Tendinopathy treatment and rehabilitation


Tendinopathies are common overuse injuries seen in both athletes (e.g. runners) and non-athletes. They are categorised by localised pain through the tendon with loading.

Tendinopathies can develop following increases or high volumes of exercise, or an increase in day-to-day activities that exceed someone’s current level of capacity. People with tendinopathies usually report pain localised to the tendon, and morning stiffness that can sometimes warms up or improves with activity.

Types of Tendinopathy We Treat

Tendinopathies exist in both the lower body and upper body and can include:

Our Approach to Tendinopathy Injuries

At Complete in Richmond we have world renowned physios leading research on tendinopathy injuries. The clinic has contributed a large volume of tendinopathy research, including the papers listed below.

Due to our expertise, we see a high volume of people with tendon issues, and regularly consult for second opinions or work with other health professionals to guide care, in difficult and challenging cases.

Rehabilitation for some tendinopathies can be long, but with patience and the right guidance, great outcomes are still possible, even in people who have had pain for many months or years. Our team will work closely with you throughout your journey to support you to get back to things that are important to you.

Published Tendinopathy Research by our Team

Malliaras, P; Rodriguez Palomino, J; & Barton, C.J. (2018). Infographic. Achilles and patellar tendinopathy rehabilitation: strive to implement loading principles not recipes British Journal of Sports Medicine, 52. 1232-1233. http://dx.doi.org/10.1136/bjsports-2017-098615

Scholes, M; Stadler, S; Connell, D; Barton, C; Clarke, R.A; Bryant, A.L; & Malliaras, P. (2018).
Men with unilateral Achilles tendinopathy have impaired balance on the symptomatic side.
Journal of Science and Medicine in Sport, 21(5). 479-482. https://doi.org/10.1016/j.jsams.2017.09.594

Sancho, I; Malliaras, P; Barton, C; Willy, R.W; & Morrissey, D. (2019). Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis,
Gait & Posture, 73. 189-201. https://doi.org/10.1016/j.gaitpost.2019.07.121.

Show all papers

Sancho, I; Morrissey, D; Willy, R.W; Barton, C; & Malliaras, P. (2019). Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: A single cohort feasibility study. Physical Therapy in Sport, 40. 107-116. https://doi.org/10.1016/j.ptsp.2019.08.007.

Rowe, V; Hemmings, S; Barton, C; Malliaris, P; Maffulli, N; & Morrissey, D. (2012) Conservative Management of Midportion Achilles Tendinopathy. Sports Medicine, 42. 941–967 https://doi.org/10.1007/BF03262305

Malliaras, P; Barton, C.J; Reeves, N.D; & Langberg, H. (2013) Achilles and Patellar Tendinopathy Loading Programmes. Sports Medicine, 43. 267–286 https://doi.org/10.1007/s40279-013-0019-z

Malliaras, P; Chauhan, A.A; Barton, C; Waswelner, H; & Morrissey, D. (2014). 21 The Response Of Human Tendon To Different Chronic Loading Interventions: A Systematic Review. British Journal of Sports Medicine, 48(2). A14. https://doi.org/10.1136/bjsports-2014-094114.21

Malliaras, P; Cook, J; Purdam, C; & Rio, E. (2015). Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic & Sports Physical Therapy, 45(11). 887-898. https://www.jospt.org/doi/10.2519/jospt.2015.5987

Malliaras, P; Cook, J.L; & Kent, P. (2006). Reduced ankle dorsiflexion range may increase the risk of patellar tendon injury among volleyball players. Journal of Science and Medicine in Sport, 9(4). 304-309. https://doi.org/10.1016/j.jsams.2006.03.015

Boesen, A.P; Hansen, R; Boesen, M.I; Malliaras, P; & Langberg, H. (2017). Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. The American Journal of Sports Medicine, 45(9). 2034-2043. https://doi.org/10.1177/0363546517702862

Herman, K; Barton, C; Malliaras, P; & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Med 10(75). https://doi.org/10.1186/1741-7015-10-75

Comin, J; Malliaras, P; Baquie, P; Barbour, T; & Connell, D. (2013). Return to Competitive Play After Hamstring Injuries Involving Disruption of the Central Tendon. The American Journal of Sports Medicine, 41(1). 111-115. https://doi.org/10.1177/0363546512463679

Scott, A; Squier, K; Alfredson, H, et al. (2020). ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology. British Journal of Sports Medicine 54. 260-262. http://dx.doi.org/10.1136/bjsports-2019-100885

Littlewood, C; Malliaras, P; & Chance-Larsen, K. (2015). Therapeutic exercise for rotator cuff tendinopathy. International Journal of Rehabilitation Research, 38(2). 95-106. http://10.1097/MRR.0000000000000113

Morton, S; Williams, S; Valle, X; Diaz-Cueli, D; Malliaras, P; & Morrissey, D. (2017). Patellar Tendinopathy and Potential Risk Factors: An International Database of Cases and Controls. Clinical Journal of Sport Medicine 27(5). 468-474. http://10.1097/JSM.0000000000000397

Florit, D; Pedret, C; Casals, M; Malliaras, P; Sugimoto, D; & Rodas, G. (2019). Incidence of Tendinopathy in Team Sports in a Multidisciplinary Sports Club Over 8 Seasons. Journal of sports science & medicine, 18(4), 780–788. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873129/

Malliaras, P. (2022). Physiotherapy management of Achilles tendinopathy. Journal of Physiotherapy 68(4).221-237. https://doi.org/10.1016/j.jphys.2022.09.010

Goom, TSH; Malliaras, P; Reiman, MP; & Purdam, C.R. (2016).
Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management.
Journal of Orthopaedic & Sports Physical Therapy, 46(6). 483-493. https://www.jospt.org/doi/10.2519/jospt.2016.5986

Färnqvist, K; Pearson, S; & Malliaras, P. (2020). Adaptation of Tendon Structure and Function in Tendinopathy with Exercise and its Relationship to Clinical Outcome. Journal of Sport Rehabilitation, 29(1), 107-115. https://doi.org/10.1123/jsr.2018-0353

Turner, J; Malliaras, P; Goulis, J; & McAuliffe, S. (2020) “It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy. PLOS ONE 15(5). e0233459. https://doi.org/10.1371/journal.pone.0233459

Littlewood, C; Malliaras, P; Bateman, M; Stace, R; May, S; & Walters, S. (2013). The central nervous system – An additional consideration in ‘rotator cuff tendinopathy’ and a potential basis for understanding response to loaded therapeutic exercise. Manual Therapy, 18(6).468-472. https://doi.org/10.1016/j.math.2013.07.005

Boesen, AP; Hansen, R; Boesen, MI; Malliaras, P; & Langberg, H. (2017). Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. The American Journal of Sports Medicine, 45(9). 2034-2043. https://doi/10.1177/0363546517702862

Mallows, A.J; Debenham, J.R; Malliaras, P, et al. (2018) Cognitive and contextual factors to optimise clinical outcomes in tendinopathy. British Journal of Sports Medicine, 52(13). 822-823. http://dx.doi.org/10.1136/bjsports-2017-098064

Stubbs, C; McAuliffe, S; Mallows, A; O’sullivan, K; Haines, T; & Malliaris, P. (2020) The strength of association between psychological factors and clinical outcome in tendinopathy: A systematic review. PLOS ONE 15(11): e0242568. https://doi.org/10.1371/journal.pone.0242568

Jhingan, S; Perry, M; O'Driscoll, G; Lewin, C; Teatino, R; Malliaras, P; Maffulli, N; & Morrissey, D. (2011). Thicker Achilles tendons are a risk factor to develop Achilles tendinopathy in elite professional soccer players. Muscles, Ligaments and Tendons Journal, 1(2). 51–56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666468/

(adapted from Rudavsky and Cook 2014, J Physio, p123)
Common questions

Tendinopathy FAQ

  • Pain during tendon rehabilitation is normal. Tendon pain during exercise may go up and down but should be relatively stable on a day to day or week to week basis
  • In the first week the muscles may be very sore for a few days after exercises if you are not used to the exercise

If you have degenerative tendinopathy with associated muscle weakness and wasting, you should see improvements in strength by 3-4 weeks. Improvements in your pain may take longer, up to 6-10 weeks

1-6 months. Depending your goals and initial condition

Possibly, but most people continue to have very mild symptoms even when back to sport and full function

Yes. Unfortunately, tendon injuries are recurrent. Your physiotherapist will discuss strategies to prevent the pain from returning

Yes, some supplements may be helpful. These include Green Tea, L-arginine and fish oils – please discuss further with your physiotherapist


Located in Richmond

High value physiotherapy care at 656 Bridge Rd, Richmond. We’re here when you need us!