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Tendinopathy refers to an unhealthy tendon characterised by overuse and the presence of tiny tears along with the breakdown of collagen fibres and other changes to the intracellular structure of the tendon.


Here are some vital facts to know about tendinopathies.


1) Tendinopathy does not improve with rest. Pain may settle temporarily but returning to activity is often painful again because rest does nothing to increase the tolerance of the tendon to load.


2) There is NO good evidence that these injuries are caused by inflammation. Therefore, anti-inflammatories often have limited effectiveness for these injuries.


3) The main factor for tendinopathy is overuse or simply too much of certain activities. Activities that

require the tendon to store energy such as walking, running, jumping, along with loads that cause compression are the most common causes of tendinopathy. Tendon pain is sometimes caused with only subtle changes in activity.


4) Exercise is the most evidence-based treatment for tendinopathy – tendons need to be loaded progressively so that they can develop greater tolerance to load. In a vast majority of cases tendinopathy will not improve without this.


5) Modifying load is important in settling tendon pain. This often involves reducing tendon load that involves energy storage and compression.


6) Pathology on imaging is NOT equal to pain. This is one of the things that most people have the most difficulty understanding about tendon injuries. You can have severe pathology or tearing of the tendon, but this will not determine the amount of pain you will have or necessarily affect your recovery. Tendon pathology is also common in people without pain,


7) Tendinopathy rarely improves long term with only passive treatments such as corticosteroid injections, massage, acupuncture, dry needling, etc. Exercise is the most important treatment and passive treatments should only be used as adjuncts. There is lots of evidence to support this and if you are interested, more information can be found in the links provided.


8) Exercise needs to be individualised to a person’s pain and presentation. There must be progressive increase in load to enable restoration of function whilst respecting pain.


9) Tendinopathy responds very slowly to exercise. You need to have patience, ensure that exercise is correct and progressed appropriately, and try and resist the common temptation to accept ‘short cuts’ like injections and surgery. There are no short cuts.



Abate M, Gravare-Silbernagel K, Siljeholm C, et al.: Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research and Therapy. 2009, 11:235.
Cook J, Purdam C: Is compressive load a factor in the development of tendinopathy? British Journal of Sports Medicine. 2012, 46:163-168.
Littlewood C, Malliaras P, Bateman M, et al.: The central nervous system–An additional consideration in ‘rotator cuff tendinopathy’and a potential basis for understanding response to loaded therapeutic exercise. Manual therapy. 2013.
Malliaras P, Barton CJ, Reeves ND, Langberg H: Achilles and Patellar Tendinopathy Loading Programmes. Sports Medicine. 2013:1-20.
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