What is Tendinopathy?

Tendinopathy is a painful tendon condition caused by overuse. It happens when your tendon can’t heal fast enough to keep up with the stress you’re putting on it. You might know it by its old names: tendonitis or tendinosis.

Understanding Your Tendons

Tendons connect your muscles to your bones. While muscles contain proteins that help them contract and generate power, tendons are different. They’re made of tightly packed collagen protein, which makes them strong and able to bear heavy loads.

What Causes Tendinopathy?

When you repeatedly stress a tendon, it develops tiny injuries. If you overtrain without enough rest, your body can’t heal these micro-injuries properly. Eventually, damage occurs faster than healing. This causes the tendon to degenerate, becoming weak and prone to rupture.

Common risk factors include:

Excessive training without rest
Using heavier equipment suddenly
Poor movement patterns
Training on incorrect surfaces
Back-to-back competitions

Which Tendons Are Most Affected?

In the legs:

Achilles tendon
Patellar tendon

These are especially vulnerable in athletics, running & jumping or power based sports. If you are training for an event or have recently increased your training load then you will be especially prone to tendon pain

In the arms:

Supraspinatus tendon
Biceps tendon

These are common in those that weight-train, in people who work overhead eg. plasterers & painters. It can also occur in elderly individuals, especially those that are deconditioned or weak in the muscles around the shoulder.

Recognising the Symptoms

Tendinopathy develops in stages:

Early stage: You feel pain before and after activity, but not during it.

Progressive stage: Pain starts occurring during your activity.

Advanced stage: You experience morning stiffness, nighttime pain, swelling, redness, and tenderness around the affected tendon.

Who’s at Higher Risk?

Older Athletes

As we age, our collagen fibers lose structural integrity. When older individuals suddenly start running or increase training intensity, their already compromised tendons face greater stress. This can quickly lead to tendinopathy.

People with Metabolic Conditions

Research shows a strong link between metabolic disorders and tendon injuries. If you have diabetes, gout, high cholesterol, or obesity, you’re more susceptible to tendinopathy.

Diabetes affects tendons in two ways:

It disrupts the small blood vessels that supply tendons
It reduces nerve signals from tendons to your brain

This means you might not feel pain signals warning you about overuse until significant damage has occurred.

Obesity simply increases the load your tendons must bear.

High cholesterol and gout cause harmful substances to accumulate in tendons, triggering chronic low-level inflammation that weakens the collagen structure.

How to Treat Tendinopathy

What Doesn’t Work Well

Since tendinopathy isn’t primarily an inflammatory condition, traditional anti-inflammatory treatments show limited long-term success:

NSAIDs (like ibuprofen)
Corticosteroid injections
Ultrasound therapy
Laser therapy

What Does Work

Immediate care:

Reduce movements that cause pain
Modify your training load
Controlled loading of the injured site

Effective rehabilitation:

Strengthening exercises (where your muscle lengthens while contracting) have proven most effective. These exercises:

Increase collagen fiber connections
Promote tendon remodelling
Encourage new blood vessel formation
Improve tissue alignment
Prevent muscle wasting

Combining eccentric training with static stretching reduces pain and improves function better than either approach alone.

Manual therapy, such as joint mobilization, can also help by improving joint mobility and muscle-tendon efficiency.

The Neuroplasticity Connection: Latest Research

Recent studies reveal that tendinopathy affects your brain, not just your tendon. After injury, the brain area controlling your muscle-tendon unit changes. This alters nerve signals going back to the tendon, making it more sensitive to pain.

Traditional exercise protocols improve tendon structure and reduce pain but don’t address these neural changes. This may explain why tendinopathy often recurs.

New neuroplasticity training uses random visual or auditory cues to help athletes contract and relax muscles. This approach retrains brain control of the muscle-tendon unit, potentially reducing recurrence.

Why Early Intervention Matters

Tendinopathy involves reversible changes, especially in early stages. The key is catching it quickly.

Early tendinopathy pain comes from fluid buildup and vascular changes within the tendon structure. This explains why pain often eases with movement and worsens when you’re still. These early changes respond well to treatment.

However, tendons heal slowly by nature. Rehabilitation requires patience as gradual changes occur within the tendon structure.

Chronic tendinopathy requires much longer rehabilitation because the tendon’s matrix and blood vessel characteristics have become permanently altered. This is why early intervention is so important.

Key Takeaways

Tendinopathy results from a healing-versus-loading mismatch, not inflammation
Early recognition is crucial for successful recovery
Eccentric exercises are the most effective treatment
Anti-inflammatory medications provide limited long-term benefit
People with diabetes, obesity, or high cholesterol face higher risk
New brain-based training approaches show promise for preventing recurrence
Early intervention leads to faster, more complete recovery

References

D. M. Cushman, D. Stokes, L. Vu, B. Corcoran, M. Fredericson, S. F. Eby, M. Teramoto, Br. J. Sports Med 2025, 59, 241. https://advanced.onlinelibrary.wiley.com/doi/10.1002/advs.202514023

Tendinopathy