Tendon Injuries

Tendon pain behaves differently from most injuries, and the difference is worth understanding, because the instinct to rest a painful tendon is the single most common reason tendon problems drag on.

Tendons attach muscle to bone and transmit force. They’re built to handle high loads, and they adapt to the loads they’re regularly given, getting stronger and more tolerant with consistent use. That adaptability is also the catch: when load increases faster than the tendon can adapt, it becomes painful, and when load drops away it becomes less capable.

What causes tendon injuries

The usual cause is a change in load rather than a single event. A sudden increase in training, a return to activity after a break, a new job or a new piece of equipment all ask the tendon for more than it’s currently built for, and pain follows within days or weeks.

Common tendon problems each have their own page: Achilles tendonitis at the heel, tennis elbow and golfer’s elbow at the elbow, and rotator cuff injury at the shoulder. Gluteal tendon pain at the hip and patellar tendon pain at the knee follow the same rules.

Age plays a part, as tendons become less tolerant of rapid change over time. So does an extended period of doing less, which is why tendon pain so often appears in the first weeks back after a lay-off rather than during it.

When to see a physiotherapist

Sooner rather than later, because tendon pain that’s been present for months takes longer to turn around than tendon pain caught early, and because the common self-treatments, rest and stretching, tend to make the underlying capacity problem worse rather than better.

A sudden, sharp pain with an audible snap, an inability to use the limb, or a visible change in the shape of the muscle can indicate a tendon rupture rather than tendinopathy, and needs urgent medical assessment rather than a routine appointment. Marked redness, heat and swelling with a fever also need prompt assessment. If you contact the clinic with any of these, you’ll be told the same thing and helped to get seen.

Physiotherapy treatment for tendon injuries

Andrew’s assessment establishes which tendon is involved, how irritable it currently is, and what it tolerates today, because that’s the starting point for loading. Treatment then combines:

• Exercise rehabilitation, the core of tendon treatment, a graded loading programme progressed on how the tendon responds rather than on a fixed schedule.
• Manual therapy and soft tissue work to ease the surrounding muscle tension and improve the movement patterns adding to the load.
• Shockwave therapy for long-standing tendon pain that hasn’t responded to loading alone.
• Activity guidance, a specific plan for what to keep doing and at what volume while the tendon builds capacity, rather than stopping altogether.

What to expect

Andrew will explain what stage your tendon is at and what that means for the pace, and he’ll be direct that this is a programme measured in weeks. He’ll also set the rule for how much pain is acceptable during loading, which is what lets you progress confidently between appointments rather than guessing.