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  • Tendons are tough, flexible bands of fibrous tissue that connect muscles to bones
  • Tendonitis is an acute injury which is an inflammation of the tendon
  • If pain persists for more than a few weeks, it is more likely that the injury is tendonosis, a more common and chronic injury
  • Tendonosis (also called tendonopathy) is when the tendon is damaged at a cellular level and becomes weaker and degenerated. It is not an inflammatory condition.
  • Treatment is different for these conditions: Tendonitis requires anti-inflammatory type treatment, tendonosis requires specific strengthening exercises

Interesting facts

  • Morning soreness is a strong indicator of tendonosis
  • Tendons are slow to heal due to their low blood supply
  • Common tendons to be affected include: Achilles tendon, extensor tendons of the forearm (tennis elbow), flexor tendons of the forearm (golfers elbow), patellar tendon (jumpers knee)

Management options

  • Braces/taping for support and to de-load the tendon
  • Eccentric (lengthening phase of muscle contraction) exercises to strengthen the tendon
  • Cortisone injections can help reduce inflammation
  • Anti-inflammatory creams/patches or medication may be prescribed by your GP

Hints for self-management

  • For an acute injury follow the RICER principles:

R = Rest

I = Ice wrapped in towel (20mins every 2 hours for the first 48 hours post injury)

C = Compression

E = Elevation

R = Review with a health professional

  • For tendonosis, or non-acute injury:
    • Eccentric exercises
    • Gentle stretching
    • Correct biomechanical problems i.e. posture/footwear
    • Gradual return to exercise

What you can expect/look out for

  • Tenderness directly over the tendon
  • Swelling with an acute injury
  • Thickening of the tendon with a chronic injury (more than 3 months)
  • Pain on first moving after rest
  • Pain may ease once area is warmed up, then become sore again once area has cooled
  • Eccentric exercises take 12 weeks to strengthen the tendon to original levels

More information

  • Eccentric loading exercises have been proven to strengthen and remodel chronically damaged tendons
  • Ultrasound imaging can differentially diagnose a tendon injury
  • De-loading the tendon in the initial phases will help with pain. These can include taping, heel raises and orthotics
  • New techniques are using autologous (your own) blood injections to help treat chronic tendonoses


At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.



Contact us today – 9252 5770


This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

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