Tendinopathy and tendon injuries
Achilles, patellar, gluteal, hamstring, and rotator cuff tendon problems share a common pattern: they are load-related, and they respond to structured loading programmes guided by good diagnosis. Specialist input narrows the diagnosis and shapes the rehabilitation plan.
Tendon problems are load problems. They develop when load demand has exceeded tendon capacity for too long, and they recover through structured loading that progressively rebuilds capacity. Specialist diagnosis identifies which tendon is the actual driver of pain, and structured rehabilitation does the rest.
Common tendon problems we see
What is tendinopathy
Why tendon pain is a load problem, and what that means for treatment.
Read more Common sitesCommon tendon problems
Achilles, patellar, gluteal, hamstring and rotator cuff tendinopathy.
Read more TreatmentHow tendinopathy is treated
Structured loading programmes that rebuild tendon capacity over time.
Read more InjectionsWhere injections fit
When an injection helps, and when it does not, alongside loading.
Read more
What is tendinopathy
Tendinopathy is a load-related tendon condition where tendon structure and capacity have changed in response to demands that exceeded what the tendon could absorb. The pain pattern is characteristic: stiff and sore at the start of activity, often warming up briefly, then returning worse afterwards or the next morning.
Imaging shows changes that match this clinical picture, but pain and imaging are not perfectly correlated.
Common tendon problems
- Achilles tendinopathy: mid-portion or insertional, common in runners and active middle-aged adults
- Patellar tendinopathy (jumper's knee): common in jumping and change-of-direction sports
- Gluteal tendinopathy: pain on the side of the hip, often confused with bursitis
- Hamstring tendinopathy: proximal, deep buttock pain, common in runners and field-sport athletes
- Rotator cuff tendinopathy: shoulder, often with subacromial bursitis
- Lateral elbow tendinopathy (tennis elbow) and medial elbow tendinopathy (golfer's elbow)
- Posterior tibial tendinopathy and peroneal tendinopathy at the ankle
How tendinopathy is treated
Effective tendinopathy management is unromantic. It is a structured loading programme, progressed over months, with appropriate temporary load modification. The work is done by the patient, with the specialist and physiotherapist setting the dose, monitoring response, and protecting against the common pitfalls.
Confirm the diagnosis
Distinguishing tendinopathy from a tear, a referred pain pattern, or a confounding condition (such as a stress fracture nearby) matters.
Settle the load temporarily
Brief reduction (not cessation) of provocative activity, alongside isometric loading, often eases acute irritation.
Build tendon capacity
Heavy slow resistance training, eccentric work, or progressive loading depending on the tendon, the stage, and the goals. This is the work that produces durable change.
Reintroduce sport-specific load
Plyometrics, change of direction, and sport-specific loading return progressively, matched to the tendon's tolerance.
Where injections fit
Cortisone injections are not first-line for tendinopathy and may impair tendon health when used repeatedly. They have a small role in selected cases, usually to settle acute pain enough to start loading work. PRP has emerging evidence in selected tendons (lateral elbow, patellar) where structured loading has not progressed. Both are discussed in the wider context of the loading programme. See injection therapies.
Common questions
How long will it take to get better?
Most tendinopathies need months of consistent loading to settle meaningfully. Some take longer. Quick fixes do not have a track record of producing durable outcomes.
Should I rest completely?
No. Complete rest deconditions the tendon further. The plan modifies load rather than removing it.
Will I need imaging?
Often, yes, particularly to rule out a tear or to clarify the stage. Ultrasound and MRI both have roles depending on the tendon.
Can I keep training?
Most patients can keep training in a modified form. The plan is built around your sport.
