What we are talking about
For decades people said «tendinitis», meaning inflammation. Tissue studies have shown that in most chronic cases classic inflammation is not there: there is a tendon that has become disorganised because it was asked for more than it could take. That is why the correct term is tendinopathy, and why anti-inflammatories alone do not resolve it.
The mechanism is nearly always the same: load increased too quickly. You started running again after months off, you changed jobs, you started the gym, you did a house move. The tendon does adapt, but slowly, and it does not forgive acceleration.
The good news is that it responds very predictably to well-dosed loading. The bad news is that it takes time: you think in months, and progress is measured by how it feels the next day, not by how it feels during.
When it makes sense to get seen
The pictures we see most often:
- Pain that appears cold, warms up during activity and comes back afterwards
- One precise spot that hurts if you press it
- Morning stiffness in the area involved
- The pain appeared after you increased something: kilometres, weights, hours on your feet
- It has lasted months and every time you start again it goes back to square one
- You have already tried rest and anti-inflammatories without anything changing
What can be done remotely, and what cannot
Tendinopathies are perhaps the area that suits this best: the treatment with the most evidence behind it is progressive exercise, and that is programmed and checked perfectly well at a distance.
What can be done remotely
- Reconstructing what changed in the weeks before it started
- Setting the progressive load: which exercise, how much weight, how many times
- Teaching you to read the tendon's response the next day, which is the real thermometer
- Correcting execution by watching you do the exercises
- Deciding together how much to cut back without stopping completely
What cannot
- Manual therapy and soft-tissue work
- Shockwave, tecar, laser and other instrument-based therapies
- Ultrasound scanning and injections
If you suspect a tendon rupture — a sudden giving way, being unable to use the limb — you need a doctor straight away, not an exercise programme.
Frequently asked questions
How long does a tendinopathy take to heal?
Months, not weeks, and anyone promising you short timescales is telling you something that is not in their hands. The tendon remodels slowly. The encouraging part is that improvement usually shows up well before full recovery.
Do I have to stop playing sport?
Almost never completely. You reduce what lights the symptom up and keep the rest: stopping altogether weakens the tendon and makes the return harder. The formula is «less, not zero».
Why does it hurt in the morning?
It is the most typical sign. Overnight the tendon «cools» and the first loads catch it unprepared. If the morning stiffness gets shorter week by week, you are doing well.
Do anti-inflammatories help?
They can give relief in a difficult phase, but they do not repair the tendon, and used to cover the pain and carry on as before they do harm. The part that changes things is progressive loading.
