Understanding Tendinopathy: How Physiotherapy Can Help
Tendinopathy is persistent tendon pain caused by a change in a tendon’s ability to tolerate load. Unlike a short-lived episode of tendonitis, it rarely settles with rest alone — for many people the pain returns as soon as they get back to their usual activity.
Tendonitis vs. Tendinopathy
A tendon is a cord of connective tissue, made of collagen, that attaches muscle to bone and transmits the force of a muscle contraction to move joints. When a tendon becomes inflamed following an injury, this is known as tendonitis – there is usually swelling and pain on movement, and it often settles within a few weeks with rest and a temporary reduction in activity.
Tendon pain that persists for much longer is called tendinopathy. Here the problem is capacity rather than inflammation: if the load being placed through the tendon exceeds what it can currently tolerate, it causes pain.
Why rest alone isn’t the answer:
Rest can reduce symptoms, but it doesn’t rebuild capability. That’s why pain so often comes straight back the moment normal activity resumes – the tendon feels better because it’s being asked to do less, not because it has become more resilient. Load needs to be reintroduced progressively, through a structured programme.
How We Treat Tendinopathy
At First4Therapy we use recognised, evidence-based graded tendon loading protocols to guide rehabilitation. Your programme is built around your assessment findings, the demands of your sport or occupation and the stage your tendon is at.
Assessment and diagnosis
Our chartered physiotherapists assess the affected tendon, the joints and muscles around it, and the demands you’re placing on it — so treatment targets the cause, not just the sore spot.
Settling the irritated tissue
In the early stages, the priority is calming symptoms enough to begin loading — through soft tissue treatment, short-term activity modification and practical training or work adjustments.
Graded loading and exercise therapy
The foundation of rehabilitation — rebuilding strength and capacity through gradual, progressive loading, strengthening the whole joint chain rather than the tendon in isolation.
Shockwave Therapy (ECSWT)
For stubborn cases, radial Extracorporeal Shockwave Therapy passes low energy acoustic pressure waves into the tissue to increase blood flow and stimulate repair. NICE has published guidance on its use for several persistent tendon conditions. Shockwave is always used alongside your exercise programme, never instead of it.
Return to sport and activity
Once capacity has improved, sport-specific or task-specific load is reintroduced so the tendon is properly prepared — whether that's a return to sport or a physical job.
Reducing the risk of recurrence
Tendinopathy has a habit of returning if load isn't managed well. We’ll help you recognise your own early warning signs and give you a maintenance programme to stay strong once back to full activity.
Where Tendinopathy Can Occur
Tendon pain can affect almost any tendon in the body. The areas we see most often include:
Why Choose First4Therapy?
At First4Therapy we take a holistic approach to tendon pain. Our expert physiotherapists will assess your condition and build a tailored plan that combines graded loading, hands-on treatment and, where appropriate, shockwave therapy. By focusing on capacity and long-term recovery rather than short- term relief, we aim to help you get back to doing what you enjoy (and stay there!).
