33) The Truth About Tendon Injuries: A No-Nonsense Guide to Getting Back on Track

Tendon injuries can be sneaky—starting as a niggle, then becoming that one thing stopping you from doing what you love. In this blog, we break down what issues surrounding this structure, why they don’t just go away with rest, and how physiotherapy can help you turn things around.

What Are Tendons, Anyway?

Let’s start with the basics. Tendons are the strong, fibrous tissues that connect your muscles to bones. Their job? To transfer the force your muscles generate so you can move. Simple enough. But when they’re overused, overloaded or just not looked after properly, they can become irritated or damaged.

Tendon injuries, also called tendinopathies, are super common—especially if you’re active, over 30, or just pushing yourself a bit too hard too soon (hello, weekend warriors).

Some of the usual suspects when it comes to pain include:

Achilles tendinopathy
Patellar tendinopathy (aka “jumper’s knee”)
Gluteal tendinopathy (pain on the side of the hip)
Rotator cuff tendinopathy (in the shoulder)
Tennis/golfer’s elbow (lateral/medial elbow tendinopathy)

Tendonitis, Tendinosis, or Tendinopathy?

You’ve probably heard these terms thrown around, but what’s the difference?

Tendonitis: This used to be the go-to term, and it refers to inflammation of a tendon. But research shows that inflammation isn’t the main issue in most chronic injuries.
Tendinosis: This refers to a degenerative process in the tendon, usually from overuse.
Tendinopathy: This is the umbrella term we use now, because most tendon injuries involve a mix of mechanical overload and structural changes—not just inflammation or degeneration.

So next time someone says they’ve got “tendonitis,” chances are they’re actually dealing with tendinopathy.

Why Do Tendon Injuries Happen?

Tendon injuries usually come down to load—too much of it, too quickly, without giving it time to adapt. Think:

Going too hard after a break (classic New Year’s resolution injuries)
A sudden increase in training (like prepping for a half marathon)
Weak supporting muscles or poor biomechanics
Age-related changes in tendon structure
Under-recovery between sessions

Tendons love slow, controlled loading. What they hate is a sudden spike in activity with no build-up. And unfortunately, once a tendon gets grumpy, it tends to stay that way for a while—unless you treat it properly.

Rest Doesn’t Work (Sorry!)

This is the part most people don’t want to hear: resting a tendon injury doesn’t fix it.

Sure, it might feel better after a few days or weeks of laying low. But as soon as you go back to your usual activity, the pain is back. That’s because rest doesn’t restore the strength or capacity—it just de-loads it temporarily.

The gold standard for rehab? Progressive, targeted loading. That’s where physiotherapy comes in.

How Physio Can Help

When it comes to tendon rehab, we don’t muck around. Here’s how we usually approach it in the clinic:

1. Accurate Diagnosis

We’ll start by figuring out exactly which tendon is affected and what stage of the injury you’re in—early reactive phase, disrepair, or degenerative. This helps us tailor your treatment plan. Furthermore, we will determine the specific part that has become injured as this will also determine the rehabilitation.

2. Load Management

This might involve reducing or modifying your activity (not just stopping altogether) while gradually building your tendon’s tolerance to load.

3. Strengthening Program

We’ll guide you through a tailored loading program, often using isometric, isotonic, or eccentric exercises depending on the phase of healing. These help rebuild the tendon’s capacity and reduce pain over time. The finish line will be determined by you. We will work towards your individual end goal, this could be reaching a faster pace with your 5km run or being able to complete 3000-5000 steps in a day.

4. Biomechanical Corrections

If your movement patterns or posture are contributing to the issue, we’ll help correct that. This could include strengthening weak muscles, improving joint mobility, or tweaking your technique.

5. Education

Understanding your injury is half the battle. We’ll chat about what to expect, how to pace yourself, and when to push versus pull back.

6. Adjunct Therapies

In some cases, we might use hands-on treatment, dry needling, taping, or shockwave therapy to complement your exercise program.

Real Patient Story: Meet Cam

Cam’s a 47-year-old dad of two, ex-footy player, and now a keen weekend runner. He came to us after noticing a persistent ache just above his heel that flared up every time he went for a run. He’d tried resting, stretching, and even new shoes—but nothing worked.

Turns out, Cam had mid-portion Achilles tendinopathy—a classic case.

Here’s what we did:

Initial Phase: We started him on isometric calf holds (holding a heel raise for 45 seconds) to reduce his pain and gently load the tendon.
Loading Progression: As his pain settled, we introduced slow calf raises with increasing load (eventually adding dumbbells).
Running Technique: We noticed he was overstriding and landing too hard through the heel, so we worked on cadence and foot strike.
Cross Training: While we deloaded his running, he kept up his fitness with cycling and pool running.
Return to Running: After about 6 weeks, he started a graded return-to-run program. By 12 weeks, he was comfortably back to 5km runs with no pain.

Now? Cam’s running three times a week and mixing in strength training to keep his tendon happy. No niggles. No flare-ups. And he reckons he’s running better than he did in his 20s.

Common Tendon Injury Myths—Busted

“It’ll go away on its own.”
Probably not. Most tendon injuries are persistent and can get worse if ignored.

“I just need to stretch more.”
Stretching a grumpy tendon can actually make things worse, especially if it’s already overloaded. Strengthening is the priority.

“Cortisone will fix it.”
Cortisone might reduce pain in the short term, but it doesn’t address the underlying issue—and repeated injections can weaken the structure long-term.

“I’m too old to fix this.”
Nope! They respond to load at any age. It just takes a bit more time and consistency

What Recovery Looks Like

Tendon injuries don’t follow the quick-fix timeline. They heal on their own clock. Here’s a rough idea:

Phase	Focus	Duration
Acute (0–3 weeks)	Pain relief, isometric loading, activity modification	1–3 weeks
Subacute (3–6 weeks)	Load progression, address contributing factors	3–6 weeks
Remodeling (6–12+ weeks)	Build tendon capacity, return to full sport/activity	6–12+ weeks

Consistency is key. Stick to your program and avoid the temptation to jump ahead too soon.

When to See a Physio

If you’ve got tendon pain that’s:

Sticking around for more than a few weeks
Worse with activity and settles with rest
Tender to touch or sore the next day
Starting to limit your usual exercise or daily tasks

…it’s time to book in.

The earlier we catch it, the quicker you’ll bounce back.

Final Word

Tendon injuries can be annoying—but they’re also very treatable. With the right mix of education, progressive loading, and a bit of patience, you can get back to doing what you love, pain-free.

So if your Achilles, knee, shoulder or hip is holding you back, don’t just rest and hope for the best. Come see us at XPhysio, and let’s put a proper plan in place. You can book online via this LINK