The Do and Do not’s of tendon pain

Tendon injuries are one of the most common injuries that are often the cause of overuse or repetitive strain (RSI). In the past you may have heard tendon injuries referred to as tendinitis (indicating inflammation) and thus was treated with the conventional RICE protocol (Rest, Ice, Compress and Elevate), unfortunately for many this is unsuccessful especially over long periods of time, leaving sufferers to resort to medication or steroid injections.

With further research it’s been found that most tendon disorders are generally degenerative, this can be from overuse and increased stress over time. Other causes can include impingement and resultant lack of blood flow, age related degeneration or sports related injury such as an Achilles rupture. Sometimes tendon issues can arise from an anatomical issue which can be from the way a person is built or even the way they move.

What is a tendon?

A tendon is a piece of fibrous connective tissue that connects our muscles to our bones, for example your Achilles attaches your calf muscle to your heel bone. A tendon isn’t elastic and wont stretch, but will tear or rupture. It’s important not to confuse tendons and ligaments, ligaments connect bones to other bones and are designed to stabilise joints.

Might I have a tendon issue?

People with tendon pain often present with some, if not all of the following symptoms

  • Pain after they’ve finished exercising
  • Pain whilst resting (may be an ache or a throbbing sensation)
  • Initial pain on starting exercise but gets better when ‘warmed up’
  • Often can complete full training sessions in early stages of the injury
  • Local tenderness
  • Swelling, and crepitus (any crackles or clicking in or over a joint)

Where might I get a tendon issue?

Common places we see tendons injured in clinical practice are :

  • Achilles – common in runners or jumpers, anyone with recent increase in activity
  • Gluteal – found in lateral hip/pelvis can be biomechanical, common in women more so. Can have pain laying on the affected side or squatting down to do things such as garden
  • Rotator cuff – or back of the shoulder, pain may radiate over the top of the shoulder, towards the neck or through the front of the arm, typical overuse injury or impingement caused
  • Biceps – right at the front of your shoulder joint, common in lifters and desk workers
  • Tennis elbow – Outside of your elbow, common in you guessed it, tennis players. But is also quite common in desk workers
  • Golfers elbow – located in the inside of the forearm, and yes it’s common in golfers!
  • Tibialis posterior – common overuse injury or runners, but frequently found in people who wear high heels.

By the time many patients see their practitioner the tendon has been left a long time without treatment and has become a chronic pain. This is often due to people managing the condition poorly or are simply trying to ignore the pain hoping it gets better.

The 10 things NOT TO DO with a tendon injury

1, Rest Completely

Although resting can be helpful initially to help relieve the pain associated with a tendon injury, just resting alone won’t help your tendon recover.  The longer you rest it for the more the tendon loses its conditioning and strength, which means it will no longer have the capacity to take as much load when you go to use it again.  The current research shows that our tendons respond best to gradual increase in load to rebuild strength.

2, Ignore your pain

Always acknowledge your pain.  Pain is your brain’s way of telling your body that there is something wrong.  These messages are our own innate way of taking pressure off a damaged tissue in the body.  Pain in a tendon is your body’s way of telling you that there is too much load going through it and it is not coping.  It is a normal response and is only trying to prevent further damage.  It is always best to address the issue early to get the best results in recovery. 

3, Seek solely passive treatment

Hands on techniques can aid somewhat in your recovery, relieving some of your painful symptoms.  However typically with tendon pain there is an underlying reason why the injury occurred in the first place, which hands on therapy can’t change.  Addressing the underlying cause of the issue and then providing education on how to best improve the injured tendons capacity to tolerate load is something we are famous for at Sports & Spinal Albury.

4, Go straight for cortisone injections

Often clients go for a corticosteroid and PCP (platelet rich plasma) injections.  For years there were among the first line therapy for tendon problems.  Current research has found that these therapies are not an effective form of treatment long term.  Injections can mask the symptoms for a short period of time but failing to address the underlying cause of the tendon injury will most likely mean a return of the pain once the injection wears off.   In fact, laboratory studies have shown that high doses of cortisone or repetitive use of the medication can lead to further damage of the tissue. 

5, Stretch your tendon

Often our first thought when we have aching muscles or tendons is to stretch it out.  For muscles this can help, but in tendinopathies this stretched position can actually squeeze and compress the tendon further.  This compressive force can actually aggravate an irritable tendon, potentially increasing the already painful levels of inflammation and swelling present.  Thus it can be detrimental to stretch a tendon, apart from the occasional very short term relief.

6, Massage your tendon

The tendon is already inflamed, massaging will bring further blood flow to the area causing greater irritation and therefore more pain.

7, Worry about scan results

Often people get sent for scans if a tendon issue is suspected, but it’s important not to fret about the findings that come back.  The report itself may include words such as degeneration, inflammation, swelling, tears, etc.  Research has shown that people without pain in their tendons often also have these findings.  So whilst these findings can be scary, it is now understood that these tendons will still respond well to load.  An appropriate, gradually progressed loading of these tissues will often help in resolution of a tendinopathy.

8, Worry about tendon rupture because of the pain

This is why we feel pain, our brain is alerting us to the potential for further damage.  It alerts you well ahead of time, typically long before a rupture is likely to occur.  Of course if it’s not addressed and inflammation continues, slow degradation of the tissue could weaken the area so it is still considered important to get your condition addressed ASAP.

9, Take short cuts

Unfortunately there is no magic one off cure for a tendon injury.  It will take quite a bit of time and effort.  Allow for at least 3 months to really start seeing improvements.  That is, of course, if you are consistent with your rehabilitation exercises and stick to a dedicated plan.  At Sports & Spinal Albury we never give up on helping you attain a return to full fitness!  We’ll always be here to provide support and structure, helping motivate you through the process to give you the best chance in recovery. 

10, Be uneducated about your pain

Education is the key to many injuries.  Understanding your pain and why it is happening can make it a lot easier to manage your pain.  Learning about appropriate loading, inflammation and how pain works can help with your recovery and aid in eliminating fears during your rehabilitation.  Educating you is what we pride ourselves on here at Sports & Spinal Albury.  We believe that KNOWLEDGE IS POWER.

So what can I do about my tendon pain?

  • It’s important to listen to your body. Pain is your way of helping you avoid further harm to your body.  Seek a qualified health care practitioner who has experience in treating tendinopathies ASAP.  It is vitally important your recovery and to get you on the right path.  Typically the longer your pain hangs around, the longer it takes to go away.  Sports & Spinal Albury’s Osteopaths have completed additional training with world leading tendinopathy experts in order to enhance our knowledge and understanding of this debilitating injury.
  • Acknowledge that all of the short term fixes have failed and it might be time to see someone in the know.  You will have to rebuild the strength and endurance of the tendon, starting with isometric loading and then progressing to eccentric exercises.  Your chosen practitioner will help guide you through increases in load until you have built up the capacity to load the tissue again for your chosen activity that was causing you grief.
  • Learn about your pain, it always helps understand the rehabilitation process if you can understand why the tendon is hurting, why it’s happening and what can you do in case of flare ups. Sports & Spinal Albury prides itself on enhancing our client’s knowledge of their problem.
  • AND OF COURSE………re-read the above information on what not to do!


Sports & Spinal Albury have brought new, world leading technology to the border to help aid in the healing of tendinopathies.

Introducing Extracorporeal Shockwave Therapy.

Extracorporeal Shockwave Therapy (ESWT), otherwise known as Shockwave Therapy, uses high energy sound waves that are transmitted via a probe through the skin and dispersed outwards into the underlying tissue. This is believed to induce increased blood flow and metabolic activity around the site of pain accelerating the healing process. At the very least it effectively reduces pain from this area.

Any proof this particular machine works?

Our machine has been widely researched.  Since 2007, there have been 27 double-blind randomised level 1 studies published which demonstrate positive outcomes. Most importantly, it has been demonstrated as a safe treatment option.   The machine we have is the only shockwave therapy machine with FDA approval for treatment of plantar fasciitis.

How many treatments will I require?

This differs between individuals and various injuries. A typical treatment course is between 3-5 sessions to gain a successful result. Generally, we expect immediate improvement from their first shockwave therapy session. With the second treatment, the pain should further reduce and by the third treatment there should be a significant decrease in pain, which is long lasting. We also provide our patients with specific strengthening and stretching exercises to aid in the shockwave treatment with the aim of achieving excellent long-term results.

How does Radial Shockwave Therapy work?

  • Increases circulation: improved supply of oxygen and nutrients to increase healing
  • Reversal of chronic inflammation: restoring the body’s normal healing processes
  • Stimulation of collagen production: healing injured tissue and making it stronger
  • Reduces ‘Substance P:’ pain relief from reducing the concentration of this pain mediating chemical at the injury site

What will happen during my Radial Shockwave Therapy session?

A contact gel is applied to the injury site, where acoustic shockwaves are delivered in a controlled and focused manner via a hand-held probe. The treatment itself typically lasts up to 10 minutes per area treated. You are able to continue with your activities straight after treatment with very little down time.

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