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Tendons are important structures in the human body as provides link between a muscle and onto the bone it attaches. They help control joint movements through transmission of muscle forces exertion during loading and contraction. For that, they are incredibly strong and can withstand large forces and impact.


Nonetheless they can be susceptible to pain when they become unhealthy and weak (e.g. sedentary lifestyle weakening tendons) or when they are suddenly exposed to unexpected or too much increase in load (i.e. strain).


Healthy Tendon, Tendinopathy

Common medical diagnostic labels for tendon pain includes: tendinopathy, tendinitis, tendon degeneration or a tendon tear / rupture. Tendon pain occurs when the tendon itself and surrounding tissue becomes swollen and thickened, sensitive to load (i.e. strain), and tender to touch.

Common tendons affected:  

  1. Achilles tendon -This tendon connects the calf muscle to the heel bone of the foot. 

  2. Patella tendon – This tendon has its attachment to the knee cap (patella) and the thigh muscle (quadriceps) exerts force on it via the tibial tuberosity on the leg bone (tibia)

  3. Gluteal tendon – This tendon connects the buttock muscles (gluteal) to the thigh bone (femur).

  4. Hamstring tendons –These tendons connects three hamstring muscles from the sit bone on the pelvis (ischial tuberosity) to the back of the shin bones below the knee (tibia & fibula). 

  5. Rotator cuff tendons – These tendons connect the rotator cuff muscles from the shoulder blade to the upper arm bone (humeral head).

  6. Forearm flexor and extensor tendons - These tendons connect the hand and wrist muscles to the bones above the elbow at a common origin point (humeral epicondyles). Commonly known as tennis and golfers elbow when pain.

*note that bone structures mentioned above can also contribute to tendon pain because of compression


Recovery for tendon pain can take 6-12 weeks or more (if chronic pain). It is crucial to take a disciplined approach where an exercise program is the cornerstone – progressive loading over a period of time.


The first step is to screen for serious causes of tendon pain such as rupture. If your tendon pain have developed over time, it would also be helpful to identify the key factors relevant to your pain. Physiotherapy is an effective first line of treatment for tendon pain (level 1 evidence).


It is key to build a plan to get tendons well and stronger in capacity:

  1. Understand how tendon pain began and how it impacts you functionally and in activities of daily living

  2. Screen for serious tendon pain causes.

  3. Undertake a comprehensive physical examination of affected tendon and surrounding body parts relevant. This includes: movements, posture and activities that restricting or painful to you.

  4. Identify source of pain and contributing factors relevant

  5. Develop an exercise plan to reduce tendon pain which will usually involve activating and gradual loading of muscles around tendon.

  6. This exercise plan should also get you fit, active and healthy without overstraining tendon too fast.

riadmap to recovery
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