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Tendon Pain Tendinopathy Physiotherapy

Tendinopathy is another name for tendon injuries, and these tendon pains and injuries unfortunately can (and will) develop in any tendons all over the body.

It goes by many, many names:

  • tendinitis
  • tendonitis
  • tenosynovitis
  • tendinosis...

...but really, they all point to the same thing: tendinopathy.

Basically they are tendon injury pathology, so the medical community decided to refer them as tendinopathies (which makes sense).

Typically, tendon injuries occur in three areas:

  1. tendon insertion (where the tendon attaches to the bone)
  2. mid-tendon (non-insertional tendinopathy)
  3. musculotendinous junction (where the tendon attaches to the muscle)

first of all, What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone.

They are tough, tough stuff.

Most tendon injuries occur near joints, such as the

  • shoulder
  • elbow
  • knee and
  • ankle

(Typically high use, weight bearing or pivoting joints)

A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading.

What is Tendonitis? is it different?

Tendinitis (or tendonitis): This means “inflammation of the tendon”.

Mild inflammation is a normal tendon healing response to exercise or activity loading, but it can become too much, where the rate of injury exceeds your healing capacity.

Tendonitis is the inflammatory phase of tendinopathy.

Tendinopathy Phases

An example of tendon injury (in this case, achilles tendon) pathology

The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four (4) phases of tendon injury.

While it is healthy for normal tissue adaptation during phase one, further progression and damage can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent.
  • Normal Recovery

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good.
  • The tendon tissue is attempting to heal.
  • You must prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Prognosis: Poor
  • Tendon cells are dying

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis is inferior.
  • Surgery is often the only option at this point (advanced stage)

What is Your Tendinopathy Phase?

It is imperative to have your tendinopathy professionally assessed by Phoenix principal physiotherapists and sports physiotherapists to identify its current injury phase.

The reason why this is important is identifying accurately is more than 50% of the recovery process - it helps to provide the most direct and effective treatment as specific treatment modalities or exercises should only be applied or undertaken in distinct tendon healing phases.

Systemic Risk Factors

The evidence is growing that it is more than just the tendon and overload that causes tendinopathy.

There are people who are more at risk to developing tendon-related pains, injuries and tendinopathies such as patients who have / are:

You will need to observe your training loads.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy / clicking / cracking sound or feeling when you use the tendon.

The symptoms of a tendon injury can be similar or combined with bursitis.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, our principal physiotherapists and hand therapists will ask questions about your

  • past health
  • symptoms and
  • any new exercise regime

We'll do a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan.

They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI

Tendinopathy Treatment

Tendinopathies can typically rehabilitate injured and painful tendons fairly quickly and effectively.

That being said, there are a percentage of tendinopathies that can take months to treat effectively.

As mentioned earlier in this article, it is essential to know what phase your tendinopathy currently is. Our physiotherapist can assist not only in your diagnosis but also guide your treatment to fast-track your recovery.

Before you seek the advice of our principal physiotherapists or hand therapists, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:

  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as two times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.

When to Return to Sport

Every tendon injury, pain and tendinopathy is different, so please be guided by your physiotherapist assessment.

Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage and set you back weeks!

It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting load

Tendinopathy Prevention

To minimize re-injuring your tendon, you may require some long-term changes to your exercise activities. Please discuss this with your physiotherapist.

Some factors that could influence your tendinopathy risk include:

  • Altering your sport/activities or your technique
  • Regular prevention exercises.
  • Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
  • Always take time to warm up before and cool down / stretch after you exercise.

Tendinopathy Prognosis

While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve.

Long-term or repeat tendinopathies usually have multiple causes and aggravating factors that contribute to the tendon injury and pain.

These definitely definitely will require a thorough assessment and individualised rehabilitation plan. 

Researchers have found that tendon injuries respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery.

Common Tendinopathies

General Information

  • Tendinopathies
  • Tendonitis / Tendinitis
  • Tendinosis
  • Tenosynovitis
  • Overuse Injuries

Specific Tendinopathies Foot & Ankle


Hip & Groin



Wrist & Hand

FAQS About Tendinopathy

Acute Injury Signs & Acute Tendon Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines   

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.