Why Tendons Get Grumpy (and What Actually Helps)
If you’ve ever had a stubborn ache at your Achilles, shoulder, elbow, or knee that just won’t settle especially with training, lifting, or repetitive work - you might be dealing with a tendinopathy.
Tendinopathies are one of the most common “nagging” injuries we see because they can feel fine one day, flare the next, and hang around far longer than expected if you push through the wrong way. The good news! Most tendinopathies respond really well to the right plan.
At Epoch Health, we take an evidence-based approach combining load management, progressive strengthening, and hands-on support, to help you recover properly and get back to what you love.
What is a tendinopathy?
A tendon is the strong tissue that connects muscle to bone. It’s designed to handle load - running, jumping, lifting, gripping, throwing, and more.
A tendinopathy is a broad term for tendon-related pain and reduced function, usually caused by a mismatch between:
how much load the tendon is exposed to, and
how well it can currently tolerate that load.
This is why tendinopathy often starts after:
a sudden increase in training intensity, hills, speed work, or volume
returning to sport after a break
changing shoes, surfaces, or technique
repetitive work tasks (lifting, gripping, overhead reaching)
long periods of underloading (sedentary phases) followed by a big spike
Common types of tendinopathy we see
Tendinopathy can occur in many areas, but these are some of the most common:
Achilles tendinopathy (back of the ankle/heel)
Patellar tendinopathy (front of the knee - “jumper’s knee”)
Gluteal tendinopathy (side of hip pain)
Rotator cuff tendinopathy (shoulder pain with reaching/overhead)
Tennis elbow (lateral elbow tendinopathy)
Golfer’s elbow (medial elbow tendinopathy)
Plantar heel pain (often related to plantar fascia/tendon loading)
All of these tendon problems are common things we see weekly at Epoch.
Tendinitis vs tendinosis vs tendinopathy (what’s the difference?)
You’ll often hear terms like “tendinitis” or “inflammation,” but modern research has shifted how we understand tendon pain.
Tendinitis implies inflammation is the main issue (often not the case in persistent tendon pain).
Tendinosis refers to degenerative changes in the tendon tissue.
Tendinopathy is the most accurate umbrella term - describing tendon pain with reduced function, regardless of what stage it’s in.
In real life, tendons can be sensitive and painful without being “torn,” and imaging changes don’t always match symptoms.
Why tendon pain can be so stubborn
Tendons adapt slower than muscles. Muscles can strengthen quickly; tendons generally take longer to build capacity.
And here’s the tricky part:
Rest alone often isn’t enough.
If you fully stop loading a tendon for too long, it can become less tolerant to load, so symptoms return as soon as you resume activity.
The goal isn’t “no load.”
The goal is the right load, at the right time, progressing gradually.
Signs you may have tendinopathy
Common symptoms include:
Pain that builds during or after activity (especially the next morning)
Stiffness on first steps/movement after rest
Tenderness when you press on the tendon
Pain with loading tasks (calf raises, squats, gripping, overhead reach)
A pattern of “warm-up effect” (feels a bit better once moving, then aches later)
Red flags (get assessed sooner):
sudden sharp pain with a pop (possible rupture)
significant swelling/bruising
inability to push off, lift, or bear weight normally
night pain, fevers, unexplained weight loss (rare but important)
The 3 biggest drivers of tendinopathy flare-ups
1) Load spikes
This is the classic: you increase training, add hills, start a new job task, or do a big weekend of activity.
2) Poor recovery
Sleep debt, stress, low protein intake, and poor overall recovery can reduce tissue resilience.
3) “All-or-nothing” rehab
Either you push through pain and irritate it - or you rest completely and lose capacity. Tendons do best with a structured middle path.
What actually works for tendinopathy?
Step 1: Calm it down (without doing nothing)
Early on, we aim to reduce irritating load while keeping you active.
Helpful strategies:
temporarily reduce the most provocative movements (not all movement)
modify training volume, intensity, or frequency
switch to tendon-friendly cross-training (bike, swim, incline walk, etc. depending on the area)
use pain as a guide (more below)
Step 2: Build tendon capacity with progressive loading
This is the foundation of lasting improvement.
Depending on your tendon and stage, we often use:
Isometrics (holds) for pain modulation and early strength
Heavy slow resistance for tendon remodeling and strength
Eccentric and concentric loading (controlled lowering + lifting)
Plyometrics / energy storage later (hopping, jumping, sprint prep)
Sport-specific drills at the end, to bridge back to full performance
Step 3: Improve contributing factors
Tendon pain is rarely “just the tendon.”
We also assess and address:
joint mobility and stiffness (ankle/hip/thoracic spine etc.)
movement strategy and technique (running mechanics, lifting patterns)
strength and control around the region (glutes, scapula, forearm strength)
training plan structure and recovery habits
footwear and workload setup (for runners and workers)
Pain rules - How much is okay?
A common fear is: “Am I damaging it if it hurts?”
In most tendinopathies, some discomfort with rehab is normal and acceptable. What matters is the response.
A simple guideline we often use:
0–3/10 pain during exercise: generally okay
4–5/10: proceed with caution, reduce volume/load if symptoms linger
6+/10: usually too provocative - modify
The key check:
Symptoms should settle within 24 hours and not progressively worsen week-to-week.
If your pain is consistently worse the next morning or keeps trending up, the tendon is telling you it needs a better load plan.
What about stretching, massage, shockwave, or injections?
These can be helpful in the right context, but they’re not the “main course.”
Stretching: can help if you’re stiff, but aggressive stretching of an irritated tendon can flare it.
Massage / soft tissue work: can reduce tension and improve comfort short-term.
Shockwave therapy: may help in some stubborn cases (tendon/location dependent).
Cortisone injections: can reduce pain short-term in some regions, but may not improve long-term outcomes and can carry risks depending on the tendon.
PRP / other injections: mixed evidence; sometimes used for persistent cases.
At Epoch Health, we’ll talk you through options and match them to your situation - but progressive loading and smart rehab stays the cornerstone.
How long does tendinopathy take to recover?
This depends on the tendon, the stage, and consistency.
As a general guide:
Reactive/early-stage: can improve significantly in 2–6 weeks
Long-standing/persistent: often needs 8–16+ weeks of structured loading
return to full sport performance may take longer, depending on goals
The biggest predictor of success is usually consistency with the right plan - not a perfect one-off treatment.
How Epoch Health can help
If you suspect tendinopathy, our team can help you:
confirm the diagnosis and rule out other causes
identify what’s driving the flare-ups (training errors, biomechanics, overload)
design a progressive tendon-loading program that suits your goals
modify sport/workload so you can keep moving without constantly flaring it
support recovery with hands-on care, mobility work, and strength coaching
coordinate with our multidisciplinary team where needed (massage, nutrition, counselling support)
Want help with your tendon pain?
If you’ve been dealing with a tendon issue that keeps coming back - or you’re not sure what’s safe to do - we’d love to help.
Reply to this email or book an appointment with Epoch Health and we’ll map out a clear plan to get you moving confidently again.
Your tendon isn’t “broken” - it’s underprepared for the load it’s facing.
Let’s rebuild capacity, step-by-step.