How We Treat Tendon Pain and How You Can Prevent It

Last month, I shared how tendons work and why they’re such a common culprit of physical pain, with unique causes depending on whether you’re active, sedentary or overweight. If you missed it, click here to catch up.

This time, let’s talk about how we treat your tendon pain and the exercises you can do to reduce your risk of injury.

Our Shocking Tendon Treatments

The most common mistake when treating tendinopathy is to treat it as an inflammatory condition rather than degenerative. Reducing inflammation may provide pain relief but it doesn’t address the underlying problem.

Steroid injections are highly effective at reducing pain because they reduce inflammation but some evidence shows that they may be detrimental to the long term health of the tendon, causing further degeneration. That’s why people who get steroid injections are far more likely to experience recurrence of pain than people who go through physiotherapy alone.

Shockwave therapy, on the other hand, actually stimulates inflammation within the tendon, which may seem counter-productive, but bear in mind that inflammation is the body’s natural healing response. The problem with tendons is that – due to the lack of blood supply within the tissue – this healing response is very slow, so it needs to be encouraged by external means.

Our preferred method of tendinopathy treatment is shockwave therapy combined with heavy strength training. While much of our physiotherapy programmes can be achieved using body weight exercises, sometimes they’re not enough to strengthen certain tendons.

Let’s say your Achilles tendon is damaged. When you run, this tendon is loaded with 6-8 times your body weight, so if you want to start running again, it needs to be able to comfortably handle this very heavy stress, which can’t be achieved with body weight alone. Complete rehabilitation usually takes around 8-12 weeks of gradually increased heavy weight training because, as always, taking on too much at once will only cause further injury.

But that 8-12 weeks is usually only required for people who have been ignoring their tendon pain for a few months, if we intervene earlier the recovery time can be far shorter. If you’re experiencing tendon pain that doesn’t naturally recover after two weeks of rest, it’s important that you come and see us before it requires lengthy rehabilitation.

How You Can Reduce Risk of Tendinopathy

In my last blog, I talked about how tendinopathy can arise no matter your lifestyle, from dedicated athletes to dedicated couch potatoes. It’s true that anyone can suffer a tendon injury, but there are steps you can take to significantly reduce your risk.

The basic principle of tendon health is simple: strong tendons are harder to damage. Weight training, like we use in our rehabilitation, is the most effective way to increase tendon strength. You don’t have to do it every day, but 2-3 days a week will be enough to put the necessary stress on your tendons.

Start with general limb strengthening such as bridging, squats, lunges and pull backs then very gradually add weights to your exercises to increase the load. Our advice – as with any exercise – is to only increase exertion by 10% a week.

It’s also important to do exercises that match the movements of your physical activities. For example, if you run, your tendons take on short, high intensity bursts of stress as your foot pushes off the ground before relaxing again.

This is where plyometric training comes in, which are high speed exercises designed to increase the power of your movements. For example, rapidly jumping on and off a step and bending your hips, knees and ankles on contact with the ground more closely resembles the natural behaviour of your tendons while running than weight training does.

Plyometric training is very important at the end stages of rehab, particularly for athletes. Simply making the tendons strong again isn’t enough, they also need to be re-adapted to sudden, high intensity movements to prevent another injury the moment they’re back jumping and twisting on the pitch or the court.

With regular but gradual strength training and plyometrics, your tendons will develop the strength and flexibility they need to handle all of life’s challenges.

As always, exercise and a healthy lifestyle is the best prevention, but if you have concerns about your tendon health or want advice on how to improve it then book an appointment at my dedicated Tendon Clinic.

david wynne physiotherapist knightsbridge

David Wynne BSc (Physio) MSc (Sports and Exercise Medicine) MCSP MHCP

Musculoskeletal and Sports Physiotherapist, Research Lead at West London Physiotherapy

For any other questions regarding this topic please do not hesitate to contact West London Physio on 0207 937 1628 or email David at