Understanding Tendinopathy: From Pain to Prevention

Written by: Brian Bannon, Senior Physiotherapist @ Uplift Physio

Tendinopathy is a common condition that can affect athletes, desk workers, and active individuals alike. It often starts as a minor pain near a joint that can become a chronic issue if left untreated. Understanding the condition is the first step toward effective treatment and a full recovery. It can be extremely stubborn and therapists often find that it’s one of the trickiest injuries to treat.

Our Senior Physiotherapist, Brian, is here to break it all down for you, and how you can approach tendinopathies with an effective step-by-step guideline!

What is Tendinopathy?

Tendinopathy is a broad term for a painful and impaired tendon. While often confused with tendonitis, which is inflammation, tendinopathy is more complex and can involve degeneration, microtears, and failed healing of the tendon. Tendinopathy is a dysfunction of the tendon that typically results from excessive loads that the body cannot handle, and it is classified as an overuse injury with a gradual onset of pain.

The "Continuum of Tendon Pathology" model, developed by expert Jill Cook, describes tendinopathy as a spectrum with three progressive stages: reactive tendinopathy, tendon disrepair, and degenerative tendinopathy.

·      Reactive Tendinopathy: This is an initial, short-term response to excessive stress or load, such as a sudden increase in physical activity. The tendon thickens and stiffens in this non-inflammatory stage.

·      Tendon Disrepair: This stage is characterized by a significant breakdown of the tendon's matrix, including collagen separation and disorganization, and is a result of a failed healing response to overloading.

·      Degenerative Tendinopathy: Also known as tendinosis, this is a condition where the tendon's collagen fibres break down and weaken, often due to overuse.

Fortunately, this process can be reversed with the tendon being able to return to its normal healthy self if properly managed and the correct rehabilitation steps are taken.

The ‘Tendon Continuum’

Just because it becomes a ‘degenerative tendinopathy’ doesn’t mean it’s not able to recover. It just needs more investigations, deeper dive into biomechanics and your lifestyle, and formulating an efficient plan that suits you!

There’s not a one-size-fits all tendon programme - so don’t fall into the trap of doing a generic programme!

Signs and Symptoms

Tendinopathy symptoms usually appear gradually over time and may include:

·      Localized pain during or after an activity.

·      Stiffness, particularly in the morning or after a period of rest.

·      Swelling or thickening of the tendon.

·      Tenderness to the touch.

·      Weakness or reduced function in the affected limb.

Common areas for tendinopathy include the Achilles tendon (heel), patellar tendon (knee), rotator cuff tendons (shoulder), and the lateral and medial epicondyles (tennis and golfer's elbow).

Leg extension isometrics could be a good way to reduce pain in the patella tendon.

It has to be maximal effort - isometrics tend not to cause any flare-ups or pain due to it being in a very safe and pain-tolerant range of motion!

Causes and Risk Factors

Tendinopathy is typically an overuse injury that occurs when a tendon is repeatedly strained without adequate time for rest and recovery. The key factor is "overload," which is any activity that exceeds what the tendon is currently adapted to handle. This can happen from a sudden increase in the volume, intensity, or frequency of training, or by returning to high-load activities too quickly after a period of inactivity.

Treatment and Rehabilitation

The key to treating tendinopathy is a structured rehabilitation plan that focuses on managing load and strengthening the tendon. Tendons heal slowly, so it's important to be patient and persistent, as improvement can take 6 to 12 weeks with consistent rehab. Severe or chronic cases may take several months to heal.

Rehabilitation often involves a progression of exercises, including isometric, isotonic, and plyometric movements. Heavy strength training with long times under tension has been shown to be a particularly effective stimulus for triggering adaptation of the tendon's mechanical properties. This type of training can lead to a significant increase in tendon stiffness and muscle strength.

Let’s think force = mass * acceleration. The higher the weight or faster the speed of an exercise, the more force that will be transmitted through those tendons. Given this, we can use this equation as a guide during our tendon rehabilitation!

Mid-to-late stage rehab - we started incorporating some plyometrics when the tendon became more tolerant to SPEED.

This increases the amount of stress and force placed on the tendon - making it more resilient and adaptable!

Prevention

Once you've experienced tendinopathy, you are more susceptible to it returning if you aren't careful. To prevent a recurrence, it is important to:

·      Warm up properly before any physical activity.

·      Include regular strength training and load the tendon through a joints full range of motion.

·      Gradually increase your training intensity and volume (roughly no more than a 10% increase each week).

·      Listen to your body, as pain is a warning sign that should not be ignored.

·      Not neglecting SPEED training as part of your injury prevention plan!

Final Thoughts...

Tendinopathy is a common and frustrating condition, but it doesn’t have to sideline you forever. Understanding what it is and how to manage it puts you in control of your recovery. If you’re dealing with persistent tendon pain, don’t wait—get it assessed early, and stick with a structured rehab plan. Your tendons will thank you.

Need help managing tendon pain? Reach out to one of our qualified Physiotherapist’s at Uplift Physio to help you regain control of your recovery and get back to the activities you love, pain-free.