The basics
What is a tendon injury?
Tendons are strong, cord-like tissues that connect muscle to bone. They store and release energy every time you walk, run, jump or lift.
Most tendon pain is tendinopathy: the tendon has been loaded more, or differently, than it could adapt to, and becomes painful and less able to take load. It is usually not mainly an inflammation problem, which is why the old term "tendinitis" is often misleading. Less commonly, a tendon can partly or completely tear.
Where it hurts
Common tendon problems
Achilles tendinopathy
Where: Back of the heel or lower calf
Common in: Runners and people on their feet a lot
Patellar tendinopathy (jumper's knee)
Where: Just below the kneecap
Common in: Jumping and change-of-direction sports
Tennis elbow
Where: Outside of the elbow
Common in: Racquet sports, manual and desk work
Golfer's elbow
Where: Inside of the elbow
Common in: Throwing, gripping and golf
Rotator cuff tendinopathy
Where: Front or side of the shoulder
Common in: Overhead sports, gym and manual work
Gluteal tendinopathy
Where: Outer hip, often worse lying on that side
Common in: Common in midlife, runners and walkers
Hamstring tendinopathy
Where: Deep in the buttock, near the sitting bone
Common in: Runners and sprinters; sitting may hurt
Signs to watch for
Symptoms of a tendon problem
- Pain where the tendon attaches or along it, brought on by loading it
- Stiffness first thing in the morning or after sitting
- Pain that eases as you warm up, then returns later or the next day
- Tenderness when you press on the tendon
- Thickening or swelling of the tendon
- Reduced strength, speed or power in that area
Why it happens
Why tendons get painful
Tendon pain usually starts when load changes faster than the tendon can adapt. Common triggers and risk factors include:
- A sudden increase in training — more distance, speed, hills, jumping or a new sport
- A change of footwear, surface or technique
- Returning to sport after a break
- Weakness in the muscles that support the tendon
- Some health conditions, such as diabetes or high cholesterol, and life stages such as menopause
- Certain antibiotics (fluoroquinolones, e.g. ciprofloxacin), which are linked to tendon problems
Diagnosis
How tendon injuries are assessed
Assessment starts with a detailed history of your symptoms, training and general health, and a clinical examination to identify which tendon is involved and what is driving the problem.
Dr. Ganda may use ultrasound in clinic to look at the structure of the tendon, check for a tear, and rule out other causes of pain. MRI or other tests are sometimes needed.
Your treatment plan
Treatment options
Tendon problems usually respond best to a structured, progressive loading programme. Other options are discussed after assessment.
- 1
Progressive tendon loading
Isometric, then heavy slow resistance, then return to running and jumping, supervised by our on-site rehab team.
- 2
Training load review
Volume, footwear, surfaces and technique.
- 3
Image-guided injections
Occasionally considered for persistent symptoms despite a good rehab programme.
- The evidence for PRP in tendinopathy is mixed and varies by tendon. It is weaker for the Achilles tendon.
- Injections are always combined with rehabilitation, never used instead of it.
Recovery
How long does recovery take?
Tendons adapt slowly. Many people notice improvement within a few weeks of starting the right exercises, but a full recovery commonly takes three months or more of consistent rehabilitation. Long-standing tendon problems can take longer.
Progress is rarely a straight line. Flare-ups are common and usually mean the load needs adjusting, not that the tendon is getting worse.
Getting help
When to see a sports physician
Book an assessment if you have:
- Pain that has not settled after 2–3 weeks of reducing aggravating activities
- Pain that is stopping you from training, competing or working
- Tendon pain that keeps coming back
- You think you may have torn a tendon
Questions
Tendon injuries: frequently asked questions
Should I rest my tendon completely?
Usually not. Complete rest reduces tendon pain in the short term but also weakens the tendon, so pain often returns when you go back to activity. Reducing the aggravating activities while keeping the tendon loaded with the right exercises works better.
Can I keep running or playing sport?
Often yes, with changes. Many people can continue a modified level of activity if pain stays mild and settles by the next morning. Your plan will set out what is safe for your tendon.
Do I need a scan?
Not always. Tendon problems are usually diagnosed from your history and examination. Ultrasound in clinic can help confirm the diagnosis and check for a tear, and MRI is sometimes needed.
Will I need an injection?
Most people do not. Exercise-based rehabilitation is the main treatment. Injections are only considered case by case when a tendon is not improving despite good rehabilitation, and Dr. Ganda will discuss the benefits and risks with you.
Do anti-inflammatories or ice help?
They may ease pain in the short term, but they do not treat the underlying tendon problem. Paracetamol (e.g. Panado) is an alternative for pain relief. Check with your doctor before taking anti-inflammatories regularly.
Should I stretch a painful tendon?
Not always. For some tendons, such as the Achilles where it attaches to the heel, or the gluteal tendons at the hip, stretching can compress the tendon and increase pain. Your rehabilitation plan will say which exercises suit your tendon.
How long will it take to get better?
It varies, but a full recovery commonly takes three months or more of consistent rehabilitation, and longer for long-standing problems. Your progress is reviewed at follow-up visits.
Where is the practice?
Dr. Janesh Ganda consults at 55 Scott Road, Observatory, Cape Town. Consultations can be booked via WhatsApp.