A persistent, load-related tendon pain and dysfunction.
Tendinopathy is a persistent, painful tendon disorder marked by reduced load tolerance and impaired function. Rather than an inflammatory event, it reflects a mismatch between the load placed on the tendon and its current capacity, with changes to tendon structure over time. It commonly affects the Achilles and patellar tendons, though it can occur at any tendon exposed to repetitive or unaccustomed loading.
The label shapes the whole conversation with the patient: this is not an injury to protect and rest, but a capacity problem to rebuild through load. Framing it this way early prevents the common trap of prolonged rest or passive modalities, which tend to deload the tendon further and delay recovery. It also sets realistic expectations, since tendinopathy typically improves over months rather than weeks.
Diagnosis is largely clinical, based on history of a change in load, localised tendon pain, and reproduction of symptoms with tendon loading tests such as single-leg heel raises or decline squats. Imaging is used selectively, since structural changes on ultrasound or MRI correlate poorly with pain and are common in asymptomatic tendons. Management centres on a progressive loading programme, usually starting isometric or heavy slow resistance and advancing toward energy-storage and sport-specific loads as tolerated.
Pain during loading does not always mean harm, and clinicians often under-dose exercise out of caution, which slows capacity gains. Conversely, progressing load too quickly or ignoring a symptom flare can aggravate the tendon, so monitoring response over 24 hours is essential. Imaging findings should not drive treatment decisions in isolation, and coexisting factors such as biomechanics, training load errors, or metabolic health should be considered when recovery stalls.