What NOT To Do If You Have Lower Body Tendon Pain

What NOT to do if you have lower body tendon pain!

1. Ignore your pain:

Pain is a subjective marker and tells you that the load placed on the tendon is too much. Therefore it is important to manage the load on your tendon. You must reduce certain aspects of your running/training schedule that is overloading your tendon.

2. Rest completely:

Resting tendons is not advised. Collagen-based tissues need load to maintain structure and mechanical strength. If you rest, this decreases the ability of the tendon to take load. It also affects the muscle attached to the tendon and in some cases leading to muscle wastage, resulting in less ability to load the tendon (Rio et al, 2013). However acknowledging you cannot ignore the pain, effective rehabilitation must begin by reducing loads to the level that the tendon can tolerate and then slowly increase the tolerance of the tendon to load.

3. Have passive treatments:

You must accept that it may take 10-12 weeks for tendon pain to heal.  Treatments like icing a tendonelectrotherapy  such as ultrasound and ice in the short term will only temporarily decrease pain only for it to return when the tendon is loaded.  Therefore, treatments that modify the need to increase the ability of the tendon to take load will help in the long term

4. Have injection therapies:

Injections of substances into a tendon have not been shown to be effective in good clinical trials. De Vos et al. in 2010 found no significant difference with a plasma rich protein injection with eccentric exercises when comparing to a normal saline injection with eccentric exercises. Only consider an injection when the tendon has not responded to a structured exercise based programme.

5. Stretch your tendon:

Stretching the tendon can be detrimental. At its longest length, there are compressive loads on your tendon, adding stretching to most tendons only serves to add compressive loads. Your normal calve stretching while you are standing can especially cause insult to your tendon. Therefore massage is best recommended if muscle tension is apparent.

achilles tendon

6. Massage your tendon:

Only massage of the attached muscle may be beneficial. Occasionally tendons will feel better post massage but then can be worse when loaded. By massaging the tendon, it may increase the pain.

7. Be worried about the images of your tendon:

Degeneration and tears as found on ultrasound or MRI investigations can make you wonder if your tendon should be loaded. There is good sufficient evidence that the pathological tendon can tolerate loads, especially when you gradually increase the loads on them.

8. Be worried about rupture:

Surprisingly people who suffer a tendon rupture may never have had pain before even though the tendon may have had substantial pathology in it. Therefore when rupture occurs pain is a protective mechanism of your tendon, it makes you unload it.

9. Take short cuts with rehabilitation:

I’m not telling you it’s going to be easy, I am telling you it’s going to be worth it. Progressive rehabilitation is imperative; you need to take the time that the tendon needs to build its strength. This can take 10-12 weeks or occasionally longer, however the long-term outcomes are good if you do the correct rehabilitation. As outlined above, some treatments often give short-term improvement but the pain recurs when the loads are resumed on the tendon.

10. Not have an understanding of what loads are high for your tendon:

Activities such as jumping, changing direction and sprinting place the highest load on your tendon. Any loads that do not use these movements are low load for a tendon, so exercise using weights and exercise that is slow will not place a high load on the tendon, but will have benefits such as strengthening the attached muscles.


The take home message is that exercise-based rehabilitation is the best treatment for tendon pain. A progressive program that starts with a strength program and then progresses through to more spring-like exercises and including endurance aspects will give the right loads on the tendon and the best long term results. If you have any queries about any of the above points or are experiencing tendon pain, make an appointment to see a physiotherapist at JT Physiotherapy today. We would only be delighted to guide your rehabilitation.


  • Cook, J. and Purdam, C. (2013). The challenge of managing tendinopathy in competing athletes. British Journal of Sports Medicine, 48(7), pp.506-509.
  • de Vos, R., Weir, A., van Schie, H., Bierma-Zeinstra, S., Verhaar, J., Weinans, H. and Tol, J. (2010). Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy. JAMA, 303(2), p.144.
  • Rio, E., Moseley, L., Purdam, C., Samiric, T., Kidgell, D., Pearce, A., Jaberzadeh, S. and Cook, J. (2013). The Pain of Tendinopathy: Physiological or Pathophysiological?. Sports Medicine, 44(1), pp.9-23.




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cathal-ellis-jt-physio                            Cathal Ellis MISCP

Replies for “What NOT To Do If You Have Lower Body Tendon Pain”

  • Barney McGlade

    Many thanks for this wonderful advice. I have been a client at JT for both a physio assessment and orthotics advice. Please may I ask Ryan to begin making the orthosis he moulded – or dores he need to mould. I cannot find time to go to the clinic in Manila (where I live) but I will be home in April for a couple of weeks April 19 May 1). Please is that possible

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