Tendon Pain
What's going on & what to do
A plain-language guide to tendinopathy — how it happens, how it heals, and how to keep moving through it.
Tendons are the tough, rope-like tissues connecting your muscles to your bones. When one becomes painful — whether it's your Achilles, patellar tendon, rotator cuff, elbow, or somewhere else — we call this a tendinopathy.
The old term was "tendinitis," but that implies active inflammation, which is rarely what's actually happening. The tissue is irritated and sensitised, but it isn't on fire — and that distinction matters for how we approach treatment.
Think of a tendon like a rope. Ropes get stronger with use, but if you suddenly pull harder on it before it's adapted, the surface starts to fray. That fraying isn't catastrophic — the rope can strengthen again — but it needs to be managed while it adapts.
Tendon pain almost always comes down to a mismatch between load and capacity. Usually that looks like one of these:
- Too much, too soon — a sudden spike in training volume, intensity, or frequency
- Too little for too long — the tendon becomes under-prepared, then gets hit with demands it isn't ready for
- A combination of both — very common after an off-season, illness, or time away from training
This is why tendon flare-ups are so predictable: they tend to hit at the start of a season, on return from time off, or after a big jump in training load.
Tendons don't need rest — they need appropriate load. Complete rest actually makes tendons weaker and more sensitive over time. Here's how we build back up:
Contracting the muscle without movement. Think wall sit or static calf raise hold. Hold 30–45 seconds × 4–5 reps.
Slow, controlled tempo (3 sec down, 3 sec up) with a challenging load. 6–8 reps, 3–4 sets, 2–3 days per week. Tendons respond to meaningful load.
Gradually reintroduce aggravating activities — running, jumping, sport-specific movement. Find a tolerable starting point and progress gradually.
Because we're not dealing with a damage problem, it's OK to work into some discomfort. Pain doesn't mean you're making things worse — but there's no benefit to pushing through high levels of pain either.
Also check in 24 hours after a session. If pain is significantly worse and takes hours to settle, dial back next time.
Tick all four boxes and you have the green light to progress in your next session:
Flare-ups are a normal part of the process — not a sign things have gone wrong. When one hits, don't stop training entirely. Scale back instead: reduce load, shorten range of motion, slow the tempo, or drop to isometrics until things settle.
To prevent recurrences, avoid the boom-bust cycle. The graph of stress on your tendon over time should look like a gradual, consistent incline — not a series of peaks and crashes.
- Approach everything like dipping your toe into a hot tub — ease in gradually
- Avoid large spikes in training volume, intensity, or frequency
- Sleep, stress, and nutrition all influence tendon recovery