If you’ve ever experienced persistent pain around your joints, you might have encountered the term “tendinopathy.” But what exactly is it, and how is it different from “tendonitis”?
At Dyer Street Clinic, we’re experts in musculoskeletal health and we’re here to clarify everything you need to know about tendinopathy and its effective management.
What is Tendinopathy?
Tendinopathy refers to pain and dysfunction occurring in a tendon, the strong, fibrous structure connecting muscle to bone. Unlike the outdated term “tendonitis,” which implies inflammation, tendinopathy reflects a chronic, degenerative process. Most cases involve changes in tendon structure rather than acute inflammation.
This condition often arises due to repetitive strain, overload, or a sudden spike in activity levels. It’s common in athletes, gym-goers, and even people with physically demanding jobs or those who’ve suddenly increased their training volume.
Tendonitis vs. Tendinopathy: What’s the Difference?
- Tendonitis suggests inflammation and is usually linked to short-term injuries.
- Tendinopathy reflects chronic degeneration and structural disorganisation of the tendon, making it the more accurate term in most cases.
The 3 Phases of Tendon Pathology
According to leading research, tendinopathy progresses through three stages:
- Reactive Tendinopathy – A short-term response to overload, with thickening but no inflammation.
- Tendon Disrepair – Disruption of collagen and increased vascularity.
- Degenerative Tendinopathy – Advanced damage with little healing capacity; common in older adults or longstanding issues.
These stages help guide appropriate treatment, from early intervention to more advanced rehabilitation.
Diagnosing Tendinopathy: Clinical Assessment is Key
At our clinic, diagnosing tendinopathy starts with a detailed history and physical examination. Imaging (such as ultrasound or MRI) can provide supporting evidence, but clinical assessment is the gold standard.
You may notice:
- Localised tendon pain
- Symptoms worsened by specific activities (e.g. running, stairs)
- Morning stiffness or pain after rest
Imaging may show structural changes, but remember: painful tendons don’t always look abnormal, and abnormal tendons aren’t always painful.
Effective Management: Active Loading is Essential
Passive treatments like rest, massage, or ultrasound may provide short-term relief—but they won’t fix the issue long-term. What tendons need is progressive loading.
At Dyer Street Clinic, our onsite gym allows us to design tailored rehabilitation programmes that help you build strength, restore tendon structure, and return to the activities you love.
The 4-Phase Rehab Framework
Borrowing from proven rehabilitation models, we structure recovery in phases:
- Isometrics & Neuromuscular Control – Early stage pain relief and motor control.
- Heavy, Slow Resistance – Building tendon strength and tolerance.
- Plyometrics & Return to Sport – Reintroducing dynamic loading.
- Maintenance – Keeping the gains and avoiding relapse.
These phases are tailored to your individual pain levels, goals, and progress.
Shockwave Therapy: A Helpful Add-On
Shockwave therapy (ESWT) can help reduce pain and stimulate healing in stubborn tendinopathy cases. It can be a powerful adjunct when paired with a structured rehab programme. We offer this service in-house.
Additional Considerations: Lifestyle Factors Matter
Recovery isn’t just about exercises. We also explore:
- Sleep quality – Essential for tissue repair.
- Nutrition – Protein intake supports tendon healing.
- Alcohol and smoking – Both can impair recovery.
- Stress – Chronic stress can affect pain sensitivity and motivation.
We call these “easy low-hanging fruit”—important lifestyle changes that support healing.
Tendon Compression: A Hidden Culprit
Some tendons, like the Achilles insertion and gluteals, become painful due to compression against bony structures, especially at end ranges of motion. Understanding and modifying movements that aggravate compression (e.g., sitting with crossed legs, walking barefoot) can help reduce symptoms.
Timeframes: Tendons Take Time
One of the most important things to know: tendon recovery takes longer than expected. Most people need 3–6 months of consistent rehabilitation. Some may take longer. Patience and consistency are key.
You may feel better after a few sessions, but full tendon healing and load capacity improvements take time.
How Dyer Street Clinic Can Help
If you’re struggling with tendon pain, you’re not alone—and we can help. Our expert clinicians use evidence-based rehabilitation strategies and guide you through the 4-phase loading framework, all within our onsite gym facilities.
Whether you’re a weekend runner, CrossFitter, or simply want to walk without pain, we’ll help you recover stronger.
Ready to get started? Contact Dyer Street Clinic today and book your initial consultation.
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