Tendinopathy – to rest or not to rest the tendon?

26 Aug, 2019

Tendinopathy is a prevalent injury that people struggle with, in day to day life. It’s characterised as an overuse injury and usually results from people doing too much too soon. Perfect examples are people who go on a holiday and have a sudden increase in their walking or a baker who has an increase in orders and needs to whisk away for hours and hours.

This type of injury can arise from any given population, may it be your average joe or a sporting athlete, if the exposure to a given load is not adequately managed. In this post, we will cover; what it is, the stages of it, and whether you should completely rest to let the tendon heal or do the complete opposite.

What is Tendinopathy?

Tendinopathy is the blanket term used clinically to describe the failure of a tendon to heal effectively when exposed to a repetitive load with corresponding pain and decreased performance. It is more often known as the overuse injury of the tendon. After too much repeated load on the tendon, the collagen matrix is disrupted and a proliferation of tendon cells (tenocytes) are present. It is commonly seen in posterior tibialis, rotator cuffs, patella, Achilles, quadriceps, wrist extensors, and wrist flexor tendons.

To best understand, please use the graph above. As a normal tendon goes through different loading (also known as activities), there is an optimal phase where the tendon is able to heal appropriately in conjunction to the right amount of load and adaptation. However, if the load increases too much, it can lead to three distinct phases:

  • Reactive tendinopathy

Short-term adaptation where the tendon thickens to increase stiffness and reduce stress

  • Tendon dysrepair

An increase is changes between the collagen fibres, matrix, and tenocytes but can still be reversible – meaning can still heal

  • Degenerative tendinopathy

Minimal collagen, disarray of collagen fibres, and few tenocytes present – can lead to tendon rupture

Touching the tendon and causing pain does not indicate the presence of tendinopathy. Several factors play a role to possibly confirm this: localised pain, localised pain that increases when load is applied, and specific to the activity that has aggravated it.

Why is Tendinopathy Important to treat immediately?

The troubles of not managing this injury effectively is the continuum as mentioned above and the effects it has going forward as the tendon is unable to heal properly. It can affect normal activities and may decrease a person’s freedom to do a variety of activities such as playing sport, cooking, or even walking.

Real examples of tendinopathy

A 26 year old, started playing basketball 5x a week and goes to the gym 4x a week from a weekly schedule of playing sport 1x a week and gym 3x a week. After two weeks, developed knee pain specifically just on top of the knee cap and gets worse when doing squats at the gym or doing single-leg jumps playing basketball.

A 35 year old, AFL veteran, playing in mid-season and due to other injuries in the team, has increased his playing time by 40% in the past two weeks. Has started to develop pain in his Achilles tendon that gets aggravated whenever they do a vertical jump or heel-raises at the gym.

A 60 year old, does sweeping of the floor 1x hour for once a day. Moved into a new home that is twice the size of their previous home. Now needing to do 3x hours of sweeping once a day and started developing pain on the outside of their elbow whenever they sweep the floor.

To summarise, tendinopathy is a clinical term used to describe pain and limitations of activities due to a tendon being overloaded. If not

attended early,it can lead to a downward spiral of load mismanagement and decrease in functional activities. The main emphasis is not to completely rest the tendon, but to load it effectively and appropriately.

If a tendinopathy is your clinical issue, physiotherapists can help in a variety of ways:

  • Decrease pain and increase range of motion
  • Appropriate loading of the tendon
  • Troubleshooting load management not only with exercises but with daily activities
  • Return to sport/activity planning

What to do now?

If you or a friend are suffering from tendinopathy give us a call at Generation Physio, we have a friendly team of professionals that are dedicated to changing the lives of our clients. All of our clinicians are mobile and come to your own home to conduct an examination. Give us a call on 1300 122 884 to book a consultation today.

Article written by Rafael Basa


Cook, J., & Purdam, C. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine43(6), 409–416. https://doi.org/10.1136/bjsm.2008.051193

Hosie, R. (2017, June 12). The secret to getting yourself back into exercise. Retrieved July 28, 2019, from https://www.independent.co.uk/life-style/health-and-families/how-to-get-yourself-back-into-exercise-shape-celebrity-personal-trainer-nicola-addison-elle-a7779651.html


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