Tendon Trouble

This month our attention has been drawn to a new infographic and video all about tendons. It has been produced by Latrobe University and features Prof Jill Cook detailing what NOT to do for lower limb tendon issues. It’s a reader friendly resource and I recommend giving it a watch.

The two most frequent tendons we see implicated are the Achilles and the patellar tendon. They can be extremely difficult to manage and to improve but they really really can get better IF the correct principles are applied.

Common symptoms

Typically people suffering with Achilles problems complain of pain when running or jumping, or some swelling around the tendon. It could be painful to touch in the earlier stages or, if its been going on for a while it can be lumpy so it’s always worth feeling the opposite side to compare.

They can start for many reasons, perhaps a change in training, footwear or activity and they can be more prevalent in people with flatter arches.

The recommendations of what not to do detailed in the infographic pertains largely to how we choose to “load” the tendon, when we use this term with respect to tissue healing we mean the pressure we are applying to the tendon.tendon injury

So thank you Latrobe University and Prof Jill Cook for the following of what NOT to do for lower limb tendon injurie!

  1. REST completely!

The tendon still needs to do SOMETHING to maintain its ability to absorb some load, but do this within sensible parameters. For example if your pain comes on after 20mins of running, then why not slow down a bit and run for fewer minutes, or with some rest periods in between. This way you can develop the tolerance of the tendon.


Treatments such as ultrasound, acupuncture or ice may provide some pain relief but will not serve to strengthen the tendon itself.


Good clinical trials have not shown benefit from injection into the tendon and certainly not before you have given an exercise program a good go.


The term “no pain no gain” is simply one of the biggest lies we have been sold. Pain suggests your tendon cannot handle the load you are placing on it so you must change and listen to your body! If pain comes on with running then you may need to temporarily consider non-loading alternatives such as cycling or swimming to allow the tendon to settle down.

  1. Stretch your tendon

This is only adding more pressure to the already angry and weakened tendon, if the surrounding muscles are tight then massage may be helpful in feeling looser.

  1. Massage the tendon

Again, it’s an angry piece of tissue begging to be left alone so leave it be!

  1. Worry about imaging results of tendons

As mentioned in previous blogs loaded words such as degeneration can make you want to lock yourself in a room, get into bed and never leave but fear not, there is evidence that tendons with pathology i.e. inflammation acute or chronic can tolerate some loading, especially when controlled and gradually introduced.

  1. Worry about rupture

Most of the time ruptures occur without warning in people who have not experience any tendon issues beforehand.

  1. Take Short Cuts

Rehabilitation/ exercise therapy/ loading programs whatever you want to call any exercise you are doing for your tendon, these take time. How long is dependent on other factors such as age, activity and general health, so it’s difficult to give an exact time frame. In my experience, any rehab program will not be less than 6 weeks and is more likely to stretch to 12 weeks.

  1. Not understand what loads are high for your tendon

The most difficult thing for your tendon to do is act like a spring, for example when jumping and sprinting. Everything else is low load compared to these tasks, understand this and it’s relatively straightforward to follow a tendon rehab program.

In summary Tendon problems are very common and something we see a lot of ,so don’t suffer in silence. The sooner you do something about them the sooner they improve and you get back to pain free function. Physios are expertly placed to advice on loading programs and get your back to normal activity.

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