive tissue settles down. But if the tendon continues to be stressed without adequate recovery time, the repair process becomes disrupted. Over time this can lead to:
- Disorganisation of collagen fibres
- Thickening of the tendon
- Reduced structural strength
- Increased sensitivity and pain
What Causes Tendinopathy?
Tendinopathy usually develops from repeated mechanical stress combined with inadequate recovery.
Common causes include:
Sudden increases in activity
For example:
- Increasing running distance too quickly
- Returning to sport after time off
- Starting a new gym program or activity
Repetitive movements
Occupations and activities that involve repetitive gripping, lifting, or overhead movements can overload tendons over time. Tradespeople often suffer with these types of conditions.
Muscle weakness or imbalance
When surrounding muscles are weak or poorly coordinated, tendons may absorb more force than they are designed to handle.
Joint movement issues
Both restricted movement and excessive joint mobility can increase tendon strain.
Risk Factors for Tendinopathy
Some factors increase the likelihood of developing tendon problems.
Non-modifiable risk factors
These include things that cannot easily be changed:
- Age
- Genetics
- Biological sex (women appear slightly more predisposed)
Health-related factors
Certain medical conditions can influence tendon health, including:
- Obesity
- Diabetes
- High cholesterol
These conditions can affect the way tendons repair themselves and may slow recovery.
Lifestyle and training factors
- Rapid changes in training load
- Poor recovery between activities
- High-intensity sport or manual work
Athletes experience tendinopathy frequently, accounting for around 30% of sports-related injuries.
Common Types of Tendinopathy
Tendinopathy can occur in many areas of the body, but some tendons are affected more often.
Achilles tendinopathy
Located at the back of the ankle.
Common in runners and people who perform jumping activities.
Patellar tendinopathy (Jumper’s Knee)
Occurs at the front of the knee just below the kneecap.
Frequently seen in sports that involve jumping and sprinting.
Gluteal tendinopathy
A common cause of outer hip pain, particularly in middle-aged adults, women with wider hip angles and runners.
Rotator cuff tendinopathy
Very common due to the importance of the rotator cuff muscles about the shoulder joint and the shoulder’s varied ranges of motion requiring coordinated muscle function. Rotator cuff tendinopathy affects the tendons in the shoulder and can cause pain when lifting the arm.
Tennis elbow (lateral epicondylitis)
Causes pain on the outside of the elbow, often linked to repetitive gripping or wrist movements.
Signs and Symptoms of Tendinopathy
Symptoms usually develop gradually over time rather than suddenly.
Common symptoms include:
- Localised tendon pain
- Pain during or after activity
- Morning stiffness
- Tenderness when pressing on the tendon
- Reduced strength
- Pain when loading the tendon (for example jumping or lifting)
A key feature is that pain often improves with gentle movement but worsens with excessive load.
How Is Tendinopathy Diagnosed?
Diagnosis begins with a thorough assessment by a physiotherapist.
This usually includes:
Clinical assessment
Your physiotherapist will ask questions about:
- When the pain started
- Activities that aggravate it
- Training or workload changes
They will also examine the affected area, checking:
- Tenderness along the tendon
- Strength and movement
- Pain during specific tests
Examples include:
- Single leg heel raises for Achilles tendinopathy
- Single leg decline squat for patellar tendinopathy
- Resisted wrist extension for tennis elbow
Imaging (when required)
In some cases imaging may help confirm the diagnosis or rule out other conditions.
Common options include:
- Ultrasound
- MRI
- Xray to rule out other conditions
Ultrasound imaging can show tendon thickening, changes in collagen structure, and increased blood vessel growth within the tendon.
However, imaging is not always necessary, as tendinopathy is often diagnosed clinically.
How Is Tendinopathy Treated?
The good news is that most tendinopathies respond very well to physiotherapy treatment.
Treatment typically focuses on improving the tendon’s ability to tolerate load.
Load management
One of the most important steps is adjusting activities temporarily to allow the tendon to settle while still maintaining some movement.
Complete rest is rarely recommended.
Instead, the goal is to find the right level of activity that keeps the tendon moving without aggravating it.
Exercise rehabilitation
Specific exercise programs are considered the gold standard treatment for tendinopathy.
These programs may include:
Isometric exercises
These involve muscle contractions without movement and can help reduce pain.
Eccentric exercises
These strengthen the tendon while it lengthens under load and can improve tendon structure and resilience.
Progressive strengthening
Gradually increasing load helps the tendon adapt and tolerate stress again.
Other physiotherapy treatments
Depending on the condition, physiotherapists may also use:
- Shockwave therapy
- Laser therapy
- Manual therapy
- Movement retraining
- Taping and other external supports such as braces
These treatments may support recovery but are usually combined with exercise-based rehabilitation.
What About Injections or Surgery?
Injection therapies are sometimes considered when conservative treatment hasn’t provided enough relief.
These may include:
- Platelet-rich plasma (PRP) injections
- Autologous Tenocyte Implantation
Note research shows that corticosteroid injections often provide only short-term relief, and repeated use may weaken the tendon and contribute to long term issues and are therefore not usually recommended for tendons.
Surgery rare and is considered only after extended conservative treatment has failed.
The vast majority of people improve with non-surgical physiotherapy management.
Why Early Treatment Matters
Tendinopathy often becomes more difficult to treat if symptoms persist for a long time.
Early assessment can help:
- Identify contributing factors
- Correct movement patterns
- Develop a structured rehabilitation plan
- Reduce the risk of long-term tendon damage
Addressing the issue early also helps people return to their normal activities faster and more safely.
How Physiotherapy at Logan Physio Can Help
At Logan Physio, our physiotherapists regularly help people manage and recover from tendinopathy.
Your treatment plan may include:
- A detailed assessment of the affected tendon
- Identification of training or workload factors
- A personalised strengthening program
- Advice on activity modification and recovery
The goal is not just to settle the pain but to build stronger, more resilient tendons that can tolerate activity again.
Take the First Step Toward Recovery
If you’re experiencing persistent tendon pain in your shoulder, elbow, hip, knee, or ankle, early treatment can make a significant difference.
A physiotherapy assessment can help determine the cause of your symptoms and guide you toward the most effective treatment plan.
📅 Book an appointment with Logan Physio today and take the first step toward getting back to the activities you enjoy.
