Treatment decision6 min read
Tendon pain that persists: finding what is going wrong
Tendinopathy responds well when managed correctly but requires patience. In prolonged cases the problem is usually not the diagnosis but the loading dose or not allowing enough time.
The most common errors
Inadequate loading comes first. High repetitions with light weight do not provide the stimulus tendon adaptation needs; the programme runs for months without progressing.
Complete rest is the second common error. Pain falls during rest but tendon capacity drops, and the picture recurs faster on returning to activity.
Skipping stages is also frequent. Moving to heavy loading before completing the isometric stage increases pain and leads to the programme being abandoned.
Reviewing the programme
If there is no progress despite twelve weeks of an appropriate programme, loading dose and tempo are reassessed. In most cases the problem is found there.
Hip and calf strength are measured separately. Deficits there keep load on the tendon higher than expected.
Training load is reviewed. If weekly sporting load is still rising despite the programme, the tendon cannot adapt.
Findings suggesting another diagnosis
Pain that is diffuse and around rather than over the tendon suggests other diagnoses. Fat pad irritation and bursitis can be confused here.
Marked swelling and pain persisting at rest at night do not belong to tendinopathy and require assessment.
In growing athletes, pain at the bony prominence below the kneecap suggests Osgood-Schlatter disease, which is managed differently.
Key points
- The most common error is inadequate loading.
- Complete rest reduces pain but lowers tendon capacity.
- Skipping the isometric stage increases pain.
- If no progress in twelve weeks, review the loading dose.
- Pain persisting at rest at night does not belong to tendinopathy.
Frequently asked questions
Is ultrasound or MRI needed?
Not in a typical picture, and it does not change treatment. Imaging changes are found in pain-free athletes too; diagnosis rests on clinical examination.
Does shockwave therapy help?
It can be used as a supporting measure in stubborn cases and benefit has been reported in some studies. It does not replace the loading programme and is planned alongside it.
How long should I wait?
Twelve weeks is a reasonable review period on an appropriate loading programme. If there is no progress at all, both programme and diagnosis are reviewed.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.