Tendinopathy (tendinitis): recovery with a physiotherapist

In short Tendinopathy, often called tendinitis or tendonitis, is a painful tendon that tolerates less load. It usually develops because you suddenly load the tendon more than it is used to.[3] Complete rest does not help: what works best is making the tendon stronger again step by step with exercises, guided by your physiotherapist.[3][12] Recovery takes patience and usually lasts a few months.

What is tendinopathy?

A tendon connects a muscle to a bone. It transfers the force of your muscle to your bone and works like a spring: it stores energy and releases it again, for example when you run or jump.

A painful tendon is often called "tendinitis", which suggests inflammation. That word is only half right. In a painful tendon, researchers mainly see fibres that are out of line, more small blood vessels and nerves, and some inflammatory cells and substances. It is not a classic inflammation, like an infection.^[2] That is why experts prefer the word tendinopathy: an umbrella term for persistent tendon pain with less function under load.^[1] On this page we use both words.

Where does it often occur?^[2]

• Shoulder: the tendons of the rotator cuff. Read more about rotator cuff injuries.
• Elbow: on the outside (tennis elbow) or the inside (golfer's elbow).
• Hip: the tendons of the buttock muscles on the side of your hip (gluteal tendinopathy).
• Knee: the tendon below your kneecap (patellar tendon, "jumper's knee").
• Heel: the Achilles tendon.

How does tendinopathy develop, and who is at risk?

Tendons respond to how heavily you use them. If you increase the load gradually, the tendon gets stronger. If you load it much more than it is used to in a short time, it can become painful.^[3] That happens to athletes, for example when you suddenly train more or harder, but also to people who do not play sport: moving house, a job around the house or more hours of the same work.

Besides that sudden change in load, some factors increase the chance of tendon problems:

Factor	What does the research say?
Age	Shoulder tendon problems are more common over the age of 50.[5] Achilles tendon problems are more common over the age of 45.[9]
Diabetes, high cholesterol and being overweight	Linked to more tendon problems.[5][6] Diabetes, for example, clearly increases the chance of Achilles tendon problems.[6]
Previous tendon problems or a fracture in the leg	Increase the chance of Achilles tendon problems.[4]
Less calf strength	Linked to more Achilles tendon problems.[4]
Working with your arms above shoulder height	Increases the chance of shoulder tendon problems.[5]
Certain antibiotics (fluoroquinolones)	Increase the chance of tendon problems and a tendon rupture, especially over the age of 60 and together with corticosteroids.[7] The risk differs per drug: it is highest with ofloxacin.[8]
Alcohol	Linked to more Achilles tendon problems.[4]

Research into risk factors is still limited: many studies are small or have weaknesses.^[4] Notably, being overweight, the shape of your foot and how active you are were not linked to Achilles tendon problems in a review.^[4]

Are you taking an antibiotic and do you get tendon pain? Contact your GP. Never stop a medicine yourself.

Do you recognise this?

• The pain is in a clear spot, on or close to the tendon.
• The symptoms started gradually, not from a single fall or blow.
• It is often worse the day after a heavy effort.
• When you get up or start moving, the tendon feels stiff. That eases a little once you are warmed up, but comes back afterwards.
• Jumping, running, lifting or raising your arm (depending on the tendon) gets more painful the more you load the tendon.

When to see your GP or go to A&E straight away?

Your physiotherapist recognises signs that do not fit ordinary tendinopathy and will then refer you. See your GP straight away yourself if:

• you suddenly felt a bang or a kick against your calf or arm and can no longer stand on it or lift properly. That can point to a tendon rupture: have it checked the same day, outside office hours via the out-of-hours GP service or A&E;
• the area is red, warm and swollen and you feel ill or have a fever;
• you got tendon pain shortly after starting an antibiotic;
• several joints or tendons at the same time are painful, stiff or swollen, especially in the morning;
• the pain is new and severe, or keeps getting worse despite reducing the load.

Do I need a referral?

From 1 January 2027 you can see a physiotherapist without a referral for many complaints. Read what direct access means and what it means for your reimbursement.

How does your physiotherapist approach it at Magnus?

Tendinopathy is mainly a load problem. That is why your physiotherapist first finds out where the overload comes from. Often that is a change in training or work, but it can also lie in your body itself. A stiff ankle, for example, can make your Achilles tendon work less well, so that the tendon below your knee or at your hip has to absorb more.

At your first appointment, which lasts an hour, your physiotherapist looks at:

• your story and your risk factors (see the table above);
• how much and how heavily you load the tendon: in your sport, your work and your free time, and how much rest you take in between. Where possible, we measure this with your sports watch or an app;
• your strength and mobility, at the spot itself and in the rest of your leg or arm. We measure your strength with a hand-held dynamometer, a device whose measurements proved reliable and valid in scientific research;^[28]
• how you move: the control over your muscles during, for example, a jump or a squat.

An ultrasound or scan is usually not needed: a physiotherapist or doctor mainly recognises tendinopathy from your symptoms and the examination.^[3]

What works? (treatment with evidence)

Research sometimes looks at one technique on its own, and sometimes at a combination of treatments. That is why we show both separately.

Single techniques: what does the research say about one treatment on its own?

Treatment	What does the research say?	Evidence
Exercise therapy (loading the tendon in a targeted way and step by step more heavily)	The first choice for tendon problems. No additional treatment, on its own or on top of exercises, did clearly better than exercises alone in a large review.[12] Eccentric exercises were the most consistently effective in most reviews.[11]	Strong evidence¹
Training heavily enough	Exercise programmes with extra weight worked better on average than exercises with only your body weight. Not training every day worked better than daily or several times a day: your tendon needs recovery.[13]	Limited evidence¹
Isometric exercises (tensing a muscle without moving)	Not better than ordinary strength exercises, and they do not give immediate pain relief.[14][15] They can be a gentle start when moving is still too painful.[14]	Limited evidence¹
Exercises for tennis elbow	Work better than passive treatments, but the difference is small.[16]	Limited evidence¹
Exercises for tendon problems at the hip	Give better function than doing little or nothing, and succeed more often than a corticosteroid injection.[17]	Limited evidence¹
Blood flow restriction training (BFR)	For a painful patellar tendon, training with light weights and a band around the upper leg gave as much improvement as heavy, slow strength training. This is one small study.[19] Useful when heavy weights are not yet possible.	Limited evidence¹
Shockwave therapy	Mixed results. On average not better than other treatments, but possibly useful for tendons in the leg and for calcium deposits in the tendon.[20] On top of exercises it gave no extra benefit in the short term for the patellar tendon.[12]	Limited evidence¹
Dry needling on top of exercises	Reduced pain somewhat more than exercises alone in a small review, but the studies strongly contradict each other.[24] Read more about dry needling at Magnus.	Limited evidence¹
Complete rest	A tendon needs load to get stronger. A gradually built-up exercise programme works better than complete rest.[3][27]	No evidence that it helps¹

Combined approach (multimodal): what does the research say about a combination?

Treatment	What does the research say?	Evidence
Education, adjusting load and exercises together	For a painful patellar tendon, an approach in which the load was measured and adjusted, together with exercise therapy, was effective in the short and medium term.[18] For tendon problems at the hip, too, education, adjusting load and exercises together come first.[27]	Limited evidence¹

So at Magnus we combine what works: explaining what is going on in your tendon, adjusting the load in your sport and work, and an exercise programme that gets heavier step by step. We measure your progress and adjust the programme.

Rehabilitation in 4 phases

Your rehabilitation usually goes through four phases. You only move on to the next phase when the tendon tolerates the previous one well, not on a fixed date.

Phase 1. Loading the tendon gently

The tendon gets load again that it tolerates well. That can be with isometric exercises, for example holding a squat against the wall for a painful patellar tendon, or already with gentle strength exercises. Your physiotherapist helps you to temporarily adjust the load in your daily life and sport, without stopping completely.

Phase 2. Heavy and slow strength training

Now the focus is on strength, with heavy slow resistance: exercises that are heavy enough and done slowly, such as slow lunges with weights. Exercise programmes with enough extra weight work better on average than exercises with only your body weight.^[13]

Phase 3. Fast and springy loading

The tendon learns again to store and release energy, like a spring. Your physiotherapist adds jumps, hops and running drills. That is the heaviest load for the tendon, so we build it up carefully.

Phase 4. Back to your sport or work

The load becomes more and more specific to what you need. For a football or basketball player, jumps and sprints are important; for a runner, triathlete or swimmer, mainly repeated load over a long time. There is no standard schedule: your programme is tailored to you.

How much may it hurt during the exercises?

A little pain during the exercises is usually not a problem, up to about 3 or 4 out of 10. What matters is how the tendon feels the next morning: if the pain or stiffness has not increased, your tendon tolerates the load. If it is worse, we adjust the programme. Your physiotherapist teaches you to monitor this yourself.

Popular treatments, but little evidence

Treatment	What does the research say?	Evidence
Corticosteroid injection	Can reduce pain somewhat in the short term, especially together with physiotherapy. After a few weeks to months it is not better than physiotherapy alone.[21] Experts advise against it, because the symptoms come back more often afterwards and the chance of a tendon rupture may increase.[22]	Limited evidence¹, only in the short term
PRP injection (made from your own blood)	For a painful Achilles tendon, a PRP injection did not do better than a placebo injection in a large study.[23] In an overview of reviews, too, the evidence was not convincing.[11]	No evidence¹
Complete rest or sparing the tendon for a long time	See above: without load, the tendon does not build up strength.[3]	No evidence that it helps¹

No evidence does not mean that something is harmful or helps nobody. It means that we do not know for sure. You discuss an injection with your GP or specialist; your physiotherapist can give you advice for that conversation.

How long does recovery take?

Tendon problems recover slowly. A tendon adapts more slowly than a muscle, so expect a few months. In a recent study, for example, the exercise programme lasted 12 weeks, with follow-up until a year later.^[19]

• After one year, about one in three runners with new Achilles tendon problems still had symptoms. Those who ran more before the symptoms were less likely to have lasting symptoms.^[26]
• After ten years, about one in five people with Achilles tendon problems still had symptoms, although most had clearly improved.^[25]

That sounds long, but above all it shows that a well-structured programme, which you keep up after the treatment as well, makes the difference. At the start we set goals together and evaluate them regularly. If there is no progress after a few weeks, or your symptoms get worse, we discuss the next step with your GP.

What can you do yourself?

• Keep moving, but adjust. Mainly reduce what loads the tendon most (jumping, sprinting, lifting above your head), and keep up the rest as much as possible.
• Build up gradually. Do not increase your training or work suddenly. A large, sudden change is the most important cause of tendon problems.^[3]
• Do your exercises faithfully, even when the pain has already eased. Heavy exercises do not need to be done every day: every other day or a few times a week works well.^[13]
• Look after your general health. Diabetes, high cholesterol and being overweight are linked to more tendon problems.^[6] Discuss this with your GP.

At Magnus near you

Leuven, Naamsepoort
Erasme Ruelensvest 11, 3000 Leuven. Open 8am to 8pm.

Kessel-Lo
Platte Lostraat 278, 3010 Kessel-Lo. Open 8am to 8pm.

Antwerp, Eilandje
Tunnelplaats 1, 2000 Antwerp. Open 8am to 8pm.

Frequently asked questions

Should I rest or keep moving with tendinitis?
Keep moving, but adjusted. If you spare a tendon completely, it does not gain strength. An exercise programme that loads the tendon more heavily step by step works best.^[3][12] Your physiotherapist helps you decide what is best to do and not to do.

How long does tendinitis last?
Usually a few months. A tendon adapts slowly. The better you keep up the exercises, the greater the chance that your symptoms stay away.^[25][26]

Can I keep playing sport with tendinitis?
Often yes, in an adjusted form. Your physiotherapist looks at which load your tendon tolerates now and builds up from there. Pain that is not worse the next morning is usually not a problem.

Do I need an ultrasound or scan?
Usually not. Tendinopathy is mainly recognised from your symptoms and the examination. A scan is only needed in special cases.^[3] If your physiotherapist is in doubt, they consult your GP.

Can an antibiotic cause tendon problems?
Yes. Certain antibiotics (fluoroquinolones) increase the chance of tendon problems and a tendon rupture, especially in people over 60 and when used together with corticosteroids.^[7][8] If you get tendon pain during or shortly after such a course, contact your GP. Never stop a medicine yourself.

Does a corticosteroid injection help?
Sometimes a little in the short term, but in the longer term not better than physiotherapy, and the symptoms can come back more often.^[21][22] Always discuss an injection with your GP or specialist.

Do I need a referral?
From 1 January 2027 you can see a physiotherapist without a referral for many complaints. Read what direct access means.

Reviewed by Magnus Kinesitherapie. Last updated: 3 November 2026.

^¹ What do the labels mean? Strong evidence: several good studies or reviews reach the same conclusion. Limited evidence: there are few or small studies, or the results contradict each other; it may help, but it is not certain. No evidence: good studies find no effect greater than a placebo, or there are no good studies yet. No evidence does not mean something is harmful. We base our information on reviews and guidelines published in 2019 or later.

This page gives general information and does not replace an examination by a doctor or physiotherapist.

Glossary

Difficult words on this page, explained in plain language. The explanations are written in our own words, based on the source given.

Sources

1. Scott A, et al. ICON 2019: International Scientific Tendinopathy Symposium Consensus: clinical terminology. Br J Sports Med. 2020. doi:10.1136/bjsports-2019-100885 (PMID 31399426) [expert consensus]
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3. Cardoso TB, et al. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol. 2019. doi:10.1016/j.berh.2019.02.001 (PMID 31431267) [review article]
4. van der Vlist AC, et al. Clinical risk factors for Achilles tendinopathy: a systematic review. Br J Sports Med. 2019. doi:10.1136/bjsports-2018-099991 (PMID 30718234) [systematic review]
5. Leong HT, et al. Risk factors for rotator cuff tendinopathy: a systematic review and meta-analysis. J Rehabil Med. 2019. doi:10.2340/16501977-2598 (PMID 31489438) [meta-analysis]
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8. Sangiorgio A, et al. Achilles tendon complications of fluoroquinolone treatment: a molecule-stratified systematic review and meta-analysis. EFORT Open Rev. 2024. doi:10.1530/EOR-23-0181 (PMID 38949172) [meta-analysis]
9. Wang Y, et al. Prevalence of Achilles tendinopathy in physical exercise: a systematic review and meta-analysis. Sports Med Health Sci. 2022. doi:10.1016/j.smhs.2022.03.003 (PMID 36090915) [meta-analysis]
10. Chimenti RL, et al. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision – 2024. J Orthop Sports Phys Ther. 2024. doi:10.2519/jospt.2024.0302 (PMID 39611662) [guideline]
11. Irby A, et al. Clinical management of tendinopathy: a systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scand J Med Sci Sports. 2020. doi:10.1111/sms.13734 (PMID 32484976) [umbrella review]
12. Challoumas D, et al. Effectiveness of exercise treatments with or without adjuncts for common lower limb tendinopathies: a living systematic review and network meta-analysis. Sports Med Open. 2023. doi:10.1186/s40798-023-00616-1 (PMID 37553459) [network meta-analysis]
13. Pavlova AV, et al. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. Br J Sports Med. 2023. doi:10.1136/bjsports-2022-105754 (PMID 37169370) [meta-analysis]
14. Clifford C, et al. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ Open Sport Exerc Med. 2020. doi:10.1136/bmjsem-2020-000760 (PMID 32818059) [meta-analysis]
15. van der Vlist AC, et al. Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: a quasi-randomized clinical trial. Scand J Med Sci Sports. 2020. doi:10.1111/sms.13728 (PMID 32474979) [quasi-randomised study]
16. Karanasios S, et al. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. Br J Sports Med. 2021. doi:10.1136/bjsports-2020-102525 (PMID 33148599) [meta-analysis]
17. Cordeiro TTP, et al. Effects of exercise-based interventions on gluteal tendinopathy: systematic review with meta-analysis. Sci Rep. 2024. doi:10.1038/s41598-024-53283-x (PMID 38336959) [meta-analysis]
18. Núñez-Martínez P, Hernández-Guillen D. Management of patellar tendinopathy through monitoring, load control, and therapeutic exercise: a systematic review. J Sport Rehabil. 2022. doi:10.1123/jsr.2021-0117 (PMID 34942594) [systematic review]
19. Hjortshoej MH, et al. Effect of low-load blood-flow restricted training versus heavy slow resistance training in unilateral patellar tendinopathy: a randomized clinical trial. Scand J Med Sci Sports. 2025. doi:10.1111/sms.70186 (PMID 41452311) [randomised study]
20. Elgendy MH, et al. Effectiveness of extracorporeal shockwave therapy in treatment of upper and lower limb tendinopathies: a systematic review and meta-analysis. Physiother Res Int. 2024. doi:10.1002/pri.2042 (PMID 37493215) [meta-analysis]
21. Lazzarini SG, et al. Effectiveness of additional or standalone corticosteroid injections compared to physical therapist interventions in rotator cuff tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Phys Ther. 2025. doi:10.1093/ptj/pzaf006 (PMID 39836429) [meta-analysis]
22. Visser TSS, et al. Terminating corticosteroid injection in tendinopathy? Hasta la vista, baby. J Orthop Sports Phys Ther. 2024. doi:10.2519/jospt.2023.11875 (PMID 37506303) [expert opinion]
23. Kearney RS, et al. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in patients with chronic midportion Achilles tendinopathy: a randomized clinical trial. JAMA. 2021. doi:10.1001/jama.2021.6986 (PMID 34255009) [randomised study]
24. Tayyab M, et al. Effectiveness of dry needling combined with exercise versus exercise alone in various tendinopathies: a systematic review and meta-analysis. Cureus. 2025. doi:10.7759/cureus.92833 (PMID 41127782) [meta-analysis]
25. Lagas IF, et al. One fifth of patients with Achilles tendinopathy have symptoms after 10 years: a prospective cohort study. J Sports Sci. 2022. doi:10.1080/02640414.2022.2163537 (PMID 36617848) [cohort study]
26. Lagas IF, et al. How many runners with new-onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study. Scand J Med Sci Sports. 2020. doi:10.1111/sms.13760 (PMID 32615645) [cohort study]
27. Grimaldi A, et al. Gluteal tendinopathy masterclass: refuting the myths and engaging with the evidence. Musculoskelet Sci Pract. 2025. doi:10.1016/j.msksp.2025.103253 (PMID 39854929) [review article]
28. Espino RVS, et al. Validity and reliability of hand-held dynamometers in hip, knee, and ankle strength testing in healthy adults: a systematic review and meta-analysis. Hong Kong Physiother J. 2026. doi:10.1142/S1013702526500046 (PMID 42016044) [meta-analysis]