Understanding Tendinopathy
Tendinopathy is a broad term for tendon pain and dysfunction - it develops when the demands placed on a tendon exceed its capacity to recover. I treat a lot of tendinopathy on the Sunshine Coast, from recreational runners on the beachside trails around Noosa to competitive athletes in Caloundra and Kawana. Tendons respond differently from other tissues: rest alone often makes tendinopathy worse in the long term, and progressive loading is the cornerstone of treatment.
Tendons respond differently to treatment than other tissues. Rest alone often makes tendinopathy worse in the long term. The cornerstone of management is progressive loading - gradually increasing the tendon's tolerance through structured exercise. Additional therapies like shockwave therapy and PRP injections can support recovery in the right circumstances.
Common Tendinopathies
- Achilles tendinopathy - Mid-portion or insertional pain in the Achilles tendon, common in runners and those increasing activity. One of the strongest evidence bases for progressive loading programs.
- Patellar tendinopathy (jumper's knee) - Pain at the base of the kneecap, common in jumping, sprinting, and change-of-direction sports.
- Rotator cuff tendinopathy - Shoulder pain with overhead activities, lifting, and reaching. See Shoulder Injuries.
- Gluteal tendinopathy - Lateral hip pain (greater trochanteric pain syndrome), common in runners and more prevalent in women over forty.
- Tennis elbow (lateral epicondylitis) - Pain on the outside of the elbow with gripping. See Elbow Injuries.
- Golfer's elbow (medial epicondylitis) - Pain on the inside of the elbow with gripping and wrist flexion.
- Hamstring tendinopathy - Deep buttock pain from the hamstring origin, common in runners and those who sit for prolonged periods.
- Plantar fasciitis - Heel pain related to the plantar fascia, responding well to progressive loading and shockwave therapy.
- Calcific tendinitis - Calcium deposits within a tendon (commonly rotator cuff), treatable with shockwave therapy and ultrasound-guided needling.
Treatment Approach
- Progressive loading - Carefully structured exercise programs that build tendon capacity. This is the single most important treatment.
- Load management - Identifying and modifying the activities contributing to overload.
- Shockwave therapy (ESWT) - Non-invasive treatment with strong evidence for chronic tendinopathies.
- PRP injections - May support healing in selected tendinopathies.
- Biomechanical assessment - Identifying contributing factors in technique, footwear, or movement patterns.