Tendinopathy

Also called Tendonitis, Tennis elbow, Achilles tendinopathy, Plantar fasciitis

Tendon pain from load, not from inflammation. Rest makes it worse, and the treatment is graded loading over months.

What it is

Pain and loss of function in a tendon, most often the Achilles, the elbow, the shoulder rotator cuff, the knee or the sole of the foot.

The old name, tendonitis, means inflammation of a tendon, and it is largely wrong. What the tissue actually shows is disordered, poorly organised collagen from repeated load the tendon has not adapted to, with little inflammation. That change of understanding is not academic: it is why anti-inflammatories and rest, the obvious treatments, are the wrong ones.

The right treatment is graded loading. Progressive, monitored exercise that gradually increases what the tendon can tolerate, done for months rather than weeks. It is slow, it is dull, and it works better than anything else on offer.

Steroid injections give short-term relief and worse outcomes at a year in several of these conditions, particularly tennis elbow. They still have a place; they are just not the answer people assume.

Some pain during the exercises is expected and acceptable. Being told that explicitly is what stops people quitting, and it is the single most useful sentence in this entry.

Signs you might notice

Pain at a specific point on a tendon, worse at the start of activity, often easing as it warms up, then worse again afterwards and the next morning.

Stiffness first thing, particularly Achilles pain in the first steps out of bed and heel pain from plantar fasciitis in the same pattern.

Tenderness when the tendon is pressed, and pain when the muscle is used against resistance.

Gradual onset over weeks, usually after a change in activity, footwear, work or training load.

Different, and needing urgent assessment: a sudden pop or snap with immediate weakness, which may be a tendon rupture; a hot swollen joint with fever; or pain with a fever and feeling unwell.

Achilles pain in anybody taking a fluoroquinolone antibiotic such as ciprofloxacin needs the antibiotic stopping and a same-day discussion, because rupture risk is raised.

How it can affect day-to-day life

The recovery timescale is the thing nobody is told, and it is why people conclude the exercises failed. Three months is normal, six is common, and improvement is not linear.

Because rest feels right and helps for a day or two, most people cycle through rest, feel better, return to activity, and flare again. Breaking that loop is most of the job.

For manual workers and people on their feet all day, this is a work problem as much as a medical one, and a conversation about load, footwear and shift pattern is often more useful than a prescription.

It is more common and more stubborn in people with type 2 diabetes, rheumatoid arthritis and obesity, and in those cases the underlying condition is part of the treatment.

Supporting someone well

Do not rest it completely. Reduce the aggravating load, keep loading the tendon, and build back up.

Ask for physiotherapy. In most of the UK you can self-refer without seeing a GP first.

Expect and accept some pain during the exercises, up to a level agreed with the physiotherapist, settling within 24 hours.

Do them for months, not weeks, and keep a record so progress is visible when it does not feel like it.

Ask what changed just before it started: new shoes, a new job, more running, a different chair. That is usually the fix.

For heel pain, ask about insoles and footwear, and see podiatry.

Be cautious about steroid injections for tennis elbow in particular, and ask about the one-year outcome rather than the six-week one.

Get sudden pop-and-weakness assessed the same day.

Where to get help

NHS physiotherapy self-referral where offered, otherwise a GP practice.

A and E or an urgent care service for a sudden snap with weakness, or an inability to push off the foot.

Chartered Society of Physiotherapy publish self-management guidance and hold a directory of private practitioners.