Lower Limb Tendinopathies


‘Tendinopathy’ is an umbrella term used to describe disease of a tendon. Tendinopathies are complex injuries due to their varied nature, differential diagnoses and stubborn response to treatment. Tendinopathy encompasses any problem involving the tendon (eg. Achilles or patella tendon) and presents in two main forms – tendinitis and tendinosis.

Tendinitis involves the inflammation or irritation of a tendon. It presents as localised pain, swelling, warmth and redness (main signs of inflammation). Tendinosis is the non-inflammatory degeneration of a tendon. This includes changes to the structure or composition of the tendon due to repetitive stress over time. However, it can be also used to describe a chronic tendon condition that fails to heal.

Tendons have 7X SLOWER METABOLISM than other tissues of the body. Thus, it will take LONGER time to heal and recover. A common misconception is that complete rest and stretching of the tendon is the best recovery strategy; however, this is FALSE! Graded tendon LOAD management is key!


Injury rehabilitation of tendinopathies must utilise a combination of education, tendon load management, kinetic chain strengthening and a graded return to running/sport.

This ensures YOU know the details of your tendinopathy – what it is, why you have it, the timings and essential information involved in YOUR personal recovery.

Load Modification
RELATIVE rest is essential in order to reduce the aggravating factors inflaming the tendon; thus, settling the cell/immune response. Complete rest is NOT indicated as it decreases the ability of the tendon to take load. Relative rest involves a reduction (not cessation!) of tendon aggravating activities or sports.

Instead, reduce loads to the level the tendon CAN tolerate and strengthen the tendon from there! This strengthening must begin at an isometric (static) level, progressing to gentle eccentric strengthening and later on – adding speed to your exercise program!

Address Muscle Wasting
Tendinopathies commonly present with muscle wasting of a nearby or associated muscle group. Wasting indicates the muscle is not working, thus placing more biomechanical stress and load through the tendon. Therefore, a strengthening program of these muscles will reduce the load through improving the tendon’s efficiency in its muscular action.

Specific Tendon Loading

This a four-stage progression.

  1. Isometric: Initially, isometric (static) loading aims to reduce pain, whilst strengthening the muscle in a position out of tendon compression or stretch.
  2. Strength: this is indicated when pain is stable and has settled from peak severity. It is essential to work within 6-8 reps, at a slow pace, avoiding speed and stretch. However, ensure you are strengthening the WHOLE KINETIC CHAIN.
  3. Energy Storage: This is aiming to maintain strength gains in the injured tendon. You may begin to increase load or reps, implementing strength exercises every 2-3days.
  4. Sport’s Specific/Elastic Function: This aids the transition back to full activity, aiming to regain the tendons elastic function. Speed elements can be added to programs; however, don’t progress by adding both load and speed together – change ONE thing at a time.


  • ‘Tendinopathy’ is an umbrella term used to describe disease of a tendon.
  • Tendinopathies must be controlled principally through tendon load management.
  • A professionally implemented graded-strength exercise program is essential for the rehabilitation of tendon injuries.
  • Thus, load monitoring and controlled resumption of high tendon load is key.
  • It is essential to maintain/improve function of associated muscle groups in order to reduce the stress on the affected tendon.