Tendinopathy

Tendinopathy: what is it?

Tendinopathy is the umbrella term that replaced tendinitis in clinical language, because the tissue changes involved are largely not inflammatory. It typically develops when training load rises faster than the tendon can adapt, and it announces itself with a very recognisable pattern: pain that is worst at the start of activity, eases as the client warms up, then returns worse the next morning. Coaches meet it constantly in Achilles tendons, patellar tendons, elbows and shoulders. The point of knowing about it is not to treat it. It is to recognise it early, stop making it worse, and get the client to someone qualified.

Scope: what a coach does and does not do

A personal trainer does not diagnose tendinopathy and does not treat it. Persistent tendon pain belongs with a physiotherapist, sports physician or doctor, who can rule out the things that look similar and set a rehabilitation plan.

What a coach absolutely should do is notice the pattern, stop the loading that is aggravating it, keep the client training everything else, and make the referral without drama. Then work alongside whoever is managing it: a physio who knows the client is doing three heavy lower-body sessions a week can plan around it, and a coach who receives clear loading guidance can implement it far better than a client following instructions from memory.

Recognising the pattern

Tendon pain behaves differently from muscle soreness, and the differences are usable in the gym.

Why it happens: load, not damage from one session

Tendons adapt to load more slowly than muscle. When a client jumps their running volume, adds plyometrics, returns from a layoff at their old numbers, or a new job puts them on their feet all day, the muscle copes long before the tendon has caught up. That mismatch, repeated, is the usual origin story.

Which is why complete rest tends to disappoint. Pain settles while the tendon is unloaded, capacity keeps falling, and the same load that caused the problem is now further beyond what the tendon can handle. Modern management is built around progressive loading rather than avoidance, which is exactly why it needs a professional to prescribe the progression.

What good management usually looks like

Rehabilitation is generally staged, often beginning with isometric holds when the tendon is highly irritable, moving through slow heavy resistance work, and progressing toward the speed and elastic demands of the client's sport. Timelines are measured in months rather than weeks, which is the part clients find hardest.

Your role in that is real. Keep the client training everything else so they stay fit, strong and engaged. Adjust the training around the affected area rather than around the whole client. And be the person who protects the plan when the client feels better at week four and wants to jump straight back to where they were.

• Refer for persistent tendon pain rather than managing it yourself.
• Reduce, do not necessarily remove, load on the affected tendon while waiting for that appointment.
• Keep training the rest of the body normally.
• Progress load gradually on return, and expect months rather than weeks.
• Look for the load spike that caused it, or it will happen again.

Preventing the next one

The prevention story is unexciting and consistent: manage the rate of change. Sudden increases in running volume, a block of jumping added on top of an unchanged program, and a return from holiday at pre-break loads are the classic triggers. Building the client back gradually is duller than any protocol and works better than all of them.

Also watch the clients most likely to hide it, which is usually the ones most motivated to keep training. A client who mentions their Achilles is "a bit stiff in the mornings" is telling you something important, and treating that as a throwaway comment is how a two-month problem becomes an eight-month one.