Tendinopathy Fact Sheet

Tendon pain can affect people who are less active, just as much as the weekend warrior or the serious athlete.
It is usually caused by overuse and can affect many tendons in the body.

What is tendinopathy?

  • Tendons attach muscle to bone. They transfer load and release energy.
  • Tendons are predominantly made up of strong collagen cells and water.
  • Under load, tendons are distorted and the cells adapt, becoming stronger.
  • Unfortunately, under too much load excessive changes occur – The tendon becomes disorganised and breaks down, new blood vessels and nerves grow and water is lost. This ‘failed healing response’ is called tendinopathy.
  • Tendinopathy is different to the inflammation process of other soft tissue injuries (e.g. muscle tears).
  • These tendons are weaker and have a higher risk of ongoing issues and rupture.
  • Pain levels and the amount of tendon damage don’t often correlate.

Contributing factors

  • Sudden or long-term tendon overload
    – Compressive load (i.e. the tendon gets squashed)
    – Stretch/tensile load (i.e. stretching, jumping and fast movements)
    – Combination
  • Deconditioned or under loaded tendons
  • Altered movement patterns (e.g. stiff landing pattern, poor hip and core muscle activation)
  • Increasing age
  • Obesity
  • Post-menopause (reduced oestrogen levels)

Management and Treatment

  • Correct diagnosis to identify the stage of tendinopathy
  • UNLOAD the tendon by eliminating or minimising other contributing factors (e.g. weight loss, training load, muscle imbalances)
  • Education, activity modification and a progressive exercise program are the BEST treatment to reduce pain and improve tendon strength/structure.
  • Adjunct treatments (eg massage, dry needling, shockwave therapy, orthotics, injection therapies etc.) may provide additional benefit, but ONLY when used in conjunction with exercises.


  • Tendons are slow to respond and in most cases, the pain can often take 6-12 months to improve. However, functional improvements may be seen within a few weeks.