How-to-guide for early career physiotherapists to Diagnose and Treat tendon pain
How to Diagnose and Treat Tendon pain
Tendinopathy is one of the most common issues you’ll encounter in your first years as a physiotherapist. It affects a broad range of patients—from weekend warriors to office workers to elite athletes—and often presents as a frustrating, lingering pain that impacts daily function.
With two decades of experience in the field, I can assure you that mastering the art of diagnosing and treating tendinopathy will be crucial to your success. Let’s break down the essentials and share some practical steps to take in clinic, so you can feel confident treating this condition.
What is Tendinopathy?
Tendinopathy is a broad term for conditions of the tendon that create pain and reduce the tendons capacity for load no matter what body area it is coming from. From Tennis elbow, to jumper’s knee and back up to golfer’s elbow. We have tendons all over our body and if they have a dramatic increase in load that they aren’t used to they can become dysfunctional. Tendinopathy often involves degenerative changes in the tendon structure, meaning it’s more about faulty healing and disorganisation of tendon fibres rather than inflammation alone.
How to Recognise Tendinopathy
When assessing a patient, your first job is to gather a clear history of their symptoms and activity level. Tendinopathy typically presents with:
Pain: Pain at the site of the affected tendon, which may worsen with activity and improve with rest.
Morning Stiffness: Patients often report stiffness in the morning, particularly if the tendon was loaded the day before.
Localised Tenderness: Pressing on the tendon will often reproduce the pain.
Thickening or Swelling: A hallmark of chronic tendinopathy is visible or palpable thickening around the tendon.
Treatment: A Practical, Step-by-Step Approach
1. Load Management: The Cornerstone
Tendinopathy stems from an overload or improper loading of the tendon, so your primary goal is to guide your patient through load management. This doesn’t mean complete rest—tendons need to move to heal—but it does mean finding the right balance between activity and rest.
Practical Tip: Ask your patient to scale back the activities that aggravate their symptoms. However, encourage low-impact exercises that maintain movement without overloading the tendon, such as walking or swimming.
2. Exercise-Based Rehabilitation
Rehabilitation exercises are critical in promoting healthy tendon healing. Evidence supports a progressive loading program to stimulate tendon repair without causing further damage. Here’s a basic framework:
Isometric exercises: Ideal for reducing pain and starting tendon repair. Have the patient perform static holds, where they contract the muscle without moving the joint (e.g., wall sits or static calf raises).
Eccentric exercises: As the tendon adapts, introduce eccentric loading (e.g., slow lowering phase of a calf raise or wrist extension). This stimulates tendon remodelling.
Functional or sports specific training: Gradually introduce exercises that are functional to how your patient moves day to day and, for your athletic population, make sure you progress to exercises that are going to assist their return to sport.
Practical Tip: Track progress by measuring pain and function. If pain during or after exercise worsens, reduce the load or intensity.
3. Patient Education
Educating your patient is vital for compliance. Emphasise that recovery from tendinopathy is a long process and tends to take weeks to months. Ensure they understand the importance of sticking to the exercise regime and managing their load.
Call to Action: Provide your patients with a clear, written program to follow at home. Regularly check in on their progress and adjust the plan as needed.
Takeaways for New Graduate Physiotherapists
Don’t Rush to Inflammatory Treatment: Tendinopathy is a degenerative condition, not purely inflammatory. While NSAIDs or ice can reduce pain, the focus must remain on load management and tendon healing.
Master Progressive Loading: This is the heart of treatment. Start with isometric exercises and slowly introduce eccentric and functional or sports specific training.
Educate and Motivate Your Patients: Recovery is a slow process. Build trust with your patients by providing a clear plan, explaining the long-term nature of healing, and regularly assessing their progress.
Be Patient and Persistent: Tendon healing doesn’t happen overnight. Stick to evidence-based practices, and remind your patients to do the same.
Final Thoughts
As a new physiotherapist, treating tendinopathy effectively will significantly benefit your patients and build your confidence in the clinic. Focus on identifying the condition accurately, managing loads, and guiding rehabilitation exercises. Above all, stay patient—both with the tendon and with yourself. Tendinopathy is a marathon, not a sprint!
Mentoring for Physiotherapists
Mentoring is perfect for physiotherapists who want to build confidence in a private practice setting. This can include improving your assessment skills, diagnostic competence and treatment skills. Mentoring can also help improve your patient outcomes and your patient numbers, making you an invaluable member of your physio clinic.
You may be a new graduate, a few years out of uni, or transitioning from another role, such as a physiotherapist in the hospital system and moving into private practice. Mentoring is an effective way to grow your professional physiotherapy career.
I’d love to help
Georgia
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