Tendinopathy — Physiotherapy in London
Tendinopathy is an overload injury of a tendon — most often the Achilles, patellar, gluteal, or lateral elbow — and progressive, graded loading is the best-evidenced way to rebuild its capacity.
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What you're seeing
The concern
Why it happens
What drives it
- A rapid spike in training, running mileage, or gym load that outpaces the tendon's ability to adapt
- Repetitive or sustained loading of one tendon (Achilles, patellar, gluteal, lateral elbow) without adequate recovery between sessions
- Strength and conditioning deficits in the surrounding muscle group, so the tendon absorbs load it is not prepared for
- Returning to full training too soon after a previous injury, before the tendon has rebuilt its capacity
- A sudden change in footwear, running surface, training pattern, or technique without an adaptation period
- Reduced tendon tolerance associated with increasing age, certain medications, or metabolic and hormonal health factors
Treatment approach
How Sam treats it
Physiotherapy & Sports Rehabilitation
Price on enquiryAssessment identifies which tendon is involved and the overload behind it, then delivers a progressive-loading programme with objective return-to-sport criteria — the best-evidenced treatment for Achilles, patellar, gluteal, and lateral elbow tendinopathy, supported by the BJSM consensus.
See treatment detail →Strength Training
Price on enquiryStructured, progressive strength work — including isometric and heavy-slow resistance — rebuilds the tendon's load tolerance and the capacity of the surrounding muscle group, addressing the deficits that let the tendon become overloaded in the first place.
See treatment detail →Shockwave Therapy
Price on enquiryFor recalcitrant tendinopathies such as plantar fasciitis, calcific rotator-cuff, Achilles or patellar tendinopathy that have not resolved with first-line loading, extracorporeal shockwave therapy may be offered as an adjunct in line with NICE interventional procedures guidance; the evidence is mixed and it is never a guaranteed cure.
See treatment detail →FAQ
Common
questions
What is the difference between tendinitis and tendinopathy?
Tendinopathy is the accurate term; tendinitis is largely outdated. "Tendinitis" implies inflammation, but research summarised by the BJSM shows most long-standing tendon problems are not primarily inflammatory — they are overload-driven changes in tendon structure. This matters for treatment: rest alone rarely works, whereas progressive loading rebuilds the tendon's capacity over time.
What is the best treatment for tendinopathy?
Progressive, graded loading is the primary, best-evidenced treatment, supported by the BJSM consensus and current physiotherapy best practice. A structured programme using isometric and heavy-slow resistance gradually rebuilds the tendon's tolerance to load. Manual therapy can help manage pain alongside loading, but exercise is the core of recovery, not an optional extra.
Does shockwave therapy work for tendinopathy?
It can help some recalcitrant cases — such as plantar fasciitis, calcific rotator-cuff, Achilles or patellar tendinopathy — where first-line loading has not resolved symptoms. NICE interventional procedures guidance supports its use as an adjunct, but the evidence is mixed. We offer it alongside loading, never as a standalone cure, and discuss whether it is right for you.
Should I rest a tendinopathy completely?
Usually not. Complete rest may ease pain briefly, but it lets the tendon lose capacity, so symptoms return when you resume activity. The evidence supports relative rest — temporarily reducing aggravating load while progressively rebuilding tolerance through structured exercise. Your physiotherapist guides the right amount of load for your stage of recovery.
How long does tendinopathy take to recover?
Tendon tissue adapts gradually, so recovery is rarely quick — often three months or more of consistent, progressive loading, sometimes longer for the Achilles or gluteal tendons. We set realistic milestones at your first appointment and reassess regularly. Seek urgent medical advice if you suspect a sudden tendon rupture with severe pain or weakness.
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Physio and Performance • 111 Charing Cross Road, Soho, London WC2H 0DT
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