Tendinopathy is a common cause of pain and dysfunction, especially in people who lead active lifestyles. Whether you are a runner with Achilles pain, a gym-goer with elbow discomfort or someone who gets shoulder pain from daily tasks, tendinopathy might be behind it.
Despite how often it occurs, many people do not fully understand what tendinopathy is or why it lingers for so long. In this blog, we will explore what tendinopathy is, what causes it, how it feels and what you can do to manage it effectively.
What is Tendinopathy?
Tendinopathy is a condition that affects the tendons, which are the tough, fibrous tissues that connect muscles to bones. It is sometimes called tendinitis, but tendinopathy is the more accurate term. While tendinitis implies inflammation, tendinopathy reflects a broader process that includes tendon overload, breakdown and failed healing responses.
Tendinopathy typically occurs when a tendon is subjected to repeated or excessive load over time without enough recovery. This can cause small changes in the tendon structure and reduce its ability to handle stress.
It is not usually caused by a single injury. Instead, it develops gradually and can become chronic if not managed correctly.
Common Sites of Tendinopathy
Tendinopathy can affect almost any tendon in the body, but some areas are more prone than others.
- Achilles tendon (back of the ankle)
- Patellar tendon (just below the kneecap)
- Gluteal tendons (side of the hip)
- Rotator cuff tendons (shoulder)
- Lateral elbow (commonly known as tennis elbow)
- Medial elbow (golfer’s elbow)
These areas are often exposed to repetitive movements, force or poor loading patterns that can trigger symptoms.
What Does Tendinopathy Feel Like?
Tendinopathy pain is usually quite distinct. Here are some common features:
- Localised pain in the area of the tendon
- Pain that worsens with activity or loading
- Stiffness, especially first thing in the morning or after rest
- Tenderness to touch over the tendon
- Gradual onset, often worsening over time
- Sometimes mild swelling or thickening
The pain often starts as a mild discomfort during or after activity. Over time, it can become more constant and affect performance, daily movement and even sleep.
Why Does Tendinopathy Happen?
Tendinopathy is typically caused by a mismatch between the load placed on a tendon and the tendon’s ability to cope with that load. Common contributing factors include:
- Sudden increase in activity or training load
- Poor technique or biomechanics
- Muscle weakness or imbalance
- Inadequate recovery between sessions
- Age-related changes to tendon structure
- Occupations or hobbies that involve repetitive movements
It is not only athletes who get tendinopathy. People who work in trades, do repetitive manual tasks or spend long hours at a desk with poor posture are also at risk.
What Tendinopathy Is Not
It is important to understand that tendinopathy is not usually caused by inflammation in the classic sense. Anti-inflammatory medication and rest alone do not solve the problem. In fact, complete rest can sometimes make it worse by reducing the tendon’s ability to tolerate load.
Tendinopathy is not a tear or rupture. Although the tendon may be sensitive and irritated, it is not typically an emergency condition. However, it does require proper management to avoid worsening.
How is Tendinopathy Diagnosed?
Tendinopathy is usually diagnosed through a clinical assessment. A physiotherapist will ask about your symptoms, activity levels and training history. They will examine the affected area to look at tenderness, strength, range of motion and load tolerance.
Imaging such as ultrasound or MRI is not always necessary unless the diagnosis is unclear or symptoms are not improving.
Can Tendinopathy Heal on Its Own?
Mild cases of tendinopathy may settle with short-term rest and load reduction. However, chronic or moderate cases often need a structured rehab plan to properly restore tendon health.
The key to recovery is not just reducing pain, but restoring the tendon’s ability to handle load again. This is where exercise and progressive loading are essential.
Best Treatments for Tendinopathy
The most evidence-based treatment for tendinopathy is a progressive loading programme. This involves gradually increasing the stress placed on the tendon through specific exercises designed to promote adaptation and healing.
- Isometric exercises – Holding a muscle contraction without movement to reduce pain and gently load the tendon
- Eccentric loading – Slowly lengthening the muscle while under tension to strengthen the tendon
- Heavy slow resistance training – Using higher loads with slow controlled movements to improve tendon capacity
- Biomechanical correction – Addressing poor posture, gait or movement habits that contribute to the issue
- Manual therapy – Hands-on treatment to support mobility and ease surrounding tension
- Load management – Adjusting activity levels to avoid flare-ups while maintaining enough movement to support healing
Other adjuncts such as shockwave therapy or dry needling may be used in stubborn cases, but they should not replace a proper rehab plan.
What About Injections or Surgery?
Injections, such as corticosteroids, may reduce pain in the short term but can weaken the tendon if overused. They do not address the underlying cause and are not recommended as a first-line treatment.
Surgery is very rarely needed and usually only considered in severe cases that do not respond to several months of structured rehabilitation.
How Long Does Recovery Take?
Recovery from tendinopathy can be slow. Tendons adapt at a slower rate than muscles. With consistent rehab, many people see improvement within 8 to 12 weeks, but some cases take longer.
The most important factor is consistency. Skipping rehab or returning to high load too quickly can lead to setbacks.
Can Tendinopathy Come Back?
Yes, tendinopathy can recur, especially if the root cause is not addressed. This is why long-term management is important. Building strength, maintaining good movement habits and managing training loads can reduce the risk of recurrence.
Physiotherapy not only helps with the current issue but gives you the tools to prevent future problems.
Final Thoughts
Tendinopathy is common, but with the right approach, it is manageable. Understanding the condition, being patient with recovery and following a structured rehab plan are the keys to long-term success.
At Red Physiotherapy Northampton, we help people every day with tendon-related pain. Whether your symptoms are recent or have been lingering for months, we can help guide your recovery with an evidence-based approach tailored to your lifestyle.
If you are dealing with tendon pain, do not wait for it to go away on its own. Get the support you need and take the first step toward lasting relief.