Assessment
A detailed history, then a thorough examination of movement, strength and the affected area. You leave knowing what is wrong, why it happened, and exactly what we are going to do about it.
What We Treat
Tendinopathy Treatment in London
Tendinopathy is an overloaded tendon, and tendons don't heal with rest, they need load. Following the BJSM consensus, we build a progressive loading plan with no guesswork, so you finish with a tendon that lasts, not one that keeps flaring back.
Overview
Understanding tendinopathy
Tendinopathy is pain, stiffness and reduced load tolerance in a tendon that has been worked harder than it can adapt to, most often the Achilles, patellar (knee), gluteal (outer hip) or lateral elbow tendon. It is the accurate modern name for what used to be called tendinitis, and for the runners and lifters we treat at our central London clinics it is one of the most common reasons a training block stalls.
If a tendon warms up during your run or lift then punishes you the next morning, that pattern has a name: tendinopathy, the accurate modern term for a painful, overloaded tendon, most often the Achilles, patellar, gluteal or lateral elbow. The older word tendinitis implies inflammation, but the BJSM shows most long-standing tendon problems are changes in tendon structure from load applied faster than the tissue can adapt.
It tends to settle in the tendons that take the most repeated load, and each responds to the same loading principle applied to a different area:
- Achilles tendinopathy: pain at the heel or lower calf that warms up with activity then worsens afterwards or the next morning.
- Patellar tendinopathy: pain at the kneecap tendon, typical of repeated hopping and jumping.
- Gluteal tendinopathy: pain over the outer hip, often provoked by single-leg weight-bearing.
- Lateral elbow tendinopathy: outer-elbow and forearm pain provoked by repetitive gripping.
Why doesn't rest fix it?
Because complete rest lets the tendon lose the capacity it needs, so the pain returns the week you go back. In line with the BJSM consensus, progressive loading is the primary, best-evidenced treatment. We assess the tendon and the overload behind it, then build a loading plan around how you train, work and move.
We treat runners, gym-goers and athletes through physiotherapy and sports rehab across our Soho, Liverpool Street and Marylebone clinics, rebuilding load tolerance with strength training and adding shockwave therapy for stubborn cases, often alongside a related knee pain. You get a clear plan and a realistic idea of how long it should take from the first appointment. Self-referral; no GP letter needed.
Physiotherapy for tendinopathy can help to:
Name the problem properly
Most long-standing tendon pain is tendinopathy: an overloaded tendon whose structure has changed, rather than the inflammation the old word tendinitis implies. The distinction matters, because it explains why rest keeps failing you and why graded load is what rebuilds the tissue.
Find the overload behind the tendon
A tendon rarely fails without a reason. A training spike, a change of footwear or surface, or a strength deficit in the muscles around it usually sits underneath. We identify that driver at assessment, because treating the tendon while ignoring the cause invites a relapse.
Build a loading plan that works
Progressive loading is the primary, best-evidenced treatment for Achilles, patellar, gluteal and elbow tendinopathy, supported by the BJSM consensus. We start with what your tendon tolerates today, often isometric work, then progress through heavy-slow resistance as capacity returns.
Keep you training while it recovers
Complete rest lets the tendon lose the very capacity it needs. We use relative rest instead: easing the aggravating loads, keeping your running or lifting going where we can, and adjusting week by week. Most people stay active through the whole programme.
Add shockwave where it earns its place
For stubborn tendons that have not settled with first-line loading, shockwave therapy can be added in line with NICE interventional procedures guidance. We are honest about the mixed evidence: it is an adjunct alongside your loading programme, never a shortcut around it.
Finish with a tendon that lasts
Tendon tissue adapts slowly, so we set realistic milestones over months rather than weeks and reassess against them. The end point is measured: strength and load tolerance back to the level your sport and life demand, so the problem does not grumble on for years.
Why it happens
What causes tendinopathy?
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A rapid spike in training, running mileage, or gym load that outpaces the tendon's ability to adapt
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Repetitive or sustained loading of one tendon (Achilles, patellar, gluteal, lateral elbow) without adequate recovery between sessions
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Strength and conditioning deficits in the surrounding muscle group, so the tendon absorbs load it is not prepared for
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Returning to full training too soon after a previous injury, before the tendon has rebuilt its capacity
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A sudden change in footwear, running surface, training pattern, or technique without an adaptation period
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Reduced tendon tolerance associated with increasing age, certain medications, or metabolic and hormonal health factors
What happens at your first physio appointment?
The assessment covers a detailed history and a thorough examination of movement, strength and the affected area. We explain what we find and agree a working diagnosis and plan you understand before you leave.
You go home with a written summary and a home-exercise programme built around your diagnosis and goals, so progress continues between visits.
Move better. Train stronger. Live fully. Pain relief that lasts is not enough on its own: we find the cause, then rebuild the strength behind the pain so it stays gone. No guesswork, no generic rehab.
- Three central London clinics: Soho, Liverpool Street and Marylebone, plus home visits across London and online sessions.
- Led by physiotherapist Sam Harvey: 15 years of clinical practice and an elite-sport background across football, rugby and GAA.
- Physiotherapy, strength and nutrition under one roof: three clinicians, three disciplines, joined-up care.
Fees and booking
Ready to optimise you? You can self-refer and book directly: no GP letter needed, and every new patient can start with a free 15-minute consultation call. The same fees apply across our Soho, Liverpool Street and Marylebone clinics.
- Physiotherapy: a full 60 minutes for £145, whether it is your first visit or a follow-up
- 30-minute follow-ups at £90, with video appointments from £70
- Strength training and Reformer Pilates £120, sports massage from £75
- VALD performance and strength testing with a written report, £195
- 5% off a block of five sessions, 10% off a block of ten
- An itemised receipt with every session, for claiming back where your policy covers physiotherapy
How physiotherapy works
from assessment to return to sport
Everything starts with finding the cause. Whether the goal is a marathon start line or a week at your desk without pain, we treat what is driving the problem, then build the strength that keeps it fixed.
Treatment
Hands-on manual therapy combined with a progressive, tailored exercise programme. Sports massage, dry needling, shockwave or Reformer Pilates are added where they help your specific problem.
Rebuild
Coached, progressive strength work restores the load tolerance your body lost, paced to where you start. This is the stage that decides whether the fix lasts.
Perform
Each follow-up reassesses you against your baseline, with VALD testing where useful, so your return to work, sport or training rests on measured readiness. Discharge happens by mutual agreement when you can manage independently.
What our physiotherapists treat
- Physiotherapy and sports rehabilitation
- Coached strength and conditioning
- Reformer Pilates
- Sports massage and soft-tissue therapy
- Dry needling and shockwave therapy
- VALD performance and strength testing
- Post-operative rehabilitation
- Running and gait analysis
- Sports nutrition and dietetics
Treatment approach
How do we treat tendinopathy?
Physiotherapy & Sports Rehabilitation
£145Assessment 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 →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
Frequently asked
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.
Where can I get tendinopathy treatment in London?
You can see us at our clinics in Soho, the City and Marylebone, or book a home visit across London. Each appointment assesses the tendon and the overload behind it, then builds a progressive loading plan around your running or training. Self-referral is fine, so you can book directly without a GP letter.
Related What We Treat
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Physio and Performance • 111 Charing Cross Road, Soho, London WC2H 0DT
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